Form 1/Sem10/CUCMS

MOCK PATIENT RECORD Patient particulars:NAME: SEX : M / F AGE : D.O.B:RN:OOCUPATION:DATE OF ADMISSION: DATE OF DISCHARGED:

PATIENT’S HISTORY:

Drugs / allergy:

1

PHYSICAL EXAMINATION:Blood pressure: mmHg Pulse rate: /min Respiratory rate: /min Body temperature: 0 C Body weight: kg Height: cm

2

Summary of examination:

front

back

Provisional diagnosis:

3

INVESTIGATIONS:

MANAGEMENT PLAN:

__________________________ ________________________Name of medical student Signature

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Date:

Time:

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Form 2/Sem10/CUCMS

PROGRESS NOTESDate & Time Name & signature

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Form 3/Sem10/CUCMS

PATIENT DISCHARGE SUMMARY FORM

PATIENT DETAILS:

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

CLINICAL SUMMARY:

DIAGNOSIS (upon discharge):

MANAGEMENT:

DISCHARGE PLAN:

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Name of Medical Student

Date prepared:

Signature Time:

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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 I’ve 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:(“Materials/articles that I’ve used to answers to my own questions”)

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10

Form 5/Sem10/CUCMS

SEMESTER 10 CONTINUOS ASSESSMENT FORM:PATIENT MANAGEMENT ROUND (revised)

Student’s name: Matrix no. Group: Discipline:Date of assessment: 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 Good: 6.0 to 7.9 marksAverage: 5.0 to 5.9 Fail: 4.9 & below

Component Alloca-ted

mark

Given mark

Remark

Ability to provide sufficient summary of the patient’s information on relevant history, physical examination and diagnosis.Demonstrate rapport with patient.

10

Ability to provide information current progress; including general condition/well-being, vital signs monitoring, input/output charting

10

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)

10

Total 30

Global impression (please tick): Satisfactory Not satisfactory

General comments/remarks on ability as houseman / junior doctor:

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________________________________ ___________________ Lecturer/Examiner’s name Lecturer/Examiner’s signature

Date:

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Form 6/Sem10/CUCMS

SEMESTER 10 CONTINUOS ASSESSMENT FORM:MOCK PATIENT RECORD AND DISCHARGE SUMMARY (revised)

Student’s name: Matrix no. Group: Discipline:Date of assessment: Diagnosis:

Marking guide:Excellent: 8.0 (or 4.0) to 10.0 (or 5.0) marks Good: 6.0 (or 3.0) to 7.9 (or 3.9) marksAverage: 5.0 (or 2.5) to 5.9 (or 2.9) Fail: 4.9 (or 2.4) & below

Component Allocated mark

Given mark

Remark

Completion of Mock Patient-record and Discharge Summary:

- Generally well written, legible- Adhere to given guideline/ template

5

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

10

- Well written discharge summary based from patient record, management and discharge plans

5

Student reflection- Identification of relevant learning issues- Discussion on the learning issues

including: medical ethics and socio-cultural issues

10

Total 30

*DS (Discharge summary); MPR (Mock Patient-record)

Global impression: Satisfactory / Not satisfactory:

General comments/remarks on ability as houseman / junior doctor:

13

__________________________________ ___________________ Examiner’s name Examiner’s signatureDate:

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