Logbook Final Yr(0ct2024)

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
UNDERGRADUATE LOGBOOK
DEPARTMENT OF INTERNAL MEDICINE

BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE
1
General Instructions
1. It is expected that the students will adhere to the highest ethical standards and professionalism.
2. Shall maintain punctuality in respect to arrival and completion of the assigned work.
3. Maintain a cordial relationship with peers, unit staff and hospital staff.
4. Not to indulge in any act which would bring disrepute to the institution.
5. You should wear a clean apron and follow the dress regulations as laid down by the college and
maintain proper hygiene with wearing respective identification badge while in college and hospital.
6. You should carry the following with you for the clinics
a. Clinical textbook
b. Stethoscope
c. Clinical kit for examination.
7. Respect the patient as an individual and recognize that he/she also has rights.
8. Cases that are discussed only have to be documented and not the dummy cases.
9. Loss of this logbook at any time may affect the formative assessment results and impair the student
appearing in the summative assessment.
10. Student is solely responsible for maintaining the book and the records. If the student loses the
logbook, he/she would be withheld from appearing for the University examination unless suitable
backup proof is provided.
2
Student details
Name
Roll No
University Registration Number
Batch
Contact No
E mail Id
Guardian/Parent
Name
Contact Number
3
LOGBOOK CERTIFICATE
This is to certify that the candidate Mr /Ms......................................................................................,
Reg. No. ………………., admitted in the year………….…….. in
Bangalore Medical College And Research Institute, Bangalore, has satisfactorily completed /
has not completed all requirements mentioned in this logbook for MBBS course in the subject
Internal Medicine during the period from ..……………. to……………..
She / He is eligible / not eligible to appear for the University examination as on the date given
below.
Signature of Faculty
Name and Designation
4
Countersigned by Head of the Department
Date
5
INDEX
SL. No Topic
1. Attendance extract
2. Overall Assessment
3. Certifiable skills
4. Clinical posting 1
8. SGDs / Tutorial sessions
9. AETCOM modules
10. Integrated sessions
11. Self- Directed Learning sessions
12. Seminars presented
13. Research projects/publications
Co - Curricular Activities
14.
(Quiz, Poster, Debate, Essay, Skits)
15. CME/ Conference / Workshop
16. Awards /Recognition
6
I) ATTENDANCE EXTRACT
Theory classes
Professional Year Number Number Percentage of Signature of HOD

conducted attended Attendance
Second
Professional
Third professional-
part I
Third Professional
Part II
Tutorial/SGD sessions
Professional Year Number Number Percentage of Signature of HOD

conducted attended Attendance
Third
professional-part I
Third Professional
Part II
7
Bedside clinics:
Professional Unit Number Number Percentage Signature Signature

Year From conducted attended of of Unit of HOD
(date) Attendance Head
To
(date)
Second
Professional
Posting 1
Third
Professional
Part I
Posting 2
Third
Professional
Part II
Posting 3
Posting 4
Note:
Every candidate should have attendance not less than 75% of the total classes conducted in
theory which includes didactic lectures and self-directed learning and not less than 80% of the
total classes conducted in practical which includes small group teaching, tutorials, integrated
learning and practical sessions in each calendar year calculated from the date of commencement of
the term to the last working day in each of the subjects prescribed to be eligible to appear for the
university examination.
8
II) OVERALL ASSESSMENT OF THE STUDENT
Posting 1 Posting 2 Posting 3 Posting 4
Attendance
/5 /5 /5 /5
Discipline
/5 /5 /5 /5
Middle of
posting /5 ------ /30 ------
assessment
End of posting
/10 /20 /30 /40
assessment
Student doctor
method of /5 /10 /10 ------
learning
Total (/200)
/ 30 /40 /80 /50
Remarks if any
Total marks obtained on a total of 200 is -----
A student will be permitted to appear for final university exams only if he/she obtains
more than 100 marks in the assessments.
Final remarks if any -
9
III) CERTIFIABLE SKILLS
10
Skill/Activity Competency Year Date of Page number
number completion
1 IM,IV,SC injection IM 1.30

IM10.21
IM11.19
2 Basic Life Support IM 2.22
3 Performing and analyzing IM 1.18

ECG
4 Performing Lumbar IM 6.15

Puncture IM 17.8
5 Central Venous Catheter IM 10.22
6 Performing Ascitic tap IM 5.15
7 Performing Pleural tap IM 3.9
8 Bone marrow Biopsy IM 4.17
9 O2 delivery devices IM 3.17
10 Inhalation devices with CT 2.16

Spacer
11 GRBS,UKB IM 11.12
IM 11.13
12 Blood Transfusion IM 9.19

IM 15.13
13 ABG IM 3.8
14 Male urethral
catheterization
11
Check list for certifiable skills
1) SUBCUTANEOUS INJECTIONS- IM 11.19
S.NO STEPS COMMENTS

IF ANY
1 Gather equipments
2 Wash your hands and don PPE, if appropriate
3 Introduce yourself to the patient including your name and role
12
4 Confirm the patient's name and date of birth
5 Briefly explain what the procedure will involve using patient-
friendly language
6 Check the patient's understanding of the medication being
administered and explain the indication for the treatment
7 Gain consent to proceed with subcutaneous injection
8 Check for any contraindications to performing a subcutaneous
injection
9 Check if the patient has any allergies
10 Ask if the patient has a preferred injection site. If the
patient is receiving regular subcutaneous injections,
ensure that the injection sites are rotated
11 Adequately expose the planned injection site for the procedure
12 Position the patient so that they are sitting comfortably
13 Ask the patient if they have any pain before continuing with the
clinical procedure
14 Right person:ask the patient to confirm their details and then
compare this to the patient's wrist band(if present )and the
prescription
15 Right drug: check the labelled drug against the prescription and
ensure the medication hasn't expired
16 Right dose: check the drug dose against the prescription to ensure it
is correct
17 Right time: confirm the appropriate time to be administering the
medication and check when the patient had previous doses if
relevant
18 Right route: check that the planned route is appropriate for
the medication you are administering
19 Right to refuse: ensure that valid consent has been gained prior to
medication administration
20 Right documentation of the prescription and allergies: ensure that
the prescription is valid and check the patient isn't allergic to the
medication you are going to administer
21 Wash your hands and don some gloves (if not already done)
22 Draw-up the appropriate medication into the syringe using a
drawing-up needle
23 Remove the drawing-up the needle and immediately dispose o f
it in to a sharps bin ,then attach the needle to be used for
performing the injection
24 Choose an appropriate site for the injection
25 Position the patient to provide optimal access to your chosen site
13
Rating
Attempt at activity Decision of faculty
Below (B) expectations
First or Only (F) Completed (C)
Meets (M) expectations
Repeat (R) Repeat (R)
Exceeds (E) expectations
Remedial(Re) Remedial(Re)
Date of completion:
Feedback received:
Signature of the student:
Signature of the faculty:
INTRAMUSCULAR INJECTIONS - IM 1.30
S.NO STEPS COMMENTS IF

ANY
1 Gather equipments
2 Wash your hands and don PPE if appropriate
3 Introduce yourself to the patient including your name
and role
14
5 Briefly explain what the procedure will involve using
patient-friendly language
6 Check the patient's understanding of the
medication being administered and explain he
indication for the treatment
7 Gain consent to proceed with intramuscular injection
8 Check for any contraindications to performing an
intramuscular injection
10 Ask if the patient has a preferred injection site. If
the patient is receiving regular intramuscular
injections ,ensure that the injection sites are rotated
11 Adequately expose the planned injection site for the
procedure (e.g. deltoid)
12 Position the patient so that they are sitting
comfortably
13 Ask the patient if they have any pain before
continuing with the clinical procedure
14 Right person: ask the patient to confirm their details
and then compare this to the patient's wrist band (if
present) and the prescription
15 Right drug: check the labeled drug against the
prescription and ensure the medication has nt
expired
16 Right dose: check the drug dose against the prescription
to ensure it is correct
17 Right time ; confirm the appropriate time to be
administering the medication and check when the
patient had previous doses if relevant
18 Right route: check that the planned route
is appropriate for the medication you are
administering
19 Right to refuse: ensure that valid consent has been
gained prior to medication administration
20 Right documentation of the prescription and
allergies :ensure that the prescription is valid and
check the patient isn't allergic to the medication
you are going to administer
21 Wash your hands and don gloves/apron (if not
already done)
22 Draw-up the appropriate medication into the syringe
using a drawing-up needle
23 Removethedrawing-
upneedleandimmediatelydisposeofitintoasharpsbin,
thenattach the needle to be used for performing the
injection
15
24 Choose an appropriate site for the injection
25 Position the patient to provide optimal access to your
chosen site
26 Clean the site (if appropriate)
27 Gently place traction on the skin with your non-
dominant hand away from the injection site,
continuing the traction until the needle has been
removed from the skin. If the patient is elderly with
reduced muscle mass or the patient is emaciated, do
not apply traction, instead, bunch the muscle up to
ensure adequate bulk before injecting.
28 Warn the patient of a sharp scratch
29 Holding the syringe like adart in your dominant hand,
n pierce the skin at a75-90°angle. Insert the needle
quickly and firmly, with the bevel facing upwards,
leaving approximately one-third of the shaft
exposed(however his varies between sites and
patients).
30 Aspirate to check the location of the needle (if
appropriate)
31 If aspiration does not reveal evidence of intravascular
needle placement, inject the contents of the syringe
whilst holding the barrel firmly. Inject the medication
slowly at a rate of approximately 1ml every 10
seconds.
32 Remove the needle and immediately dispose of it
into a sharps container
33 Release the traction you were applying to the skin
34 Apply gentle pressure over the injection site with a
cotton swab or gauze. Do not rub the site.
35 Replace the gauze with a plaster
36 Dispose of your clinical equipment into an appropriate

clinical waste bin
37 Explain to the patient that the procedure is now
complete
39 Discuss post-injection care
40 Dispose of PPE appropriately and wash your hands
41 Document the details of the procedure and the
medication administered
16
Rating
Date of completion:
Feedback received:
ACCESS A VEIN FOR IV ADMINISTRATION

OF MEDICATIONS/FLUIDS- IM10.21

ANY
1 Gather equipment
2 Wash your hands using alcohol gel. If your hands are
visibly soiled, wash them with soap and water Don PPE
if appropriate.
17
3 Introduce yourself to the patient including your name
and role
5 Briefly explain what the procedure will involve using
patient-friendly language
6 Gain consent to proceed with intravenous cannulation
8 Adequately expose the patient's arms for the procedure
9 Position the patient so that they are sitting comfortably
10 Ask the patient if they have any pain before continuing
with the clinical procedure
11 Don gloves (if not already wearing some)
12 Open the dressing pack and place the cannula, cannula
dressing and other items onto the
field. Prepare the normal saline flush if a pre-filled flush is
not available.
13 If you are planning on using an extension set,you
should attach this to the flush and prime the line
14 Decide which arm you plan to cannulate
15 Place a pillow under the arm to be cannulated to make
the procedure more comfortable for the patient
16 Place a field below the patient's arm to prevent blood
spillage
17 Inspect the patient's arm for an appropriate cannulation
site
18 Position the patient's arm in a comfortable extended
position that provides adequate access to the planned
cannulation site
19 Apply the tourniquet approximately 4-5 finger-widths
above the planned cannulation site
20 Palpate the vein you have identified to assess if it is
suitable
21 Once you have identified a suitable vein you may need to
temporarily release the tourniquet, as it should not be left
on for more than 1-2 minutes at a time
22 Clean the site with an alcohol swab for 30seconds
and then allow to dry completely for 30 seconds
23 Wash your hands again, removing gloves if these were
worn for setting up the saline flush
24 Don a new pair of non-sterile gloves
25 Re-apply the tourniquet if removed previously
26 Remove the cannula sheath
27 Prepare the cannula (open wings, slightly
18
withdraw/replace the needle, unscrew the cap)
28 Anchortheveinwithyournon-
dominanthandfrombelowbygentlypullingontheskindista
l to the insertion site
29 Warn the patient that they will experience a sharp
scratch
30 Insert the cannula directly above the vein, through the skin
at an angle of 10-30º with the bevel facing upwards
31 Observe for a flashback of blood in to the cannula
chamber,which confirms that the needle has punctured
the vein
32 Lower the cannula and then advance the needle a
further 2mm after flashback is observed to ensure it's
within the vein's lumen
33 Partially withdraw the introducer needle, ensuring the
needle end is within the plastic tubing of the cannula (you
should observe blood entering the plastic tubing of the
cannula as you dothis)
34 Carefully advance the cannula into the vein as you
simultaneously withdraw the introducer needle until the
cannula is fully inserted and the needle is almost
removed
35 Release the tourniquet
36 Place some sterile gauze directly underneath the
cannula hub
37 Apply pressure to the proximal vein close to the tip of
the cannula to reduce bleeding
38 Gently pull the introducer needle backwards whilst
holding the cannula in position until it is completely
removed
39 Connect a Luer lock cap or primed extension set to the
cannula hub
40 Dispose of the introducer needle immediately into a
sharps container
41 Apply adhesive strips to secure the cannula wings to the
skin. Do not obscure the insertion site with the strips, as
this needs to remain visible to allow early identification of
phlebitis.
42 Inject the normal saline into the cannula using the flush
you prepared earlier
43 Secure the cannula with a dressing if the cannula flush
was successful
44 Explain to the patient that the procedure is now
complete
45 Thank the patient for their time
19
46 Dispose of your PPE and other clinical waste into an
appropriate clinical waste bin
47 Wash your hands
48 Document the details of the procedure on a cannulation
chart or in the patient's notes
Rating
Date of completion:
Feedback received:
2) Basic Life support IM 2.22

ANY
1 Check the patient's surroundings are safe before
approaching
2 Check the patient for a response
20
3 Call for help if there is no response from the patient
4 Position the patient on their back and perform the
head-tilt chin-lift to open the airway
5 Assess for a carotid pulse at the same time
6 Look, listen and feel for signs of breathing for 10
seconds
7 If there are no signs of life call the resuscitation
team and commence CPR
8 Deliver 30 chest compressions with the hands
positioned over the lower half of the sternum. Aim
to compress the chest by approximately 5-6cm and
perform chest compressions at a rate of 100-120
compressions per minute.
9 Deliver 2 ventilations after performing 30 chest
compressions and continue to repeat this cycle.
The person performing chest compressions
should be rotated every 2 minutes.
Rating
Date of completion: Feedback received:

Signature of the student: Signature of the faculty:
3) Perform an ECG IM 1.18

Sl. Procedure P1 P2 P3 Comments if any
No.
1. Check the accuracy of participant’s name and
hospital number
21
Sl. Procedure P1 P2 P3 Comments if any
No.
2. Wash hands
3. Explain the procedure to the patient
4. Maintain the privacy of the patient
5. Demonstrate proper preparation of skin prior to

placing the leads.
6. Place the leads on proper anatomical landmarks
after applying the electrode gel
7. Ensure that there is no electrical interference and
contact interference with cot. Correctly identify
and use the necessary keys on the keypad like
start, stop, rhythm, etc.
8. Press the ECG rhythm key to initiate a tracing and
takes the printout.
9. Turn the ECG machine off
10. Enter the patient details manually (If digital

machine, this step should be done before starting
the tracing marked)
11. Wipe of the gel from the patient’s body, clothe the
patient and get the patient to a comfortable
position.
12. Document the completion of the ECG in the
patient’s chart.
Rating
Date of completion : Feedback received:
Signature of the student : Signature of the faculty:
Checklist for reporting an ECG
22
1 Standardization
2 Technical features
3 Rhythm
4 Heart rate
5 PR interval
6 QRS interval
7 QT/QTc interval
8 Axis
9 P waves
10 QRS voltage
11 Precordial R
wave progression
12 Abnormal Q waves
13 ST segment
14 T waves
15 U waves
16 Comparison with
previous ECG
4) Lumbar puncture IM 6.15, IM17.8
23
Sl. No. Procedure Comments if any
24
1. Identify the correct patient and confirm the
indication for lumbar puncture
2. Ensure that there are no contraindications
3. Obtain written informed consent stating the

indication, the procedure and the possible
complications
4. Make sure all the necessary equipments are
available. Identify the site- L3-L4 disc space.
5. Wear head cap, eye goggles and mask.
6. Wash hand with betadine and dry the hands with

sterile towel. Wears gown and gloves.
7. Instruct the assistant to position the patient in

universal flexion position.
8. Paint the area in a circular fashion from inside
out with betadine and drape the area in such a
way that the point marked for insertion of needle
is in the centre.
9. Identify the site between L3 and L4 vertebral
bodies.
10. Administer local anesthesia. Wait for sufficient

time for it to act.
11. Insert 23-gauge LP needle with the bevelled end
upwards and tip directed towards the patient’s
umbilicus.
12. Advance the LP needle till the loss of resistance
(‘give away feeling’) is felt.
13. Withdraw the stylet and watch for flow of clear
CSF and collect the CSF in the necessary
vacutainers and bottles.
14. Label the CSF samples and send them for
analysis at the earliest.
15. Document the procedure. Check GRBS and
document.
16. Instruct the patient to rest in supine position with
legs elevated for few hours and to inform if he
has any new symptoms.
Rating
25
First or Only (F) Below (B) expectations Completed (C)
Repeat (R) Meets (M) expectations Repeat (R)
Remedial(Re) Exceeds (E) expectations Remedial(Re)
Date of completion:
Feedback received:
5) CVC insertion- IM10.22
26
27
1 Identify the patient
2 Patient is educated about the need for a

CVC. The likely complications of the
procedure are explained as well. Look
for any contraindications in the patient.
3. Obtain Written Consent
4 Identification and Marking of Site of

insertion
5 Positioning of Patient -
Trendelenburg position for Internal
Jugular Vein and Sub clavian Catheteris
zation
(OR)
Supine and flat for Femoral Vein
Catheterisation
6 Arrange equipments for insertion-

central venous catheter set, local
anesthetic, surgical blade, sedation( if
required), non-absorbable suture and
needle, heparinized syringe,
heparin/flush , sterile gloves etc
7 Doctor and assistant perform hand

hygiene. Wear sterile gloves, cap, eye
goggles, mask and sterile gown
8 Site of insertion is cleaned with betadine

and alcohol. Drape the site with a hole
towel.
9 Catheter is checked by pre-flushing and
clamping all lumens not in use during
the procedure.
10 Presence of Guide wire, dilator,

Seldinger Needle is checked and
confirmed.
11 Identify the vein using ultrasonography

if available after sterilizing the probe.
Alternatively, if USG machine is not
available, the site is to be identified
using the anatomical landmarks.
12 Administer 2 % Lignocaine as local
anesthetic and wait for few minutes
13 Introduce heparinized syringe and

seldinger needle at the site identified
28
with negative pressure.
14 Insertion and direction of needle:

Femoral
The mid-inguinal point lying half-way
between the anterior superior iliac spine
and the symphysis pubis marks the
normal location of the femoral artery.
The femoral vein lies just medial to the
artery - the needle should be oriented
with the bevelled end up and introduced
at a 20 to 30° angle to the skin pointed
towards the umbilicus.
Internal jugular -
Central approach :
Sedillot’s triangle (sternal head of
sternocleidomastoid , clavicular head
sternocleidomastoid , clavicle) is
identified. Position of cutaneous
puncture at the apex of this triangle
(meeting point of both heads) is noted.
Needle is inserted at 45 degree angle to
the skin with needle directed to the
ipsilateral nipple.
Subclavian -
Infraclavicular approach:
The midpoint approach to cannulation
of the subclavian vein is most common.
Insert the needle 2 to 3 cm inferior to
the midpoint of the clavicle. Advance
the needle aiming just deep to the
suprasternal notch, keeping the needle
parallel to the ground.
15 Seek help from seniors in case of 2
unsuccessful pricks
16 Once venous blood enters the syringe,

disconnect the syringe and thread the
guide wire through Seldinger/Introducer
needle
17 Once guide wire is inserted, confirm the

presence of the guide wire in the vein
(using USG if available) before dilator
sheath is used.
18 Blade can be used to nick the skin to

increase the site of insertion if difficulty
in inserting the dilator sheath
29
19 Thread the CVC over the guide wire.
Ensure visibility and a firm grip of
the guide wire throughout this
process.
20 CVC is inserted till the hub is

approximated to the skin.
21 Guide wire is removed.

Flow through all lumens is confirmed
followed by flushing of each lumen with
heparin.
22 Secure CVC to the underlying skin with

sutures.
23 Clean excess blood. Place sterile

tegaderm over the insertion site.
24 Reconfirm successful removal of

guide wire
25 Dressing site is labelled and dated
26 Check X-ray to confirm position of

CVC
27 Check vitals and Observe patient post

procedure for site bleeding, swelling
or breathing difficulty.
28 Discard the waste appropriately.

29 Document the procedure.
Rating
30
6) Ascitic fluid tapping IM 5.15
Sl.no. Procedure Comments if any

1 Explain the procedure to the patient
and obtain the consent of the
patient/legal guardian
2 Check if the necessary equipments are
available.
3 Review,if the patient has any
contraindications for ascitic fluid
analysis.
4 Ensure an empty bladder before
beginning the procedure.
5 Patient is positioned-supine(Lateral
decubitus in some cases) and note
vitals.
6 Localise the puncture site-lateral

lower quadrant (preferably left
side),lateral to rectus abdominis
muscle, 2 cm to 4 cm superomedial to
anterior superior iliac spine.
7 Confirm the presence of ascitic fluid
at the puncture site by percussion or
ultrasound.
8 Prepare the skin with povidone-iodine
after wearing sterile gloves and a
mask and apply a sterile drape.
9 Perform local anesthesia with 2%

lignocaine (with or without
adrenaline)-Skin and deeper tissue.
10 Insert the needle/IV cannula(with at a
syringe attached) at a 45-degree angle
to the skin.
11 Advance the needle slowly while

applying slight negative pressure till
you feel loss of resistance or ascitic
fluid is aspirated(Move the needle in
3mm increments)
12 Attach the syringe. Draw the fluid into

the syringe. If no fluid returns, rotate,
slightly withdraw, or advance.
31
13 The necessary amount of fluid is
aspirated. Containers are labeled
appropriately and sent for analysis at
the earliest.
14 Remove the needle and apply pressure
and occlusive dressing.

Rating
Date of completion:
Feedback received:
32
7) Pleural fluid aspiration IM 3.9

1. Identify the patient.
2. Explain the procedure and the complications to

the patient.
3. Obtain written informed consent.
4. Make sure that the required equipments are

available, checked and assembled.
5. Mark the point of maximum dullness lateral to

angle of scapula. Mark the point using ultrasound
if available. (recommended)
6. Perform hand hygiene and wear gloves
7. Paint the area in a circular fashion from inside

out with betadine twice and drapes the area in
such a way that the point marked for insertion of
needle is in the centre.
8. Attaches the needle to 10 cm extension with 3-
way cannula and attach the syringe to the other
end( if planning therapeutic pleurocentesis).
Otherwise, attach the needle to a 50 cc syringe
9. Administer lignocaine around 5 – 10 ml under

the skin and then into the subcutaneous tissue
and allow time for it to act
10. Insert the needle with a negative pressure in the
intercostal space along the upper border of lower
rib along the tract used for the local anaesthetic.
11. Aspirate the pleural fluid slowly. Check for gross

characteristics.
12. Stop once the required amount of fluid is
aspirated. Withdraw the needle slowly and apply
pressure at the site to achieve homeostasis.
13. Fill the fluid into the required vacutainers and
bottles and label accordingly. Samples are to be
33
sent at the earliest to the lab.
14. Discard the waste appropriately.
15. Document the procedure.
Rating
Date of completion:
Feedback received:
34
8) Bone marrow aspiration and biopsy IM 4.17

1 Identify the patient
2 Patient is educated about the need,

steps and complications of the
procedure.
3 Obtain Written Consent
4 Positioning of the patient –

universal flexion position. Identify
the PSIS.
5 Arrange and check equipments for
the procedure- Bone marrow
needle, lignocaine injection- local
anesthetic, surgical blade, sedation
( if required), sterile gloves etc..
Stylet of the needle should be
especially examined for any
manufacturing defects.
6 Doctor and assistant perform hand

hygiene. Wear sterile gloves, cap,
eye goggles, mask and sterile gown
7 Site of insertion is cleaned with

betadine and alcohol. After drying
of the site, drape with a hole towel.
8 Administer 2 % Lignocaine as local
anesthetic to the skin, subcutaneous
tissue and periosteum of the PSIS
bone and wait for a few minutes.
9 Introduce Bone marrow needle and

apply screwing type of movements
till it is fixed appropriately to the
bone. Withdraw the stylet, aspirate
the blood with marrow particles and
give it immediately to the assistant
to make good smears. Confirm the
adequacy of the smears.
10 Introduce the needle further into the

35
bone without stylet and apply
rotatory pressure on all directions
and obtain an adequate piece of
bone for biopsy.
11 Remove the needle carefully and

attain hemostasis by applying
pressure for 2 to 3 minutes. Apply
pressure dressing at the site.
13 Document the procedure
Rating
Date of completion:
Feedback received:
36
9) Oxygen delivery devices IM3.17
Sl. Procedure Comments if any

No.
1. Identifies the correct patient and the need for
oxygen
2. Chooses the appropriate oxygen delivery device
based on the oxygen saturation of the patient and
his co morbid condition
3. Arranges the regulator , the oxygen tube and the
device and connects to the patient
4. Makes sure the patient is connected to the pulse
oximeter and monitors the improvement in oxygen
status
5. Documents the intervention.
O2 flow rate FiO2 delivered Demonstrates
setting up of the
device
1 Nasal cannula
2 Simple face mask
3 Non rebreather mask
4 Venturi mask
Rating
Date of completion:
Feedback received:
37
S.NO STEPS Comments

if any
1. Identify the patient.
4. Check the patient’s current understanding of inhaler
technique which would allow you to tailor your 10) Metered dose
explanation to the patient in a better way. inhaler with spacer CT
5. Position the patient so that they are sitting 2.16
comfortably
7. Explain what an inhaler is, what type of inhaler(s)
the patient is prescribed and how they work . Advise
them to check the expiry sate over the MDI. Check
the patient's understanding by asking them to repeat
the key points back to you.
9. Hold the inhaler upright
10. Remove the cap from the inhaler and inspect to
make sure there is nothing inside the inhaler
mouthpiece
11. Shake the inhaler well
12. Attach the inhaler mouthpiece to the spacer device.
13. Breathe out gently and slowly away from the spacer
until your lungs feel empty.
14. Breathe out gently and slowly away from the spacer
until your lungs feel empty.
15. Place your lips around the spacer mouthpiece to

create an effective seal.
16. Release one dose of the inhaler into the spacer
device.
17. Breathe deeply, both in and out, through the spacer
mouthpiece several times.
18. Administer a second dose if required.
19. Once you have finished using your inhaler, replace
the cap. If you’ve used an inhaler that contains
steroids, rinse your mouth with water to reduce the
chance of side effects.
20. Assess the patient’s inhaler technique. Ask the
patient to repeat it till they do it correctly.
21. Discard waste appropriately. Document the
intervention.
38
Rating
Date of completion:
Feedback received:
39
S. NO Procedure P1 P2 Comments if
any
1 Explain the procedure to the
patient.
2 Wash your hands and put on the
gloves.
3 Identify the site (fingertip). Use an
alcohol swab to clean the site and
let the alcohol dry.
4 Check the glucometer, switch it on 11) Perform and
and insert the testing strip in the interpret a
meantime. capillary blood
5 Use a single-use lancet to prick the glucose test
site identified.
6 Apply the blood drop to the testing
strip in the appropriate way.
7 Apply a piece of gauze to the site
and let the patient hold it there for
about a minute. Monitor for
excessive bleeding.
8 Read and record the result
appropriately.
9 Tell the patient what the result is.
10
Dispose the waste appropriately.
Rating
40
Repeat (R) Meets (M) expectations Repeat (R)
Remedial(Re) Exceeds (E) expectations Remedial(Re)
S. NO Procedure P1 P2 Comments if any Date of

1 Identify the pre-collected urine
sample with the patient’s details.
2 Wash your hands and put on the
gloves.
3 Check for the availability of ketone
strips. Go through the
manufacturer’s details on the bottle.
4 Dip the test end of the strip into
fresh urine sample.
5 Remove the strip from the urine
and wait for 15 seconds.
6 Compare the colour on the strip
with the colour chart on the bottle.
7 Read and record the result
appropriately.
8 Dispose the waste appropriately.
completion: Feedback received:
Perform and interpret urine ketone body estimation
41
Rating
Date of completion:
Feedback received:
12) Blood/Blood product transfusion IM9.19, IM 15.13

1 Identify the patient correctly
2 Check the physician’s order for
transfusion.
3 Check with the patient (and the
chart) for any history of any
reactions to previous blood
transfusions.
4 Take consent for blood
42
transfusion/blood products.
5 Obtain the blood product from
blood bank just before
transfusion.
6 Check the patients’ blood group
and Rh type and ensure
compatibility with the available
blood product. Ensure that the
details on the blood product to be
transfused concur with the
patient’s. Check specifically for
the expiry date. Document these.
7 Perform hand hygiene and wear
gloves.
8 Ensure a patent IV cannula (18
or 20 Gauge is inserted). Check
IV site for any evidence of
phlebitis
10 Check vitals prior to starting the
transfusion and record it in the
patient’s chart.
11 Start transfusion slowly (25 ml in
first 15 minutes in a graded
fashion) and stay with patient for
first 15 minutes. Recheck vitals
and assess for any signs of
transfusion reaction. Infuse
remainder of transfusion as per
orders on chart (over no more
than 4 hours).
12 If transfusion reaction is
suspected, stop the transfusion
immediately. Check vitals and
call for help.
Rating
43
Date of completion:
Feedback received:
13) Arterial blood gas IM 3.8

1. Identify the patient
2. Explain the procedure
3. Assess the adequacy of collateral circulation
44
4. Heparinize 2 cc syringe
5. Perform hand hygiene and wear gloves
6. Extend the wrist and identify the radial arterial

pulse.
7. Clean the site with alcohol swab and allow it to
dry.
8. Insert 23 G needle at 45 degree angle distal to
palpating finger. Stop advancing as soon as
blood spurts into the syringe
9. Draw 2 cc of arterial blood
10. Ensure that there are no air bubbles
11. Apply pressure over the site
12. Send the sample for analysis without delay
13. Discard the waste appropriately.
14. Document the procedure.
Rating
14) Male urethral catheterization

1. Identify the patient. Discuss procedure with the
patient and assess the patient’s ability to assist
with the procedure. Discuss any allergies with
the patient, especially to iodine and latex.
45
Review chart for any limitations in physical
activity.
2. Bring the catheter kit and other necessary
equipment to bedside. Obtain assistance from
another staff member, if necessary. Perform hand
hygiene. Put on disposable gloves.
3. Ensure privacy of the patient.
4. Ensure good lighting. Raise the bed to a

comfortable working height. Stand on the
patient’s right side if you are right-handed or the
patient’s left side if you are left-handed.
5. Position the patient on his back with thighs
slightly apart. Drape the patient so that only the
area around the penis is exposed. Slide
waterproof pad under the patient.
6. Put on clean gloves. Clean the genital area with
washcloth, skin cleanser, and warm water. Clean
the tip of the penis first, moving the washcloth in
a circular motion from the meatus outward.
Wash the shaft of the penis using downward
strokes toward the pubic area. Rinse and dry.
Remove gloves. Perform hand hygiene again.
7. Prepare urine drainage setup if a separate urine
collection system is to be used. Secure to bed
frame according to manufacturer’s directions.
8. Open sterile catheterization tray on a clean over
bed table using sterile technique.
9. Put on sterile gloves. Open sterile drape and
place on patient’s thighs. Place fenestrated drape
with opening over penis.
10. Place the catheter set next to the patient’s legs
on a sterile drape.
11. Open all the supplies. Test the catheter balloon
by removing protective cap on tip of syringe and
attaching syringe prefilled with sterile water to
injection port. Inject appropriate amount of fluid.
If balloon inflates properly, withdraw fluid and
leave syringe attached to port.
12. Fluff cotton balls in tray before pouring
antiseptic solution over them. Alternately, open
package of antiseptic swabs. Open specimen
container if specimen is to be obtained.
13. With your uncontaminated, dominant hand, place
drainage end of catheter in receptacle. If the
catheter is pre-attached to sterile tubing and
drainage container (closed drainage system),
position catheter and setup within easy reach on
sterile field. Ensure that the clamp on the
46
drainage bag is closed.
14. Remove cap from syringe prefilled with
lubricant.
15. Lift penis with non dominant hand. Retract
foreskin in uncircumcised patient. Be prepared to
keep this hand in this position until catheter is
inserted and urine is flowing well and
continuously. Using your dominant hand and the
forceps, pick up a cotton ball. Using a circular
motion, clean the penis, moving from the meatus
down the glans of the penis. Repeat this
cleansing motion two more times, using a new
cotton ball each time. Discard each cotton ball
after one use.
16. Hold the penis with slight upward tension and
perpendicular to the patient’s body. Use your
dominant hand to pick up the lubricant syringe.
Gently insert tip of syringe with lubricant into
urethra and instil the 10 ml of lubricant.
17. Use your dominant hand to pick up the catheter
and hold it an inch or two from the tip. Ask the
patient to bear down as if voiding. Insert catheter
tip into meatus. Ask the patient to take deep
breaths as you advance the catheter to the
bifurcation or Y level of the ports. Do not use
force to introduce catheter. If catheter resists
entry, ask the patient to breathe deeply and rotate
catheter slightly.
18. Hold the catheter securely at the meatus with
your non dominant hand. Use your dominant
hand to inflate the catheter balloon. Inject entire
volume supplied in prefilled syringe. Once
balloon is inflated, catheter may be gently pulled
back into place. Replace foreskin over catheter.
Lower penis.
19. Attach the catheter to the drainage system if
necessary.
20. Remove equipment and dispose of according to
facility policy. Wash and dry the perineal area as
needed.
21. Remove gloves. Secure catheter tubing to the
patient’s inner thigh or lower abdomen (with the
penis directed toward the patient’s chest) with
tape. Leave some slack in catheter for leg
movement.
22. Assist the patient to a comfortable position.
Cover the patient with bed linens. Place the bed
in the lowest position.
47
23. Secure drainage bag below the level of the
bladder. Check that drainage tubing is not kinked
and that movement of side rails does not interfere
with catheter or drainage bag.
24. Put on clean gloves. Obtain urine specimen
immediately, if needed, from drainage bag.
Cover and label specimen. Send urine specimen
to the laboratory promptly or refrigerate it.
25. Document the procedure. The amount and colour
of the urine that was drained has to be
mentioned.
Rating
48
Posting 1
Duration 4 weeks
Date of posting From
To
Unit : Name of Mentor
Signature of the faculty: Date:
49
IV) List of clinical cases presented or case discussions participated in - Posting 1
Diagnosis System
10
50
Posting 2
Duration 4 weeks
To
51
V) List of clinical cases presented or case discussions participated in - Posting 2
Diagnosis System
10
52
Posting 3
Duration 8 weeks
To
53
VI) List of clinical cases presented or case discussions participated in - Posting 3
Diagnosis System
10
11
12
13
14
15
16
17
18
19
20
54
Posting 4
Duration 4 weeks
To
Unit : Name of Mentor:
55
VII) List of clinical cases presented or case discussions participated in - Posting 4
Diagnosis System
10
56
VIII) List of SGDs/ TUTORIALS
1 Basic life support IM2.22
2 HTN management (Primary IM8.15,IM8.16,

and secondary)
IM8.18,IM8.19,
Hypertensive emergency
management
3 Anemia IM 9.9, IM9.13,
IM 9.15, IM9.16, IM9.20
4 Chronic liver disease IM5.12,IM5.17, IM 5.14
5 Ascitic tap and interpretation IM5.15

of peritoneal fluid analysis.
6 Thyroid disorders IM 12.9, IM 12.10, IM 12.11, IM

12.14,
7 Autoimmune diseases session IM7.15

1
8 Autoimmune diseases session IM7.18,IM7.20,IM7.21,IM7.22

2 (RA and crystal
arthropathies ) IM7.24,IM7.25,IM7.26
9 CSF analysis and interpretation IM17.9,
10 Headache IM17.5, IM 17.6, IM17.14,
IM 17.2
57
58
List of SGD (contd)
11 Diarrhea IM16.8
12 Gastro intestinal disorders: IM15.9
13 Snake bite and envenomation IM.20.2,IM.20.4,IM.20.5,20.6
14 Heart failure IM 1.17, IM 1.23 ,IM1.26,IM 1.20,
15 Acute coronary syndromes IM2.11,IM2.12 ,IM2.24
16 HIV session 1 IM 6.19, IM 6.20,
17 HIV session 2 IM 6.21, IM 6.22, IM 6.23
18 Fever : Haematological IM 4.12, IM 4.16, IM 4.18

malignancy
19 Fever : Disseminated TB IM 4.12, IM 4.16, IM 4.18
20 Pyrexia of unknown origin IM25.7, IM25.11, IM4.24,
21 Diabetes mellitus : session 1 IM 11.11, IM 11.19, IM 11.20, IM

II.21
59
List of SGD(contd)
22 Diabetes mellitus : IM 11.14, IM 11.15,

complications : session 2
23 Cerebrovascular accident IM18.17,IM18.10,
24 Pneumonia 1 IM3.11, IM3.12, IM3.13, IM3.18
25 Pneumonia 2 IM3.7, IM3.9
26 AKI/ Chronic kidney IM10.17, IM10.18, IM10.23,

disease IM10.29, IM10.30, IM10.31
27 Tropical fever IM25.7, IM25.8, IM25.10, IM25.11
28 Malaria IM 4.23, IM4.24,IM4.25,IM 4.26
29 Haematemesis and IM15.17;IM15.18, IM15.4

haematochezia
30 Poisoning IM24.16, IM 24.20, IM 24.21
31 ECG IM1.18, IM2.10 IM12.,IM 12.10,

IM8.17
32 ABG IM 10.20
60
IX) AETCOM MODULES
Module number: 4.1 Date:
Name of the activity: The Foundations of Communication
The student should be able to : Level

1. Demonstrate ability to communicate to patients in a patient, respectful, SH
non threatening, non judgemental and empathetic manner.
2. Communicate diagnostic and therapeutic options to patient and family in a SH
simulated environment.
Reflection
Feedback
Assessment: Signature of the faculty

Name of the activity: Medico-legal and ethical conflicts in organ transplantation

1. Identify and discuss medico-legal, socio-economic and ethical issues KH
pertaining to organ donation.
Reflection
Feedback
62
Name of the activity: Ethics, Empathy and Doctor patient relationship
Department of Internal Medicine

1. Demonstrate empathy in patient encounters. SH
2. Demonstrate empathy to patient and family with a terminal illness in a SH
Reflection
Feedback
63
Name of the activity: Dealing with death

1. Identify conflicts of interest in patient care and professional relationships SH
and describe the correct response to these conflicts.
2. Demonstrate empathy to patient and family with a terminal illness in a SH
Reflection
Feedback
64
Name of the activity: Medical Negligence

1. Identify, discuss and defend medico-legal, socio-cultural, professional and KH
ethical issues pertaining to medical negligence.
2. Identify, discuss and defend medico-legal, socio-cultural, professional and KH
ethical issues pertaining to malpractice.
Reflection
Feedback
65
X) Integrated sessions
Date of Topics covered Competency Departments Signature Signature

session numbers involved in the of the of the
addressed conduct of the student faculty
session
1
66
XI) Self-directed learning sessions:
Sl.No. Date Topic Competency number Signature of

theFaculty
10
67
XII) Seminars presented
Sl no Name of the topic Date Signature of the

faculty
68
XIII) Research projects and publications
Name of the topic Date Signature of the faculty
69
XIV) Co-curricular activities –(quiz, poster, debates, essays, skit)
Name of the topic Date Signature of the

faculty
10
70
XV) Participation in CME, conference, and workshops.

faculty
10
XVI) Awards and recognition
71
faculty
72

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

DEPARTMENT OF INTERNAL MEDICINE

University Registration Number

This is to certify that the candidate Mr /Ms......................................................................................,

Reg. No. ………………., admitted in the year………….…….. in

Internal Medicine during the period from ..……………. to……………..

Name and Designation

Professional Year Number Number Percentage of Signature of HOD

Professional Year Number Number Percentage of Signature of HOD

Professional Unit Number Number Percentage Signature Signature

Posting 1 Posting 2 Posting 3 Posting 4

Total marks obtained on a total of 200 is -----

Final remarks if any -

1 IM,IV,SC injection IM 1.30

2 Basic Life Support IM 2.22

3 Performing and analyzing IM 1.18

4 Performing Lumbar IM 6.15

5 Central Venous Catheter IM 10.22

6 Performing Ascitic tap IM 5.15

7 Performing Pleural tap IM 3.9

8 Bone marrow Biopsy IM 4.17

9 O2 delivery devices IM 3.17

10 Inhalation devices with CT 2.16

12 Blood Transfusion IM 9.19

1) SUBCUTANEOUS INJECTIONS- IM 11.19

S.NO STEPS COMMENTS

Signature of the student:

Signature of the faculty:

INTRAMUSCULAR INJECTIONS - IM 1.30

S.NO STEPS COMMENTS IF

36 Dispose of your clinical equipment into an appropriate

Signature of the student:

Signature of the faculty:

ACCESS A VEIN FOR IV ADMINISTRATION

S.NO STEPS COMMENTS IF

Signature of the student:

Signature of the faculty:

2) Basic Life support IM 2.22

S.NO STEPS COMMENTS IF

Date of completion: Feedback received:

3) Perform an ECG IM 1.18

4. Maintain the privacy of the patient

5. Demonstrate proper preparation of skin prior to

10. Enter the patient details manually (If digital

Date of completion : Feedback received:

Signature of the student : Signature of the faculty:

Checklist for reporting an ECG

4) Lumbar puncture IM 6.15, IM17.8

2. Ensure that there are no contraindications

3. Obtain written informed consent stating the

5. Wear head cap, eye goggles and mask.

6. Wash hand with betadine and dry the hands with

7. Instruct the assistant to position the patient in

10. Administer local anesthesia. Wait for sufficient

Signature of the student:

Signature of the faculty:

5) CVC insertion- IM10.22

2 Patient is educated about the need for a

3. Obtain Written Consent

4 Identification and Marking of Site of