CONFIDENTIAL

COLLEGE OF
PHYSICIANS AND FCPS PART-II EXAMINATION
SURGEONS OF
PAKISTAN APRIL 2021

ASSESSMENT FORM FOR SHORT CASE

SUBJECT: CANDIDATE’S ROLL NO: INSTRUCTIONS TO EXAMINERS:
CENTER: DATE:  Please enter your award on the
DIAGNOSIS OF THE CASE: performance against each item
SYSTEM(S) COVERED IN DISCUSSION: according to the rating scale.
 Examiners should not interrupt
 Each examiner to complete his / her own form without conferring with fellow-examiner. candidates while taking history/
 All awards must be made in ink. clinical examination of long case.
 Each examiner must mark all parts of the form.

Inadequate
Adequate
Excellent
Comments (Comments MUST be

Good

Poor
made for all ratings of Excellent and
Poor)

Time allocated 5 minutes

Interviewing & Clinical Examination Skills (30 marks)
o Professional manners.
o Performs proper & relevant clinical examination according to instructions.
o Applies correct clinical methods systematically & appropriately.

Time allocated 5 minutes

Case Presentation (70 marks)
Examiner 1 Name: Marks
o Gives correct findings. (25 marks)
o Logical interpretation & conclusion. (20 marks)
o Logical investigations & management. (25 marks)

ADDITIONAL REMARKS (if any)

SIGNATURE: ______________________________ NAME OF EXAMINER: ______________________________

(This sheet must be deposited with the examination department through the Asst. Controller / Clinical Coordinator)