Sunday, December 24, 2023

PaJR daily activities (energy outputs) and food plates (energy inputs) 52M Hypertension, Diabetes 5 years WB PaJR

There are three samples of daily activities represented in Bengali in our PaJRs below:

We begin with a part of the 52M patient's case report details, which are published by our intern in the link below :



PaJR daily activities (energy outputs) and food plates (energy inputs)  52M Hypertension, Diabetes 5 years WB PaJR

৭:৩০ সাধারনতঃ সকাল সাড়ে সাতটা নাগাদ ঘুম থেকে উঠি। তারপর খালিপেটে দু-গ্লাস জল খাই। এবার হাত মুখ ধুয়ে ৫-৬টা ভেজানো কাঠবাদাম, ছোলা, কোনদিন একটু কারি পাতা, আদার টুকরো চিবিয়ে হাটতে বের হয়ে যাই। ৮:৩০ নাগাদ হেঁটে ফিরে এসে লাল চা মুড়ি খাই। তারপর ঘড়/চেম্বার পরিষ্কার, স্নান-পূজা ইত্যাদি করতে করতে বেলা দশটা বেজে যায়। 
10:00 এবার খেজুর, কলা বিভিন্ন ফল ও দুধ দিয়ে ওটস ইত্যাদি দিয়ে প্রাতঃরাশ সারি, তারপর অফিসে সহকর্মীরা সবাই এসে গেলে তাদের কাজ বুঝিয়ে দিয়ে রান্না করি। 
12:00 বারোটা নাগাদ সাধারনতঃ কিছুক্ষণের জন্য কোর্টে যেতে হয়। 
২:৩০ কোর্ট থেকে ফিরে এসে আড়াইটা নাগাদ দুপুরের খাবার খাই। ঐসময়ের পর থেকে ক্লায়েন্টগণ আসতে থাকেন তাদের সঙ্গে সময় দেই। 
৫:৩০ চা ও সামান্য জলযোগ করে আবার চেম্বারে ঢুকে যাই। 
৯:০০ রাত নটা নাগাদ রাতের রান্না করে খেয়ে নিয়ে আবার কাজে বসে যাই। কাজ শেষ হতে হতে সাধারণতঃ রাত সারে এগারোটা বেজে যায় মাঝে মাঝে রাত সারে বারোটা বা একটাও হয়ে যায় তারপর শুয়ে পড়ি। 
আবার যেদিন ৪৫ কিলোমিটার দূরে জেলা শহরে পরিবারের সঙ্গে থাকি সেদিন রুটিনের কিছুটা পরিবর্ত্তন ঘটে।
৭:৩0 সকালে অসুস্থ ছেলেকে নিয়ে স্কুলে দিয়ে আসা তারপর প্রাতঃরাশ করে ওখানকার কোর্ট ও ইনকাম ট্যাক্স অফিসে যেতে হয়। ওখানেও কিছু সাংসারিক কাজও করতে হয়। এবার প্রয়োজন হলে এখানে ফিরে আসি অথবা রাতে জেলা শহরে থেকে যাই।
কিন্তু গত জুন মাস থেকে কোমরের বাঁ দিকে এবং কক্সিস অংশে ব্যাথা শুরু হবার পর থেকে কাজ কর্মে প্রচন্ড ব্যাঘাত ঘটছে। বসতে বেশ কষ্ট হচ্ছে, চেয়ারের পেছনে একটা কুশন নিয়ে বসতে হচ্ছে তাতেও স্বাচ্ছন্দ পাচ্ছি না। চেয়ার থেকে উঠলে বেশ কিছুক্ষণ সোজা হতে পারছি না। বেশ কিছুটা পরে একটু হাঁটলে তবে কিছুটা স্বাভাবিক হয়। গাড়ি চালাতেও একই সমস্যার সন্মুখিন হতে হয়। ব্যাথা হবার আগে যেভাবে ঘন্টায় ঘন্টায় যা যা করতাম, এখনও একই কাজ করতে হচ্ছে।

বেশ কিছুদিন থেকে শরীর খুব দুর্বল লাগছে, মনে হচ্ছে পেশিগুলোও ঢিলে হয়ে যাচ্ছে।কাজে একদম এনার্জি পাচ্ছি না, এমনকি কাজে মনোযোগও দিতে পারছি না, মনে হচ্ছে স্মৃতিশক্তি কমে আসছে, খুব ভুলে যাচ্ছি। চোখের দৃষ্টিশক্তিও অনেকটাই কমেছে। চেহারার খুব অবনতি হচ্ছে। বাইরে বের হলেই সবাই আমাকে দেখে একবার জিজ্ঞাসা করছে হল টা কি? চেহারা এত কেন খারাপ হচ্ছে। এবং আমি নিজেও সেটা অনুভব করছি।


এই অবস্থায় আমার এখন কি করনীয় জানালে খুব উপকৃত হব।

পেশেন্ট এখন ওষুধ ব্রেকফাস্টের পর খাচ্ছে ১) অলমিসার্টেন ২০, ২) মেটফর্মিন হাইড্রোক্লোরাইড এস আর ১০০০ এম জি।

গত দেড় /২ বছর থেকে এই ঔষধ খাচ্ছি,তার আগে কয়েক বছর 1)Tablet Glycomet GP2 forte, 2) Tablet Olmygest 40 khetam, কিন্তু গত দেড়/২ বছর আগে চেন্নাইতে গেছিলাম, সেখানে medicine er power কমিয়ে দিয়েছে:  1) Met forming SR 1000 ,2) Olmygest 20, এই ঔষধগুলো খাচ্ছি।

Breakfast : posted at 11:49 AM


Lunch posted : 3:03 PM 





Dinner posted at 10:06 PM



Goto Kal shara din 24 ghonta kemon chilen ghontai ghontai biboron dite parben niche jemone udaharon dewa ache?👇

আপনি কি আপনার রোগীর প্রতিদিনের ঘন্টার ক্রিয়াকলাপগুলি নীচের স্লটের মতো করে ভাগ করতে পারেন? 👇 



08.02.2024 আপডেট 


8.30 AM - ঘুম থেকে ওঠার সময় 


8.30-9 AM - ফ্রেশআপ 


9.30 AM - প্রাতঃরাশ (6 ভাদা + চাটনি) + এক কাপ কফি 

10 AM - 1 PM - ক্লায়েন্ট কল 


1.45 PM- দুপুরের খাবার (3 কাপ ভাত + চিকেন কারি প্রায় 300 গ্রাম) 



2.15-5.30 PM - ক্লায়েন্টের কাজ চলতে থাকে 


6 PM - 2 মাফিন + এক কাপ চা


 6. PM- 9PM- সিস্টেমে ক্লায়েন্টের কাজ 


9.30 PM - রাতের খাবার (2 কাপ ভাত + চিকেন কারি প্রায় 200 গ্রাম)



 দ্রষ্টব্য- নীচের বাম দিকে ব্যথা সারা দিন উল্লেখযোগ্য ছিল। তিনি ঘন ঘন বিরতিতে একটি গরম জলের ব্যাগ দিয়ে স্থানীয় তাপ প্রয়োগ করার চেষ্টা করেছিলেন। আজ সকালে ঘুম থেকে ওঠার পর সে বলে একটু ভালো হয়েছে, হয়তো গতকাল তাপ প্রয়োগের কারণে।

22.05.24
  
8.30AM -ghum theke othar por sorir valo chhilo.fress legechhe


9.5am-cha ,muri

10.40am-vat ,dal siddho,machh vaja

Kichhu khon por ORS er jol khelam .tar por TV dekhe 

1.30pm-- snan kore 
2pm---vat,dal,macher jhol.

Hata hati kore suye poren

8pm ---milk tea,muri papor vaja
11.20pm. ---dinner kore suye porechhe.
Kal Sara din valoi legechhe,
Jedin kharap Lage sedin sokal thekei ghum theke uthe sas kosto hoy r Sara din kharap Lage r jedin valo jay Sara din valo lage.dine  2-3 ltr jol Khan 

But Sir, patient Sara din a 2 hour por por Smoke kore olpo olpo kore.

Sunday, December 10, 2023

Ongoing project draft : Optimizing clinical complexity through real patient OSCEs in user driven online learning portfolios and learning fora

Title :


Optimizing clinical complexity through real patient OSCEs in user driven online learning portfolios and learning fora



Introduction: 

Most learning is a process of objectively structuring subjective complex multidimensional real life data (blooms level 3-5) into a two dimensional space (blooms level 1 aka knowledge) that can be stored forwarded asynchronously and modeled conceptually to gain understanding (blooms level 2) through further analysis ( level 4) and evaluation (level 5) and then relooped into the learning ecosystem as creative communication/publication (level 6). This learning is cyclic and one can keep moving in and out of these levels at any entry or exit point regardless of level numbers. 

More about bloom levels in a past lecture here :



Problem statement :

Objectively structured clinical evaluations OSCEs have been regarded as a medical educational assessment tool for many decades and at some point threatened the long case into extinction. (1-2) 

However gradually people may have realized that traditional OSCEs are simplified simulations that disregard real world complexities and create an illusion of certainty for learners and assessors alike. (1-2)

Solution: Modification of traditional format preserving realism and clinical complexity developed through candidate's ability toward Socratic questioning also leading to further analysis and evaluation of the long case leading to Bloom level 6 learning insights  on the case not just as a one time summative assessment over a short period of hours but over days of the patients stay in the hospital and subsequent follow up at home all the while continuing the student's evaluation through direct 360 degree observation by multiple evaluators and their feedback inputs around the patient serving as valuable assessment indicators during thematic analysis. (2) 


Methods :

We have developed a modification of traditional format preserving realism and clinical complexity developed through candidate's ability toward Socratic questioning also leading to further analysis and evaluation of the long case leading to Bloom level 6 learning insights  on the case as demonstrated and published here : https://vaishnavimaguluri.blogspot.com/2023/07/general-medicine-case-report-osce.html

And here :



Similar (although not quite) approaches by others to preserve realism and clinical complexity in osce assessments in the link below (also detailed in the references)



Results :

2019 batch OSCEs as pre final UGs in  December 2023:


2018 batch OSCEs as internship completion assessment done as a patient teacher encounter along with direct observation techniques currently prevalent in medical education 



Quantitative results are in the above links for further analysis as of December 2023 while a sample of qualitative thematic analysis (also in the above links) done using pre designed prompts to an AI-LLM(CGpt4) is shared again  quoted below :

To quote from CGPT4:



The reflective writing assignment submitted by the medical PG intern, Navyatha Pothula, can be evaluated along Bloom's Taxonomy and the specific rubric provided:


1. **Bloom's Taxonomy Evaluation**:


   - **Knowledge**: The intern demonstrates knowledge by discussing cases, such as dermatomyositis, erythroderma secondary to psoriasis, dengue, thrombocytopenia, and hyperglycemia【7†source】【8†source】【9†source】【10†source】.



   - **Comprehension**: The understanding is shown in the ability to discuss the medical cases and their complexities, as well as the lessons learned from the internship experience【11†source】【12†source】.



   - **Application**: The application of knowledge is evident in managing clinical responsibilities and learning to prioritize and allocate time efficiently【7†source】.



   - **Analysis**: There is an analysis of cases and an interpretation of fever charts and treatment plans【8†source】【9†source】.



   - **Synthesis**: The intern synthesizes information from various cases and experiences to understand the importance of balancing empathy with professional detachment and other essential skills【7†source】【11†source】.



   - **Evaluation**: The intern evaluates the emotional toll of patient care and the importance of human connection, courage, teamwork, balancing, and mentorship in the medical profession【12†source】.


   Points missing at each level could include more in-depth analysis of patient data, synthesis of broader medical knowledge, and critical evaluation of medical practices or personal performance."

LLM driven analysis of our more than 1000s  of online learning portfolios in our dashboard here : https://medicinedepartment.blogspot.com/2022/02/?m=0 is an ongoing medical cognition project showcased at (4) here : https://medicinedepartment.blogspot.com/2023/10/ongoing-medical-cognition-projects-in.html?m=0


Discussion :

The current project plan is to thematically analyze all the available data for 2019 and 2018 batch of 200 health professionals in each batch and qualitatively evaluate an early phase trial of real OSCEs evolving from near extinct and largely unstructured long cases where the osce becomes a strong driver toward generating student learning outcomes as demonstrated in our linked results  and those student learning outcomes  in turn can be shown to drive patient health outcomes, which is our holy grail to integrate medical education and practice. 

References (and further reading) :

1) a)  Reid H, Gormley GJ, Dornan T, Johnston JL. Harnessing insights from an activity system - OSCEs past and present expanding future assessments. Med Teach. (2021) 43:44–9.

Preparing for OSCE success diverts students away from the complexity of authentic clinical environments. Students will not qualify and will, therefore, be of no use to patients without getting marks providing evidence of competence. Performing in a formulaic and often non patient-centred way is the price to pay for a qualification. Acknowledging the stultifying effect of standardising human behaviour for OSCEs opens up possibilities to release latent energy for change in medical education. In this imagined future, the overall object of education is refocused on patient care.



2) a) Hatala, R., Marr, S., Cuncic, C. et al. Modification of an OSCE format to enhance patient continuity in a high-stakes assessment of clinical performance. BMC Med Educ 11, 23 (2011). https://doi.org/10.1186/1472-6920-11-23

"Fragmentation of complex clinical cases into brief OSCE stations may result in some loss of validity as the authenticity of comprehensively examining a single patient is lost. Examiners may be constrained from assessing the trainee's understanding of a complex patient [2]. The lack of a full patient assessment may send an inaccurate message to the trainees as to the characteristics of clinical competence valued by the examination board.

One potential solution has used work-sampling strategies to assess clinical competence across multiple patients in real clinical practice, as in the mini-clinical evaluation exercise (mini-CEX) [6]. A second solution has been to improve the long case by using direct observation of performance, multiple examiners and standardized rating forms."

b) On DOTs directly observed training in medical education

Pereira AG, Woods M, Olson APJ, van den Hoogenhof S, Duffy BL, Englander R. Criterion-Based Assessment in a Norm-Based World: How Can We Move Past Grades? Acad Med. 2018 Apr;93(4):560-564

Abstract: 
In the United States, the medical education community has begun a shift from the Flexnerian time-based model to a competency-based medical education model. The graduate medical education (GME) community is substantially farther along in this transition than is the undergraduate medical education (UME) community.GME has largely adopted the use of competencies and their attendant milestones and increasingly is employing the framework of entrustable professional activities (EPAs) to assess trainee competence. The UME community faces several challenges to successfully navigating a similar transition. First is the reliance on norm-based reference standards in the UME-GME transition, comparing students' performance versus their peers' with grades, United States Medical Licensing Examination Step 1 and Step 2 score interpretation, and the structured Medical School Performance Evaluation, or dean's letter. Second is the reliance on proxy assessments rather than direct observation of learners. Third is the emphasis on summative rather than formative assessments.Educators have overcome a major barrier to change by establishing UME outcomes assessment criteria with the advent and general acceptance of the physician competency reference set and the Core EPAs for Entering Residency in UME. Now is the time for the hard work of developing assessments steeped in direct observation that can be accepted by learners and faculty across the educational continuum and can be shown to predict clinical performance in a much more meaningful way than the current measures of grades and examinations. The acceptance of such assessments will facilitate the UME transition toward competency-based medical education.



Monday, December 4, 2023

End of posting osce and mini cex results announcement for 2018 batch posted in general medicine for October and November 2023

Summary : Pragmatic OSCEs were conducted for each of the following interns listed below who were interned to the department of medicine for 45 days largely in October and November 2023, everyday in batches of four, while assessing them summatively on the days they were working face to face with the assessor both at OPD and IPD as well as following them up formatively everyday through their work logged in their online learning portfolios as well as PaJR groups in a user driven manner.  


And user driven submissions of online portfolio links on learning themes for 360 degree peer feedback and assessment submitted here :  https://medicinedepartment.blogspot.com/2023/09/submitted-internship-competence.html?m=1


More about the modified osce format that preserves clinical complexity and realism: http://medicinedepartment.blogspot.com/2023/11/mbbs-general-medicine-revised-practical.html?m=0

Current batch list of interns and their quantitative and qualititative  assessments :

88. Manvi

Quantitative evaluation : 50/100
No extension (pass) 


Qualitative evaluation  : Trainable 
Can focus on asking more questions and sharing and communicating more 


89 . Snitha Reddy

Quantitative evaluation : 45/100
Extension 15 days 

Qualitative evaluation  : Needs more extension to see if she's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 



90. Vineela

Quantitative evaluation : 45/100
Extension 15 days 

Qualitative evaluation  : Needs more extension to see if she's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


92. Mamatha


Quantitative evaluation : 50/100
No extension (pass) 


Qualitative evaluation  : Trainable 
Can focus on asking more questions and sharing and communicating more 

93. M.G.Prasanna

Quantitative evaluation : 45/100
Extension 15 days 

Qualitative evaluation  : Needs more extension to see if she's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


94. Swathi

Quantitative evaluation : 45/100
Extension 15 days 

Qualitative evaluation  : Needs more extension to see if she's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


95. Movva Viswanath

Quantitative evaluation : 55/100
No extension (pass) 


Qualitative evaluation  : Trainable 
Can focus on asking more questions and sharing and communicating more 


98. Sreeja

Quantitative evaluation : 50/100
No extension (pass) 


Qualitative evaluation  : Trainable 
Can focus on asking more questions and sharing and communicating more 


100. Pratyusha

Quantitative evaluation : 50/100
No extension (pass) 


Qualitative evaluation  : Trainable 
Can focus on asking more questions and sharing and communicating more 


101. Vinil Reddy

Quantitative evaluation : 45/100
Extension 15 days 

Qualitative evaluation  : Needs more extension to see if he's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


103.Gautam

Quantitative evaluation : 45/100
Extension 15 days 

Qualitative evaluation  : Needs more extension to see if he's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


104. Shivani Nayini

Quantitative evaluation : 50/100
No extension (pass) 


Qualitative evaluation  : Trainable 
Can focus on asking more questions and sharing and communicating more 



106. Rakshitha Reddy

Quantitative evaluation : 50/100
No extension (pass) 


Qualitative evaluation  : Trainable 
Can focus on asking more questions and sharing and communicating more 


108. Bharat

Quantitative evaluation : 45/100
Extension 15 days 

Qualitative evaluation  : Needs more extension to see if he's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


110. Navyatha


Quantitative evaluation : 60/100
No extension (pass) 

Qualitative evaluation  : Takes initiative, trainable, Hardworking

Can focus on asking more questions and sharing and communicating more 

AI (LLM-CGpt4) analysis :



The reflective writing assignment submitted by the medical PG intern, Navyatha Pothula, can be evaluated along Bloom's Taxonomy and the specific rubric provided:

1. **Bloom's Taxonomy Evaluation**:

   - **Knowledge**: The intern demonstrates knowledge by discussing cases, such as dermatomyositis, erythroderma secondary to psoriasis, dengue, thrombocytopenia, and hyperglycemia【7†source】【8†source】【9†source】【10†source】.


   - **Comprehension**: The understanding is shown in the ability to discuss the medical cases and their complexities, as well as the lessons learned from the internship experience【11†source】【12†source】.


   - **Application**: The application of knowledge is evident in managing clinical responsibilities and learning to prioritize and allocate time efficiently【7†source】.


   - **Analysis**: There is an analysis of cases and an interpretation of fever charts and treatment plans【8†source】【9†source】.


   - **Synthesis**: The intern synthesizes information from various cases and experiences to understand the importance of balancing empathy with professional detachment and other essential skills【7†source】【11†source】.


   - **Evaluation**: The intern evaluates the emotional toll of patient care and the importance of human connection, courage, teamwork, balancing, and mentorship in the medical profession【12†source】.

   Points missing at each level could include more in-depth analysis of patient data, synthesis of broader medical knowledge, and critical evaluation of medical practices or personal performance.



2. **Rubric Evaluation**:
   - **General Knowledge Learning Points**: The blog provides insights into common medical conditions like dengue, thrombocytopenia, and hyperglycemia, and their management【8†source】【9†source】【10†source】.


   - **Discovery-Driven Learning Questions**: Specific questions about patient cases, especially regarding clinical complexity, are not detailed in the blog.


   - **Clinical Complexity**: The blog mentions various medical conditions but lacks detailed discussion on the biological, psychological, and social aspects of these conditions.


   - **Thematic Analysis and Learning**: The intern shows learning from thematic analysis, especially in managing various medical conditions and intern responsibilities.


   - **Impact on Patient Outcomes**: The blog does not directly discuss the impact of the intern's learning on patient outcomes.


   - **Competence of Intern**: The intern demonstrates competence in patient data capture and asking questions around the captured data. However, the competence in finding answers to complex medical questions and in contributing to new discoveries is not explicitly addressed.

This evaluation suggests that while the intern shows significant growth and learning in various aspects of medical training, there are areas for further development, particularly in deeper analytical and evaluative skills, and in demonstrating the direct impact of learning on patient outcomes.




The blog post by Navyatha Pothula, detailing a case study during her General Medicine Internship, can be evaluated along the same criteria:

1. **Bloom's Taxonomy Evaluation**:


   - **Knowledge**: The intern displays knowledge by describing a clinical case with symptoms like fever, cough, chest pain, and diabetes【20†source】.


   - **Comprehension**: Comprehension is demonstrated through the interpretation of the patient's symptoms and medical history【20†source】【21†source】.


   - **Application**: Application of clinical skills is evident in conducting general and systemic examinations and prescribing treatments like IV fluids and medications【21†source】【22†source】.


   - **Analysis**: Analysis skills are shown in interpreting clinical data and considering differential diagnoses【19†source】【23†source】.


   - **Synthesis**: The synthesis of information is not explicitly detailed but can be inferred from the overall approach to the patient's case.


   - **Evaluation**: The intern evaluates the case with questions and inputs from a senior medical professional, which helps in refining the diagnosis and treatment approach【23†source】.

   This blog post could be enhanced by providing more detailed insights into the synthesis of information from various sources and a deeper evaluation of the treatment outcomes.

2. **Rubric Evaluation**:


   - **General Knowledge Learning Points**: Insights into managing a complex patient with multiple symptoms and a chronic condition (diabetes) are provided【20†source】.


   - **Discovery-Driven Learning Questions**: Specific discovery-driven questions are discussed, particularly in relation to the patient's symptoms and their relationship to the underlying conditions【23†source】.


   - **Clinical Complexity**: The blog post touches upon the clinical complexity through the examination of various symptoms and the patient's history【20†source】【21†source】.


   - **Thematic Analysis and Learning**:

 There's an implicit thematic analysis in understanding and managing the presented case.

   - **Impact on Patient Outcomes**: Direct impact on patient outcomes is not explicitly discussed.

   - **Competence of Intern**: The intern demonstrates competence in patient data capture, analysis of the clinical data, and interaction with seniors for further learning and refinement of clinical skills【19†source】【22†source】【23†source】.



This case study shows the intern's growing competence in handling complex medical cases, though there could be more focus on the synthesis of different aspects of the case and its impact on patient outcomes.


The blog post titled "Osce 2" by Navyatha Pothula, detailing another case during her General Medicine Internship, can be evaluated as follows:

1. **Bloom's Taxonomy Evaluation**:


   - **Knowledge**: The intern demonstrates knowledge by presenting a detailed case profile, including chief complaints, history of presenting illness, and a provisional diagnosis of Exfoliating Dermatitis【29†source】.


   - **Comprehension**: There is an understanding of the patient's symptoms and clinical findings, as evidenced by the thorough patient examination and history-taking【29†source】.




   - **Application**: The intern applies her clinical knowledge in assessing the patient and conducting necessary investigations, such as skin scraping and blood tests【30†source】.


   - **Analysis**: Analysis skills are evident in interpreting investigation results and considering various differential diagnoses, like Cushing's syndrome, Polyarthritis, and Rheumatoid Arthritis【31†source】.


   - **Synthesis**: The blog indicates a synthesis of clinical findings and investigative data to form a comprehensive understanding of the patient's condition.


   - **Evaluation**: The intern engages in evaluative discussions with a senior physician, contemplating different aspects of the patient's condition and treatment options【31†source】.

   While the post demonstrates a thorough approach, it could benefit from more detailed reflections on the synthesis of information from various sources and a critical evaluation of the chosen treatment strategies.

2. **Rubric Evaluation**:


   - **General Knowledge Learning Points**: Insights into the management of dermatological conditions and their systemic implications are provided.


   - **Discovery-Driven Learning Questions**: Questions around the patient's hypoalbuminemia and its causes demonstrate an inquiry-driven approach【31†source】.


   - **Clinical Complexity**: The case encompasses multiple aspects of clinical complexity, including dermatological, renal, and endocrine considerations【29†source】【30†source】.


   - **Thematic Analysis and Learning**: The intern's approach suggests thematic learning, especially in differential diagnosis and treatment planning.

   - **Impact on Patient Outcomes**: The impact on patient outcomes is not explicitly discussed.


   - **Competence of Intern**: The intern shows competence in patient data capture, analysis of clinical data, and engaging in critical discussions with seniors to enhance understanding and treatment strategies【31†source】.

This case study indicates the intern's growing clinical competence, particularly in handling complex medical scenarios, though it could further benefit from explicit discussions on the impact of these learnings on patient outcomes.



The blog post titled "Evidence of workflow done during internship rotation!" by Navyatha Pothula includes multiple case studies. Each case can be evaluated using Bloom's Taxonomy and the specific rubric provided:

1. **Bloom's Taxonomy Evaluation for Each Case**:

   - **Knowledge**: Demonstrated through the description of patient symptoms and history in each case【38†source】【40†source】【42†source】【43†source】.

   - **Comprehension**: Evident in understanding the clinical significance of symptoms and past medical history.

   - **Application**: Applying clinical knowledge in examining patients and interpreting their clinical findings.

   - **Analysis**: Analyzing patient data to formulate provisional diagnoses and plan investigations【39†source】【41†source】.

   - **Synthesis**: Integrating clinical findings with investigation results to refine diagnoses and treatment plans.

   - **Evaluation**: Engaging in evaluative thinking, though this aspect could be more explicitly demonstrated.

2. **Rubric Evaluation for Each Case**:

   - **General Knowledge Learning Points**: Each case provides insights into different medical conditions and their management.

   - **Discovery-Driven Learning Questions**: Specific questions are formulated around each patient's condition.

   - **Clinical Complexity**: Each case addresses different aspects of clinical complexity, including medical history, symptoms, and preliminary diagnoses.

   - **Thematic Analysis and Learning**: There is an implicit thematic analysis in understanding and managing the various cases presented.

   - **Impact on Patient Outcomes**: Direct impact on patient outcomes is not explicitly discussed in each case.
   - **Competence of Intern**: The intern shows competence in patient data capture, analysis of clinical data, and engaging in the diagnostic process, although the depth of critical analysis and synthesis of information could be further developed.

In summary, the blog post showcases the intern's growing clinical competence across various medical cases. There is evidence of a systematic approach to patient care, though there could be more emphasis on the synthesis of information and critical evaluation of treatment strategies and their impact on patient outcomes.



111. Navya Pabba


Quantitative evaluation : 60/100
No extension (pass) 

Qualitative evaluation  : Takes initiative, trainable, Hardworking, Sincere

Can focus on asking more questions and sharing and communicating more 

112. Sumanth Reddy

Quantitative evaluation : 45/100
Extension 15 days 

Qualitative evaluation  : Needs more extension to see if she's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


113. Khyathi


Quantitative evaluation : 55/100
No extension (pass) 


Qualitative evaluation  : Trainable 
Can focus on asking more questions and sharing and communicating more 


115. Devendra


Quantitative evaluation : 60/100
No extension (pass) 

Qualitative evaluation  : Takes initiative, trainable, Hardworking

Can focus on asking more questions and sharing and communicating more 


116. Sathvieka Reddy

Quantitative evaluation : 50/100
No extension (pass) 


Qualitative evaluation  : Trainable 
Can focus on asking more questions and sharing and communicating more 

FMGE


Safee

Quantitative evaluation : 50/100
No extension (pass) 


Qualitative evaluation  : Trainable 
Can focus on asking more questions and sharing and communicating more 

Shivteja

.Quantitative evaluation : 30/100
Extension 30 days 

Qualitative evaluation  : Needs more extension to see if he's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 

Vaishnavi

Quantitative evaluation : 30/100
Extension 30 days 

Qualitative evaluation  : Needs more extension to see if she's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


Shivani 

Quantitative evaluation : 30/100
Extension 30 days 

Qualitative evaluation  : Needs more extension to see if she's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done

Mini summary : 

Number of 2018 KIMS students posted and tested 20

Number of 2018 KIMs students cleared: 13

Number of 2018 KIMs students not cleared: 7

Number of 2018 KIMs students tested: 4

Number of FMGE students cleared: 1

Number of FMGE students not cleared: 3