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  • Case-Based Discussion (CBD) Evaluation Form: Departemen Pulmonologi Dan Kedokteran Respirasi

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    Regi Sonjaya
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    1. This document is an evaluation form used to assess a resident's performance in a case-based discussion (CbD) conducted by the Pulmonology and Respiratory Medicine Department at a hospital in Banjarmasin, Indonesia. 2. The form collects information about the clinical case discussed such as the patient's data, complexity, location, clinical problem, and focus of the discussion. 3. The resident is graded on a scale from 1 to 4 in areas like medical record keeping, clinical assessment, investigations and referrals, treatment, follow-up and planning, professionalism, and overall clinical judgment. Feedback is also provided.

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    FORM CBD (1)

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    1. This document is an evaluation form used to assess a resident's performance in a case-based discussion (CbD) conducted by the Pulmonology and Respiratory Medicine Department at a hospital in Banjarmasin, Indonesia. 2. The form collects information about the clinical case discussed such as the patient's data, complexity, location, clinical problem, and focus of the discussion. 3. The resident is graded on a scale from 1 to 4 in areas like medical record keeping, clinical assessment, investigations and referrals, treatment, follow-up and planning, professionalism, and overall clinical judgment. Feedback is also provided.

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    © All Rights Reserved
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    16 views2 pages

    Case-Based Discussion (CBD) Evaluation Form: Departemen Pulmonologi Dan Kedokteran Respirasi

    Uploaded by

    Regi Sonjaya
    1. This document is an evaluation form used to assess a resident's performance in a case-based discussion (CbD) conducted by the Pulmonology and Respiratory Medicine Department at a hospital in Banjarmasin, Indonesia. 2. The form collects information about the clinical case discussed such as the patient's data, complexity, location, clinical problem, and focus of the discussion. 3. The resident is graded on a scale from 1 to 4 in areas like medical record keeping, clinical assessment, investigations and referrals, treatment, follow-up and planning, professionalism, and overall clinical judgment. Feedback is also provided.

    Copyright:

    © All Rights Reserved
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    of 2

    DEPARTEMEN PULMONOLOGI DAN KEDOKTERAN RESPIRASI

    Fakultas Kedokteran ULM - RSUD Ulin Banjarmasin


    Sekretariat: Jl. A Yani km 2,5 RSUD Ulin Gedung KSM Lantai 5 Pulmonologi
    Email: ppdspulmonologifkulm@gmail.com

    Case-based Discussion (CbD) Evaluation Form

    Evaluator :………………………… Date : …………………………


    Resident : ………………………… Clinical problems : …………………………
    Semester : …………………………

    Patient’s Data : New patient Follow Up

    Complexity : Low Moderate High


    Of Case
    Place : Policlinic Ward Emergency Room

    Clinical : Pulmonary Disease Radiology Findings


    Problem
    Category Pulmonary Emergency & Invasive - Diagnostic

    Focus : Data Gathering Diagnosis Therapy Radiology Findings

    Counseling

    Please grade the following areas :


    1. Medical record keeping
    Below Expectation Borderline Meet Expectation Above Expectation Not Observed
    1 2 3 4

    2. Clinical assessment
    Below Expectation Borderline Meet Expectation Above Expectation Not Observed
    1 2 3 4

    3. Investigation and referrals


    Below Expectation Borderline Meet Expectation Above Expectation Not Observed
    1 2 3 4

    4. Treatment
    Below Expectation Borderline Meet Expectation Above Expectation Not Observed
    1 2 3 4
    DEPARTEMEN PULMONOLOGI DAN KEDOKTERAN RESPIRASI
    Fakultas Kedokteran ULM - RSUD Ulin Banjarmasin
    Sekretariat: Jl. A Yani km 2,5 RSUD Ulin Gedung KSM Lantai 5 Pulmonologi
    Email: ppdspulmonologifkulm@gmail.com

    5. Followup and future planning


    Below Expectation Borderline Meet Expectation Above Expectation Not Observed
    1 2 3 4

    6. Professionalism
    Below Expectation Borderline Meet Expectation Above Expectation Not Observed
    1 2 3 4

    7. Overall clinical judgment


    Below Expectation Borderline Meet Expectation Above Expectation Not Observed
    1 2 3 4

    TOTAL

    Total x 100
    Final Score= =… … … … … …
    28

    Agree action :
    Not at all Highly
    Resident satisfaction with CbD 1 2 3 4 5 6 7 8 9 10
    Assesor satisfaction with CbD 1 2 3 4 5 6 7 8 9 10

    Feedback:
    …….………………………………………………………………………………………………..
    ….…………………………………………………………………………………………………..
    Take home message :
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………

    Signature
    Evaluator Resident

    ( ) ( )

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