ASSESSMENT FORM FOR SHORT CASE

Subject: Medicine Candidates Roll #: 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).

Centre: Date:

Case No. Diagnosis of the case:

Systems covered in 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

ADEQUATE

INADEQUATE

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 6

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 Candidates Roll #: 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).

Centre: Date:

Case No. Diagnosis of the case:

Diagnosis of the case: Systems covered in 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

ADEQUATE

INADEQUATE

POOR

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.

Case presentation (40 Marks) Examiner 1 Name: Marks: Presentation skills (05)

correctness of findings (10)

Interpretation of findings (15)

Diagnosis (10)

Discussions (40 Marks): Examiner 2 Name: Marks:

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: _______________________