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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
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
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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
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
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
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/-