1

Log Book

Diploma in Community Ophthalmology

(DCO)

Bangabandhu Sheikh Mujib Medical University

Shahbag, Dhaka

2

Table of Contents

Page No.

Trainee’s personal details 3

Supervisors/Trainer’s particulars 4

Level of Competence/Performance/Participation 6

DCO Course Outline 7

Practical Performance 8

Clinical Skill: Diagnostic Procedure 15

Clinical Skill : Diagnostic Procedure Clinical Examination 18

Clinical Skill : Diagnostic Procedure Exposure to Instrument 30

Clinical Skill : Diagnostic Procedure Investigation 42

Clinical Skills : Sterilization Procedure 58

Clinical Skill : Surgical Procedure 59

Emergency Management Sheet 71

Community Outreach Program 72

Academic Activities 73

Research Activities 78

Leave Record 79

Summary Sheets 80

Summary of Clinical Skills 81

Diploma trainee’s Block progress report 83

3

Trainee’s Personal Details

Name ………………………………………… Date of Birth ………………………….

Session ..……………………………………………………………………………………

Father’s Name …………………………… Mother’s Name …………………………….

Address……………………………………………………………………………………

……………………………………………………………………………………………..

Contact no ……………………….. E-mail ………………………………………….

Nationality ………………… National ID / Passport No: ………......………………..

BMDC Registration No ……………......................…………

Academic Data:

Graduation (MBBS): Year: ……………… Institution: …………………………………

Signature:……………………………………

Photograph

4

Supervisor’s/Trainer’s Particular

Name Designation Specimen

Initial

Specimen

signature

5

Purpose of this Log book

The purpose of this logbook is to record the day to day clinical and academic

work of the trainee.

This will act as an evidence that the candidate has undergone structured training

Instruction for DCO Students

The period of maintaining the log book will start from the date of joining in DCO

course

Students must fill up the log book and must score in minimum grade for the

course

Student should enter the required events and all entries must be signed by the

immediate supervisor

on the day of events and later on by the head of institution.

Students may use additional sheets if needed.

The log book will be pre-requisite for appearing in final examination.

Guidelines for the supervisors:

1. The log book is a day to day record of the clinical and academic work done by the

trainee.

2. It is the responsibility of the supervisor to identify and inform the trainee of the

area in which he is lacking and provide opportunities to improve the competence.

3. Supervisors or his/her designated consultant/trainer should sign the completed

events on that particular day in the appropriate column of the logbook

Important notice for the trainee: - It is your responsibility to maintain accurate and complete logbook and to

regularly update your records.

- Shall you meet any difficulty, you must contact your supervisor or coarse

coordinator

- Unsatisfactory completion of the logbook would lead to delay of training

progression.

- Unsatisfactory logbook at the end of training will prevent you from entering the

final examination.

6

Level of Competence/Performance/Participation:

The Level of Competence / Performance at which a skill is performed by the trainee

should be recorded in the given column of the logbook

A. Patient Management:

Diagnostic Procedure

Level 1: Observer Status / Assistant Status / Interpretation

Level 2: Performed under Supervisor

Level 3: Performance independently

Surgical Procedure including sterilization

Level 1: Observer Status / Assistant Status / interpretation

Level 2: Performed under Supervisor

Level 3: Performance independently

B. Community Outreach Program

C. Academic Activities

Level 1 : Active Participant

Level 2 : Participant as Assistant

D. Research Activities

Level 1: Principal Investigator

Level 2 : Associate Investigator

7

DCO COURSE OUTLINE

Term – 1

July – December (6

months)

Orientation (1 Month)

Theoretical (Lectures and Tutorials) : Basic Science and Optics

Ward attachment

Clinical Attachment

Term – 2

January - June (6

Month)

Outreach Programmes : Mobile Screening Camps

Primary Eye Care Program

Schools Eye Health Program

Theoretical (Lectures and Tutorials) : Community Ophthalmology

Subspecialty based tutorial

Patient Counseling

Ward attachment

Clinical Attachment at OPD and different

subspecialty

Term – 3

July – December (6

months)

Theoretical (Lectures and Tutorials) : Clinical Ophthalmology

Tutorial & Case discussions

Casualty Activities

Journal & Case Presentation

Project Work

Clinical Attachment at OPD and different

subspecialty

Hands on Training - Basic Surgical procedure

Term – 4

January – June (6

Month)

Jan

-

April

Refresher Course Basic Science and Optics

Community Ophthalmology

Clinical Ophthalmology

Hands on Training - Basic Surgical

procedure

Clinical Attachment at OPD and different

subspecialty

May

June Preparation for BSMMU final Exam

FFiirrsstt AAsssseessssmmeenntt

TThhiirrdd AAsssseessssmmeenntt

TTeesstt

DDCCOO FFiinnaall AAsssseessssmmeenntt

SSeeccoonndd AAsssseessssmmeenntt

8

Practical Performance

A. Clinical Skills :

I. Diagnostic Procedure

a) History taking

b) Clinical examination

c) Exposure to Instrument

d) Investigation

II. Sterilization Procedure

III. Surgical Procedure

a) Extraocular surgery

b) Intraocular Surgery

IV. Casualty Management

B. Community Outreach Program :

I. School Sight Testing

II. Screening program

III. Primary Eye Care Program

C. Academic Activities :

I. Case Presentation

II. Journal Club

D. Research Activities :

I. Project work / Study

9

A. Clinical Skills :

I. Diagnostic Procedure

a) History Taking :

First year 18

Second year 12

-------------------

Total 30

Number

Cataract 3

Glaucoma 4

Orbit & Oculoplasty 4

Paediatric Ophthalmology & Strabismus 4

Cornea 3

Medical Retina & Uvitis 4

Surgical Retina Surgical Retina 2

Neuro-Ophthalmology 3

Injury/Trauma 3

---------

30

10

A. Clinical Skills :

I. Diagnostic Procedure

b) Clinical examination

First year Second year

Visual acuity ( In Children) 05 10

Pupil Evaluation 05 10

Extraocular motility examination 05 10

Cover uncover test 05 10

Cranial Nerve Evaluation 03 05

Corneal Sensation 05 05

Tear film Breakup time 05 05

Schirmer Test 05 05

Macular Function Test 05 10

Optic Nerve Function Test 05 10

Anterior Chamber Angle Evaluation 05 05

Visual field Assessment ( Confrontation) 05 05

Ptosis Workup 05 05

Proptosis Workup 05 05

Orthoptics Workup 05 05

11

A. Clinical Skills:

I. Diagnostic Procedure

c) Exposure to Instrument

First year Second year

Retinoscopy 20 30

Slitlamp Examination 30 30

Direct Ophthalmoscopy 30 30

Indirect Ophthalmoscopy 05 20

Slitlamp Biomicroscopy (+78D+90D) 05 20

Goldmann Applanation Tonometry 05 20

Goniscopy 05 05

SPT Interpretation 10 10

Biometry 05 15

Low Vision Assessment - 05

12

A. Clinical Skills :

I. Diagnostic Procedure

d) Investigation Procedure

First Year Second Year

Maddox Rod Test 05 10

Duochrom Test 05 10

Colour Vision Test 05 10

Diplopia chart 05 05

Hess Chart - 05

Fundus Fluorescein Angiography 10 20

Interpretation of OCT 05 10

B- Scan ultrasonography 05 10

Visual Field Test(Amsler Grift Chart) 10 20

Interpretation of Corneal Topography - 10

Exophthalmometry 05 10

X-ray interpretation 05 10

CT scan interpretation 05 10

MRI interpretation 05 10

Interpretation of HVF 05 15

Pachymetry 05 10

Collection of specimen and Microscopy

Corneal scrapping 04 06

Conjunctival swab 04 06

Vitreous Tap - 05

Biopsy - 05

Prostigmine Test - 03

A. Clinical Skills :

II. Sterilization Procedures

First Year 05

Second Year 05

13

A. Clinical Skills :

III. Surgical Procedures

a) Extraocular

First Year Second Year

Local Anaesthesia 05 10

Superficial Foreign Body Removal 05 10

Incision & Curettage of Chalazion 05 10

Excision of pterygium +Autograft 02 08

Dacryorio Cystectomy (DCT) 05 10

Dacryorio Cystorhynostomy (DCR) 05 10

Enucleation, Evisceration & Exenteration 05 10

Lid procedure 03 06

(Ectropion, Entropion, Tarsorraphy)

Ptosis Surgery 02 04

Squint surgery 02 04

Socket reconstruction - 02

Orbital tumor excision - 02

14

A. Clinical Skills :

III. Surgical Procedures

b) Intraocular

First Year Second year

Manual Small Incision Cataract Surgery 10 25

(SICS +PCL)

Phacoemulsification 05 10

Trabeculectomy 05 10

Laser PI 05 10

Laser Capsulotomy (YAG) 05 10

Laser surgery (Retinal) 05 10

Vitreous Surgery / RD Surgery 02 04

Penetrating keratoplasty - 04

Combine procedure - 05

(SICS+PCL+Trabeculectomy)

Repair of Ocular Injury - 05

Removal of IOFB - 02

A. Clinical Skills :

IV. Emergency Management

First Year 05

Second Year 10

B. Community Outreach Program (First Year)

Schools Eye Health Program - 04

Screening Camp - 04

Primary Eye Care Program - 04

15

C. Academic Activities First year Second Year

Case Presentation - 02

Journal Presentation - 03

Attendance in Case Presentation 20 20

Attendance in Journal Club 20 20

D. Research Activities

First Year 01

Second Year 01

Clinical Skill: Diagnostic Procedure

History Taking

Cataract

Name Age Sex MR No Finding Diagnosis Signature

of

Supervisor

Glaucoma

Name Age Sex MR No Finding Diagnosis Signature

of

Supervisor

16

Orbit & Oculoplasty

Name Age Sex MR No Finding Diagnosis Signature

of

Supervisor

Paediatric Ophthalmology & Strabismus

Name Age Sex MR No Finding Diagnosis Signature

of

Supervisor

History Taking Cornea

Name Age Sex MR No Finding Diagnosis Signature

of

Supervisor

Medical Retina & Uveitis

Name Age Sex MR No Finding Diagnosis Signature

of

Supervisor

17

Surgical Retina

Name Age Sex MR No Finding Diagnosis Signature

of

Supervisor

Neuro Ophthalmology

Name Age Sex MR No Finding Diagnosis Signature

of

Supervisor

Injury / Trauma

Name Age Sex MR No Finding Diagnosis Signature

of

Supervisor

Signature of Head of Institution

18

Clinical Skill : Diagnostic Procedure Clinical Examination

Visual acuity( Adult/Children)

Date MR No. Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

19

Clinical Examination

Pupil Evaluation Date MR No. Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

20

Ocular motility examination

Date MR No. Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

21

Cover uncover test

Date MR No. Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

22

Cranial Nerve Evaluation

Date MR No. Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

23

Clinical Examination

Corneal Sensation

Date MR No. Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

24

Ter film Breakup time Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

Schirmer Test Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

25

Clinical Examination

Optic Nerve Function Test Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

26

Macular Function Test Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

27

Clinical Examination

Anterior Chamber Angle Evaluation

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

Visual field Assessment ( Confrontation) Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

28

Color vision Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

Clinical Examination

Ptosis Workup Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

29

Proptosis Workup Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

Orthoptics Workup Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

Signature of Head of Institution

30

Clinical Skill : Diagnostic Procedure

Exposure to Instrument

Retinoscopy

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

31

Exposure to Instrument Slitlamp Examination

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

32

Exposure to Instrument

Slitlamp Examination

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

33

Exposure to Instrument Direct Ophthalmology

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

34

Exposure to Instrument Direct Ophthalmoscopy

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

35

Exposure to Instrument Indirect Ophthalmoscopy

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

36

Exposure to Instrument Slitlamp Biomicroscopy

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

37

Exposure to Instrument

Goldmann Applanation Tonometry

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

38

Gonioscopy

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

39

Sac Patency Test

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

40

Biometry

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

41

Low Vision Assessment

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

Signature of Head of Institution

42

Clinical Skill : Diagnostic Procedure

Investigation

Maddox Rod Test Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

43

Investigation Duochrom Test

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

44

Colour Vision Test

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

45

Investigation

Diplopia chart

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

46

Hess Chart

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

47

Investigation

Fundus Fluorescein Angiography

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

48

Interpretation of OCT

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

49

B- Scan ultrasonography

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

50

Investigation

Visual Field Test

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

51

Investigation

Interpretation of Corneal Topography

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

Investigation

X-ray interpretation

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

52

Exophthalmometry

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

53

CT scan interpretation

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

MRI interpretation

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

54

Interpretation of HVF

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

55

Pachymetry

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

Corneal scrapping

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

56

Conjunctival swab

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

Vitreous Tap

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

57

Biopsy

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

Prostigmine Test

Date MR

No.

Age /

Sex

Finding/Diagnosis Level of

Participation

Signature of

Supervisor

Signature of Head of Institution

58

A. Clinical Skills :

II) Sterilization Procedure

Date Name of Instrument/Instrument set Procedure Signature of

Supervisor

Signature of Head of Institution

59

Clinical Skill : Surgical Procedure Extraocular Surgery Local Anaesthesia

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

Superficial Foreign Body Removal

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

60

Extraocular Surgery

Incision & Curettage of Chalazion Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

Excision of pterygium +Autograft Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

61

Extraocular Surgery Dacryorio Cystectomy (DCT)

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

Dacryorio Cystorhynostomy (DCR)

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

62

Extraocular Surgery Enucleation, Evisceration & Exenteration

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

Lid procedure

(Ectropion, Entropion, Tarsorraphy)

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

63

Extraocular Surgery Ptosis Surgery

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

Squint surgery

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

64

Orbital reconstruction

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

Clinical Skill : Surgical Procedure

Intraocular

Manual Small Incision Cataract Surgery (SICS + PCL)

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

65

Intraocular Phacoemulsification

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

66

Trabeculectomy

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

67

Intraocular Laser PI

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

Laser Capsulotomy (YAG) Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

68

Intraocular Laser Surgery (Retinal)

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

69

Vitreous Surgery / RD Surgery

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

Penetrating Keratoplasty

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

70

Combine procedure

(SICS+PCL+Trabeculectomy)

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

Repair of Ocular Injury Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

Removal of IOFB

Date MR No. Diagnosis Level of

Participation

Signature of

Supervisor

Signature of Head of Institution

71

Emergency Management Sheet

Sl

No

Name of patient

Age

MRD

No.

Diagnosis Management

given

Signature of

Supervisor

Signature of Head of Institution

72

E. Community Outreach Program

School eye health program

Sl No Name of patient

Age

Diagnosis Management

given

Signature of

Supervisor

Screening Camp

Sl No Name of patient

Age

Diagnosis Management

given

Signature of

Supervisor

Primary eye care program

Sl No Name of patient

Age

Diagnosis Management

given

Signature of

Supervisor

Signature of Head of Institution

73

C) Academic Activities

Case Presentation

Date Title Signature of

Supervisor

Journal Presentation

Date Title Signature of

Supervisor

74

Academic Activities

Attendance in Case Presentation

Date Name of Academic

Activities

Subject Level of

Participation

Signature of

Supervisor

75

Academic Activities

Attendance in Case Presentation

Date Name of Academic

Activities

Subject Level of

Participation

Signature of

Supervisor

76

Academic Activities

Attendance in Journal Club

Date Name of Academic

Activities

Subject Level of

Participation

Signature of

Supervisor

77

Academic Activities

Attendance in Journal Club Date Name of Academic

Activities

Subject Level of

Participation

Signature of

Supervisor

Signature of Head of Institution

78

D) Research Activities

Sl. No. Name of

Research

Activities

Period Place Level of

Participation

Signature of

Supervisor

Remarks

Signature of Head of Institution

79

Leave Record

From To No. of days Reason Supervisor’s

signature

80

Summary Sheets Summary of the Academic/ Community Activities: Period:

Sl.

No. Events/ Tasks

Minimum requisite

number/percent for the

training period

Number

performed/

% performed

1 Lectures attended 75% of schedule lecturer

2 Tutorials/small group teaching

attended 75% of the schedule

3 Attendance Journal club & Case

presentations 75% of schedule

4 Case presentations 3

5 Journal club presentation 3

6

Attendance Community

Activities

I. School Sight Testing

II. Screening program

III. Primary Eye Care

Program

4

4

4

81

Summary of Clinical Skills : Period:

SL

No

Description Level of

Competence

Minimum

No.

required

during

the

training

peroid

Total

Number

done

01 History Taking : - 30

02 Clinical

Examination

Visual acuity ( In Children)

Pupil Evaluation

Ocular motility examination

Cover uncover test

Cranial Nerve Evaluation

Corneal Sensation

Tear film Breakup time

Schirmer Test

Macular Function Test

Optic Nerve Function Test

Angle Evaluation

Visual field Assessment

Ptosis Workup

Proptosis Workup

Orthoptics Workup

03

03

03

03

03

03

03

03

03

03

03

03

03

03

03

10

10

10

10

05

08

08

08

10

10

08

08

05

05

05

03 Exposure to

Instruments

Retinoscopy

Slitlamp Examination

Direct Ophthalmoscopy Indirect Ophthalmoscopy

Slitlamp Biomicroscopy

(+78D+90D)

Goldmann Applanation Tonometry Goniscopy

SPT Interpretation

Biometry

Low Vision Assessment

03

03

03

03

03

03

03

03

03

03

25

30

30

10

10

15

05

10

10

03

04 Investigation

Procedure

Maddox Rod Test

Duochrom Test

Colour Vision Test

Diplopia chart

Hess Chart

Fundus Fluorescein Angiography

Interpretation of OCT

B- Scan Ultrasonography

Amsler Grid Chart

Corneal Topography

03

03

03

03

03

03

03

03

03

03

10

08

10

05

03

15

08

05

15

05

82

Exophthalmometry

X-ray interpretation

CT scan interpretation

MRI interpretation

Interpretation of HVF

Pachymetry

Corneal scrapping

Conjunctival swab

Vitreous Tap

Biopsy

Prostigmine Test

03

03

03

03

03

03

03

03

03

03

03

10

10

10

10

10

10

05

05

03

03

02

05 Sterilization Procedures 01 05

06 Extraocular

Surgeries

Local Anaesthesia

Superficial Foreign Body Removal

Incision & Curettage of Chalazion Excision of pterygium +Autograft

Dacryorio Cystectomy (DCT)

Dacryorio Cystorhynostomy (DCR)

Enucleation/Evisceration/Exenteration

Lid procedure

(Ectropion, Entropion, Tarsorraphy)

Ptosis Surgery

Squint surgery

Socket reconstruction

Orbital tumor excision

03

03

03

02

02

02

02

02

01

01

01

01

10

10

10

05

10

05

05

05

05

06

02

02

07 Intraocular

Surgeries

Manual SICS +PCL

Phacoemulsification

Trabeculectomy

Laser PI

Laser Capsulotomy (YAG)

Laser surgery (Retinal)

Vitreous Surgery / RD Surgery

Penetrating keratoplasty

Combine procedure (SICS+PCL+

Trabeculectomy)

Repair of Ocular Injury

Removal of IOFB

02

01

01

02

02

02

01

01

01

01

01

10

10

10

03

03

03

04

04

05

05

02

08 Emergency Management 03 15

______________________ __________________________

Trainee’s signature and Date Supervisor’s Signature and Date

83

Bangabandhu Sheikh Mujib Medical University Shahbag, Dhaka

Diploma trainee’s Block progress report

Name of the trainee :

Name of the course :

Name of the institute :

Period of block :

Session :

Reg. No:

Performance Poor Satisfactory Good Excellent

Written*

Clinical- Practical*

Oral*

Attendance*

Attitude

* Poor: <50%, Satisfactory: ≥50-60%, Good: >60-75%, Excellent : >75%

Note: “Poor” grade in more than two performance during a particular block

means deficient training and also cause disqualification for appearing in the

final examination unless training in particular block is complete.

Signature: ....................

Head of the Department

(Seal)

Printed on : March, 2013 Price : 250/-