NEPHROLOGY, IKD, HMC (KGMC)

PESHAWAR.

LOGBOOK

By

Dr. Syed Munib

Associate Professor, Department of Nephrology,

Institute of Kidney Diseases(IKD),HMC,Peshawar..

No. Skill Observed (I)Performed with Assistance (II) Performed without assistance under the supervision of a faculty member(III)

Year 04 Year 05

1 History taking, examination& recording in the standardized format**

III* III*

An approach to examine a patient

III*

III*

2 General physical examination** III*

3 Systemic Examination* Systemic Examination CVS,Chest, Abdominal & Neurological Examination

III* III*

4 Cognitive Skills**

Making a provisional diagnosis III* III*

Making differential diagnosis III*

Initiating appropriate clinical investigations

II* III*

Making a final diagnosis II* III*

Writing up a proper daily progress report of the patient (SOAP format)

II* III*

Initiate management plan II* III*

5 Soft Skills

Informed Consent I* II*

Counseling of parents regarding CKD, DLC, Dialysis, Renal Biopsy & Transplantation

I* II*

6 Basic Clinical Procedures

Urinary catheterization ** I* II*

N/G Tube Insertion I* II*

IV Cannulation I* II*

Setting up IV Infusion I* II*

Pleural Fluid Aspiration ( DX & Therapeutic) I* II*

Asitic Fluid Aspiration ( DX & Therapeutic) I* II*

7 Advanced Clinical Skills

Double Lumen Catheter (DLC) Insertion & Removal

I*

II*

PD Catheter Insertion & Removal I* II*

Renal Biopsy (Native/Graft ) I* I*

8 Interpretation of laboratory investigations

Haematology: FBC/ESR/ DLC & peripheral smear

II*

III*

Biochemistry RFT, LFT serum electrolyte,S.Uric acid, Mg,Oxalate,Calcium,PO4, PTH, T3T4TSH, Serum Osmolality, ADH, Aldosetrone, Renin, ABGs, LDH, Amylase & Lipase, S.Lipid Profile,

II*

III*

S,Iron, Ferritin , Transferrin Sat%, Immunological

ANA, Anti d stranded DNA, AMA, Anti.Sm, RA Factor, Anti GMB Ab, C3,C4, ANCA, Coomb Test, Protein Electrophoresis, CMV Serology, PCR(HCV,HBV,CMV,TB), Immunoglobin levels, Drug levels( Aminoglycosides, Vancomycin, Cyclosporin & Tacrolimus), Tumour markers PSA etc

II*

III*

Urine: Routine examination( color,PH,Sp.gravity, wbcs, RBCs,casts, nitrite, ketone bodies), Urine osmolality, Bense Jones protein, 24 hours Urine protein & creatinince clearance, Urine Albumin/Creat ratio, Urine Na, K.Urate, Mg, Cysteine, Citrate, Calcium, PO4, Urine Anion Gap,

II*

III*

Microbiology--blood cultures, Urine C/S ,AFB/Gram staining, examination of common pathogens

II*

III*

Serological CRP, HBV, HCV,CMV,HIV, BK Virus, Dengue, Leptospira, HLA Tissue Typing & Xmatch, TB.GeneXpert,

I*

II*

Imaging

X-rays Chest & KUB** II* III*

Ultrasound scans§ Doppler U/S for

Kidneys, Graft & Lower limbs Venous

Mapping for AVF for upper limbs.

I*

II*

CT&MRI scans (brain and abdomen) §

I* II*

DTPA & DMSA Scan, CT Renal Angiogram. I*

9 Histopathological Investigation

Renal Biopsy (Native & Graft) LM,IMF studies for Acute GN etc. ,Acute & Chronic Rejection, AKI,

I*

II*

10 Planning / Management

Emergency treatment for Shock, Hypertension emergencies & Urgencies, Hypoglycemia/Hyperglycemia, Electrolyte Imbalances( K+,Na+, Ca++ Mg, Uric acid), Acid Base balance(Metabolic acidosis & alkalosis, Respiratory acidosis & Alkalosis), Septicemia, AKI, Dialysis. Fluid management. Nutrition (oral & Parental).

II*

III*

Non-emergency Treatment( for cases prescribed in the competency documents)

II* III*

11 Prescribing Treatment( Prescription writing for UTIs, BPH, General Treatment of

I*

II*

Nephrotic & Nephritic Syndromes, AKI, CKD, Anemia, Bone mineral Disorders, Electrolyte imbalances , Hyperlipidemia, Hypertension, Hypo/Hyperglycemia.

12 Maintaining patient Follow –up II* III*

13 Patient care related skills

Putting patient into the advisable position

III* III*

Changing patient’s posture in the bed III* III*

Management of unconscious patient§ I* II*

Changing bed linen and clothes of patient

I* I*

Maintaining intake and output chart III* III*

Maintaining diet chart II* III*

Temperature-Pulse-Respiration charts

III* III*

Organizing patient notes** III* III*

Filling up an appropriate investigation form§

III* III*

Multisource Feedback (MSF) Form for the Assessment of Attitude- Form A

Name of the person providing MSF -------------------------- Designation----------------------- Signature of the head of the Department-----------------------------

Please read thedescriptors carefully and tick the appropriate cell under” unsatisfactory, satisfactory and above expected”. If you have not observed the concerned behaviour please tick NA/ not applicable, in case of more than 05 NAs the focal clinical tutor (FCT)should take the MSF from another person)

U N S A T I S F A T c tory

Satisfactory Above Expected

NA Unable to comment because of lack of observation

0 1 2 3 4

1 Attitude of the patient

1-Builds rapport with the patient by Greeting

2- Take consent before history taking, examination & procedure

3- Listens to the patient carefully during

doctor- patient interaction

4.Explains the procedure to the patient

before performing

5- Respects the rights, choices & beliefs

of the patients

6- Provides health education to the

patient and the family whenever needed

2 Attitude with the Teachers. 7- Demonstrates respect towards

teachers

3 Attitude towards other staff members ( Nursing & support staff) 8-Respects and values contributions of other members of the team

4 Reliability

9- (Takes responsibility of assigned

tasks, completes them in time and is

compliant with instructions regarding

patient care)

5 Attitude as a Learner:

10- Demonstrates interest in

learning and acquiring new skills (

purposeful

Attitude as a Leader:

communication during tutorials,

more than one case presentation

and asks pertinent questions)

6 Punctuality 11- (based on attendance record)

7 Communication Skills: 12- communicate effectively with patients

and families 13- Communictae effectively with healthcare professionals(Teachers, Senior Students & other staff members)

8 Honesty and Integrity 14- Demonstrate honesty and moral integrity in doctor-patient communication, communication with other healthcare professionals, students and while handling hospital equipment.

9 Team work 15- Is supportive in group work and accepts appropriate responsibility and contribute towards group learning.

10 Leadership skills 16- Takes responsibility for his/her own actions and actions of the team and accomplishes the assigned task of the group.

11 Dress Code 17- Follows recommended dress code

Global Rating Overall , the attitude of the student during the clinical rotation was

MSF-Form-B for Peer Review Please read the descriptors carefully and tick

the appropriate cell under” unsatisfactory, satisfactory and above expected”. If you have not observed the concerned behavior please tick NA/ not applicable, in case of more than 05 NAs the focal clinical tutor (FCT)should take the MSF from another person)

Un-satisfactory

Satisfactory Above Expected

NA: Unable to comment because of lack of observation

0 1 2 3 4

1 Mutual Respect: Demonstrate mutual respect

2 Communication: Communicates effectively in a friendly manner

3 Teamwork: Contributes effectively to group study and shares knowledge, participates actively in a group acftivities and as an effective team member.

Case Presentation

Guiding criteria for the assessment of case presentation

1 History (accurate, relevant, focused & complete) 2 Clinical examination

(accurate findings, complete examination, accurate clinical methods)

3 Provisional diagnosis 4 Differential diagnoses 5 Investigations (relevance , interpretation) 6 Final diagnosis 7 Prognosis & Counseling 8 Case discussion

1) Adequately covering epidemiology 2) Differential diagnosis 3) Treatment 4) Complications 5) Prevention

9 Answering questions (correct, adequate & appropriate response)

10 Presentation skills (speaking skills, appropriate body language, coherent & logical discussion format, confidence)

Clinical Rotation Year 04

From To

Student’s log of clinical skills and procedures

# Date Skill

(Skills performed at the specified level of competency should be entered by the students and signed off by the supervisor on the same day; if a skill is performed at a lower level of

competency it should not be entered. Date must be entered with each entry.)

Signature of the

supervising faculty

Comments of the supervising faculty

(if any)

# Date Skill

(Skills performed at the specified level of competency should be entered by the students and signed off by the supervisor on the same day; if a skill is performed at a lower level of

competency it should not be entered. Date must be entered with each entry.)

Signature of the

supervising faculty

Comments of the supervising faculty

(if any)

Student’s log of clinical cases/ signs

# Date Clinical cases/ signs seen during the clinical posting

Comments / reflections of the student

Record of case presentations

(One case presentation is mandatory (if more than one case presentation has been presentation by the student the one with the highest score would be included in the internal assessment for the end-of-rotation

OSCE, extra presentations would be credited in the attitude assessment)

Date Title of case presentation Student’s score

(out of 20)

Signature of the supervisor

End-of-Rotation Assessment Form

Student’s Name…………………………………………………………………………………

Roll Number ………………………………………Batch………………………………………

Clinical rotation in………………………………from (Date)…………………..to…………………..

Category Total marks Student’s score

Case presentation 20

SGDs 20

MSF 40

End-of-rotation TOACS 120

Total 200

Narrative summary of the student's overall performance (punctuality, communications skills, overall behaviour, academic level & personality profile etc)

Suggestions for the next supervisor

Stamp & Signature of the head of the department

Clinical Rotation Year 05

From To

Student’s log of clinical skills and procedures

# Date Skill

(Skills performed at the specified level of competency should be entered by the students and signed off by the supervisor on the same day; if a skill is performed at a lower level of

competency it should not be entered. Date must be entered with each entry.)

Signature of the

supervising faculty

Comments of the supervising faculty

(if any)

# Date Skill

(Skills performed at the specified level of competency should be entered by the students and signed off by the supervisor on the same day; if a skill is performed at a lower level of

competency it should not be entered. Date must be entered with each entry.)

Signature of the

supervising faculty

Comments of the supervising faculty

(if any)

Student’s log of clinical cases/ signs

# Date Clinical cases/ signs seen during the clinical posting

Comments / reflections of the student

Record of case presentations

(One case presentation is mandatory (if more than one case presentation has been presentation by the student the one with the highest score would be included in the internal assessment for the end-of-rotation

OSCE, extra presentations would be credited in the attitude assessment)

Date Title of case presentation Student’s score

(out of 20)

Signature of the supervisor

End-of-Rotation Assessment Form

Student’s Name……………………………………………………………………………………………

Roll Number ………………………………………Batch……………………………………………….

Clinical rotation in………………………………from (Date)…………………..to……………………

Category Total marks Student’s score

Case presentation 50

MCQs test 40

SGDs 20

MSF 40

End-of-rotation OSCE 150

Total 300

Narrative summary of the student's overall performance (punctuality, communications skills, overall behaviour, academic level & personality profile etc)

Suggestions for the next supervisor

Stamp & Signature of the head of the department