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ASSESSMENT FORM FOR SHORT CASE

Subject: Medicine Centre: Case No. Systems covered in discussion Candidates Roll #: Date: Diagnosis of the case:

Instructions to examiners:
Please enter your award on the performance against each item according to the rating scale. Total time allocated for all short cases is 40 minutes (including both examination and discussion).

Each examiner to complete his/her own form without conferring with fellow examiner. All awards must be made in ink. Each examiner must rate all items of the form. Use separate form for each short case.
EXCELL ENT GOOD ADEQ UATE INADEQ UATE POOR COMMENTS

Clinical Examination Skills (30 Marks)


Observes professional manners. Performs proper & relevant clinical examination according to instructions given. Applies clinical methods systematically and appropriately

30

24

18

12

Discussion (70 Marks)


Gives correct findings with logical interpretation and conclusion. (25) Justifies diagnosis (20) Suggests appropriate & relevant investigations and management (including recent advances) (25)

Additional Remarks (if any):


________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________

Signature: ______________________________ Name of examiner: _______________________

ASSESSMENT FORM FOR LONG CASE


Subject: Medicine Centre: Case No. Diagnosis of the case: Systems covered in discussion Candidates Roll #: Date: Diagnosis of the case:

Instructions to examiners:
Please enter your award on the performance against each item according to the rating scale Total time allocated for all short cases is 40 minutes (including both examination and discussion).

Each examiner to complete his/her own form without conferring with fellow examiner. All awards must be made in ink. Each examiner must rate all items of the form. Use separate form for each short case.
EXCELL ENT GOOD ADEQ UATE INADE QUATE PO OR COMMENTS

Time allowed (30 Minutes): Interviewing & Clinical Examination Skills (20 Marks)
Introduces self to patient, listens patiently and attentively, is polite, obtains informed consent. Asks necessary and relevant questions. Uses connect clinical methods, is systemic and examines the patient as a whole. (including appropriate exposure and re-draping) Performs examinations of relevant system in detail.
Marks:

Case presentation (40 Marks)


Examiner 1 Name:

Presentation skills correctness of findings Interpretation of findings Diagnosis

(05) (10) (15) (10)


Marks:

Discussions (40 Marks):


Examiner 2 Name:

Suggests and justifies relevant investigations (10) Management plan including rehabilitation (15) Prognosis & counseling (10) Relevant recent advances (05)

Additional Remarks (if any):


________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________

Signature: ______________________________ Name of examiner: _______________________

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