Form 1/Sem10/CUCMS

MOCK PATIENT RECORD

Patient particulars: NAME: SEX : M / F D.O.B: RN: OOCUPATION: DATE OF ADMISSION: DISCHARGED: PATIENTS HISTORY:

AGE :

DATE OF

Drugs / allergy:

PHYSICAL EXAMINATION: Blood pressure: mmHg Respiratory rate: /min Body weight: kg

Pulse rate: /min Body temperature: Height: cm

Summary of examination:

front

back

Provisional diagnosis:

INVESTIGATIONS:

MANAGEMENT PLAN:

__________________________ ________________________ Name of medical student

Signature

Date: Time:

Form 2/Sem10/CUCMS

PROGRESS NOTES
Date & Time signature Name &

Form 3/Sem10/CUCMS

PATIENT DISCHARGE SUMMARY FORM

PATIENT DETAILS: NAME: SEX: F / M RN: ADDRESS: DATE AND TIME OF ADMISSION: DATE AND TIME OF DISCHARGE: WARD / DISCIPLINE: CLINICAL SUMMARY: AGE: CONTACT NUMBER:

DIAGNOSIS (upon discharge): MANAGEMENT:

DISCHARGE PLAN:

Name of Medical Student Signature

Date prepared: Time:

Form 4/Sem10/CUCMS

REFLECTION FORM LEARNING FROM PATIENT

[Note: Not more than 400 words. Use of word processer is encouraged (1 page, font size 12)]

Patient particulars: NAME: RN: Diagnosis: Learning Issues:

What Ive learnt from this experience and what I need to learn further? Minimum: three learning issues)

1. 2. 3. Discussions:
(Answers to my own questions)

References: 9

(Materials/articles that Ive used to answers to my own questions)

10

Form 5/Sem10/CUCMS

SEMESTER 10 CONTINUOS ASSESSMENT FORM: PATIENT MANAGEMENT ROUND (revised) Students name: Group: Date of assessment: Matrix no. Discipline: Diagnosis:

Note: The student is responsible to ensure completion of this assessment form after each PMR session Marking guide: Excellent: 8.0 to 10.0 marks Average: 5.0 to 5.9 Component Ability to provide sufficient summary of the patients information on relevant history, physical examination and diagnosis. Demonstrate rapport with patient. Ability to provide information current progress; including general condition/wellbeing, vital signs monitoring, input/output charting Ability to provide current management plan including: - Wound observation & post-operative drainage (if applicable) - Investigations - Drug prescription/s - Referral, discharge & other management plan (follow-up and ambulatory care if applicable) Total Global impression (please tick): Satisfactory Not satisfactory General comments/remarks on ability as houseman / junior doctor: Good: 6.0 to 7.9 marks Fail: 4.9 & below Allocated mark 10 Given mark Remark

10

10

30

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________________________________ Lecturer/Examiners name signature

___________________ Lecturer/Examiners Date:

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Form 6/Sem10/CUCMS

SEMESTER 10 CONTINUOS ASSESSMENT FORM: MOCK PATIENT RECORD AND DISCHARGE SUMMARY (revised)
Students name: Group: Date of assessment: Marking guide: Excellent: 8.0 (or 4.0) to 10.0 (or 5.0) marks marks Average: 5.0 (or 2.5) to 5.9 (or 2.9)
Component Completion of Mock Patient-record and Discharge Summary: - Generally well written, legible - Adhere to given guideline/ template Content & Originality - Clinical information provided valid, focus to patient daily ward management, monitoring, and further planning or other appropriate measures based on the case looking after Well written discharge summary based from patient record, management and discharge plans

Matrix no. Discipline: Diagnosis: Good: 6.0 (or 3.0) to 7.9 (or 3.9) Fail: 4.9 (or 2.4) & below
Allocated mark 5 Given mark Remark

10

Student reflection - Identification of relevant learning issues - Discussion on the learning issues including: medical ethics and sociocultural issues Total

10

30

*DS (Discharge summary); MPR (Mock Patient-record) Global impression: Satisfactory / Not satisfactory: General comments/remarks on ability as houseman / junior doctor:

13

__________________________________ ___________________ Examiners name signature Date:

Examiners

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