FATIMA JINNAH MEDICAL UNIVERSITY SIR GANGA RAM HOSPITAL, LAHORE a ae Puy 3 MEDICAL UNIT-' iA Prof. Dr. Bilquis Shabbir FJMU rea ome HEAD OF DEPARTMENT 9-22 Date: 98 “2 Wee Associate Professor Dr. Tahir Bashir LETTER OF RECOMMENDATION AND INTERNAL MEDICINE MBBS, MCPS, FCPS. | STRUCTURED EVALUATION LETTER FOR RESIDENCY PROGRAM It gives me great pleasure to write these lines about Miss Bireera Muzaffar d/o Muzaffar Ahmad Khokhar whom | know as a medical student of MBBS during her clinical clerkship at Fatima Jinnah Medical University, Lahore. Fatima Jinnah Medical University, Lahore is the premier institute of Medical Education in Pakistan and also 1 Women Medical University in Asia. We especially boast one of the largest Internal Medicine Departments in the country comprising outpatient, inpatient, and emergency and critical care settings as regards the number Assistant Professor Dr. Shazia Siddique MBBS, MRCP Senior Registrar Dr. Zia-ul-Haq MBPE KCTS of patients dealt with each year giving him good clinical exposure to a variety of Registrars: clinical cases. Dr. Anam Khan Some of the salient features of her performance are described here. A detailed MBBS evaluation is given in the following pages. Dr, Syed Ali Raza | ¢ She secured Honors inthe Intemal Medicine Objective Stactured Cinieal Evaluation MBBS Examination at the end of her clerkship, ‘© She secured Honors in the written part of the Internal Medicine Examination at the end of her clerkship. © She was adept at taking history performing a general physical and systemic ‘examination, and formulating treatment plans including further diagnostic tests for the patients in multiple settings. © She worked as a team player with residents, nurses, social workers and pharmacists ‘under my supervision to provide the best care for his patients. She was always proactive and steadfast in every task that I ever assigned her. ‘© She was the elected batch representative during her rotation with our department duc to his excellent communication and leadership skills. ‘© She used her communication skills o provide the best care for her patients and delivered presentations on multiple topics, especially cardiovascular diseases. ‘© She possesses a strong moral character. She executed her duties with honesty. She was punctval and went along well with her juniors and seniors. Prof. Dr. Biiquis Shabbir MBBS, MCPS, FCPS (Medicine) Consuitan: Medical Specialist Professor of Medicine ; = Head of Department of Medicine Fatima Jinnah Sir Ganga Ram Hospital, Lahore, Pakistan Ema: sbumelvabunconInternal Medicine Structured Evaluation Letter for Residency Program ireera Muzaffar AAMC ID: 15851917 Institution: Fatima Jinnah Medical University, Lahore Primary Evaluator Name: Prof. Dr. Bilquis Shabbir MBBS, FCPS, Chairperson & Head of Department of Medicine, Fatima Jinnah Medical University/ Sir Ganga Ram Hospital, Lahore, Pakistan Secondary Evaluator Name(s): Prof. Dr. Bilal Azeem MBBS, FCPS; Assistant professor Department of Medicine, Fatima Jinnah Medical University/ Sir Ganga Ram Hospital, Lahore, Pakistan Primary evaluator contact information: medicine! @fjmu.edu.pk A. Primary Evaluator Information 1. How long have you known the applicant? Three Years (3 Year, 4" Year & 5 Year) 2. Nature of contact with applicant: (Check all that apply) v Residency Advisor ¥ Direct observation of patient care Direct observation in extramural settings (e.,, learning communiti ¥ Direct observation during didactics, small groups, simulations ¥ Indirect through others / evaluations Other: 8. Evaluation Details 1. Student evaluations included in this letter are from these settings: (check all that apply) Inpatient ¥ Outpatient ¥ Critical Care Unit Classroom Other: ER, Skill Lab, Procedure Room 2. Student evaluations included inthis ler were obtained from these observers: (check al hat apply) ~ Faculty v Residents: Interprofessional team members (nurses, advanced practice practitioners, therapists, etc.) © Patients Other : Peers ©. Core Medicine Clerkship and Cardiology Clerkship 1. Duration: Six months 2. Settings: ‘The Internal Medicine Core Clerkship for Bireera Muzaffar comprised of a 06- ‘week rotation in the 3" year, another 4-week rotation in the 4" year and finally a 12-week rotation in the Final Year of medical school at the University-affiiated Sir Ganga Ram 1|Page4 & Hospital. She also rotated in Cardiology for 02 weeks in the 4* year of medical school. Sir Ganga Ram Hospital is a large tertiary care teaching hospital in Pakistan. It provides @ learning environment, patient exposure and clinical skills practice in multiple settings including inpatient, outpatient (including rheumatology, dietetic and endocrine clinics), ical care and emergency departments Student roles and responsibilities: During her rotation in our department, Bireera ‘Muzaffar was assigned duties in different settings in the Internal Medicine and Cardiology ‘ward, she was responsible for taking care of 23 patients daily, She would take the history, perform the physical examination, document patient progress notes and vitals in the files, devise her plan for the patient and then discuss it with the residents. She was exceptional in communicating the plan for patient management to the incoming team after her duty was over. She was responsible for presenting cases in the morning rounds. In the outdoors, she ‘would present her plan of management to the consultants after a thorough evaluation. She ‘would then suggest appropriate investigations and prescribe treatment forthe patients. She used to attend 12 hourly calls twice per week where she worked in the emergency department and intensive care unit with the consultants. There she was responsible for monitoring, documenting patient vital sings, and passing Foley eatheters and NG tubes. Student’s Grades for the rotation: (include a chart with final grade/percentage and separate components) Final Grade / Percentage a 7% Clinical Grade/OSCE Grade Percentage 80% Remarks Honors Grading Policies: + The clinical exam comprises 45% of the grading criteria, and includes long cass, short eases and OSCE (Objective Structured Clinical evaluation) and judges the student on professionalism, case presentations, history taking and clinical examination, +The written exam comprises 45% of the grading criteria which includes problem-based questions and MCQs. ‘© Internal assessment comprises 10% of the grading criteria and includes the student's performance throughout his academic year including punetuality and attendance, ‘© Cate-off for Distinction or Honors is 70 % Bireera Muzaffar secured 74.34%, hence met the criteria of Honors) 2|Page7. Performance Description: Bireera Muzaffar was scrupulous during her Intemal Medicine clerkship. She had a strong grip on the pathophysiological mechanism of diseases as depicted by her good academic record. Therefore she performed spectacular in the written examination. Due to these months of clinical experience in our ward, she was able to secure Honors in Internal Medicine, especially in the OSCE part of the Examination, She was the elected batch representative during her rotation with our department, She worked as a team player and gained the trust of everyone including her fellow students, doctors, nurses ete, COVID-Specitfic Details (If applicable): ‘The core clerkship of medicine of this student was not affected by COVID-19 Qualifications for IM: Utilizes ACGME Internal Medicine Milestone 2.0 sub- ‘competencies for assessment descriptions 8 Patient Care (Adapted from Milestones 2.0 PC 1,2, 3,4, 5) Select the highest level the learner most consistently reached in each of the settings(s). Remove any setting notapplicable to this student. a. Outpatient setting j) Low complexity patients with common acute or chronic com © Leamer accurately recited observations. © Inclusive of above; learner reported a hypothesis-driven history and physical and provided anappropriately prioritized differential diagnosis. @Inclusive of above and leamer developed appropriate treatment plans (including further diagnostiestudies and recognition of need for additional guidance in patient care). High complexity patients with multiple chronic conditions or urgentlemergency conditions in the settingof ehronic comorbid © Leamer accurately recited observations. © Inclusive of above; learner reported a hypothesis-driven history and physical and provided anappropriately prioritized differential diagnosis. © Inclusive of above and learner developed appropriate treatment plans (including further diagnostiestudies and recognition of need for additional guidance in patient care), tions: b. Ward setting i) Low complexity patients with a common or single complaint: © Leamer accurately recited observations. © Inclusive of above; learner reported a hypothesis-driven history and physical and provided anappropriately prioritized differential diagnosis. @ Inclusive of above and learner developed appropriate treatment plans (including further diagnostic studies and recognition of additional guidance needed in patient care) ii) High complexity patients with multisystem disease and comorbid conditions: © Leamer accurately recited observations, © Inclusive of above; learner reported a hypothesis-driven history and physical and provided anappropriately prioritized differential diagnosis @ Inclusive of above and leamer developed appropriate treatment plans (including further diagnostic studies and recognition of need for additional guidance in patient care). C. Critical care setting i) Patients with critical care needs: (© Leamer accurately recited observations, (© Inclusive of above; learner reported a hypothesis-driven history and physical and 3|Pageprovided an appropriately prioritized differential diagn @ Inclusive of above and learner developed appropriate treatment plans (including, further diagnosticstudies and recognition of need for additional guidance in patient care). 2. Teamwork/Ac i ‘a. How often did the learner perform patient care responsibilities requested by the team? (Milestones 2.0 PROF 3—Level 1) © Always without prompting © Usually without prompting. (© Sometimes without prompting © Rarely without prompting ONot assessed b. How often did the learner perform administrative tasks in a timely manner? (Milestones 2.0 PROF 3 ~ Level 2) (© Always without prompting @Usually without prompting Sometimes _ without prompting ORarely without prompting © Not assessed 3. Communication ‘a. How often did the learner use language and non-verbal behavior to establish, rapport and ensure patientand caregiver comfort? (Adapted from Milestones 201CS 1 Level 1) @ Always OUsually OSom: imes © Rarely © Not assessed b. How often did the learner use language and non-verbal behavior to effectively ‘communicate ailments andtreatment plans to patients and caregivers? @ Always OUsually Sometimes © Rarely © Not assessed c. How often did the learner use verbal and non-verbal communication that values all members of thehealtheare team? (Adapted from Milestones 2.0 1CS2-Level 1) @ Always OUsually Sometimes © Rarely © Not assessed d, How often did the learner engage in shared decision making with consideration of patient values and psychosocial determinants? (Adapted from Milestones 2.0 SBP3 ~ Level !) @ Always — OUsually Sometimes © Rarely Not assessed 9. Commitment to personal growth ‘a. How often did the learner demonstrate openness to performance data (feedback and other input) to inform personal and professional goals? (Adapted from Milestones 2.0 PBL 2 - Level 2) @ Always OUsually Sometimes _© Rarely O Not assessed b. How often did the learner accept responsibility for personal and professional development by establishing goals and identifying gaps between ideal and actual performance? (Milestones 2.0 PBLI2~Level !) @ Always OUsually Sometimes __O Rarely © Not assessed 4|PageWritten Comment Bireera Muzaflar is an exemplary candidate for residency, as is established by her remarkable record as a student. She embodies all the fine qualities needed to be a distinguished physician. Bireera has consistently remained amongst the top of her class during the clinical rotations and has always persevered in tasks she found difficult. In team settings, Bireera takes the requirements of the leader. She is fully invested in taking care of her patients, prioritizing their wellbeing and comfort above all else. Bircera is empathetic, respectful, honest, hardworking, focused, and skillful at taking histories, performing physical exams, writing notes, and formulating treatment plans. (Our evaluators have commented on Bireera asa vital and unrivaled component of any team she is a part of. We have the strong belief that Ms. Bireera Muzaffar will prosper and be a strength to your residency program. APPENDICES APPENDIX A. This letter of evaluation was prepared upon request of the student in support of an application to your residency program. The student has waived their right to review this letter. The letter was written in accordance with the revised 2021- AAIM Guidelines for the Department of Medicine Structured Evaluative Letter, composed by the student's primary evaluator. The content of this letter is derived from clinical evaluations and comments from faculty from the student's internal medicine rotations, his performance on theory and OSCE examinations, and personal interactions with and assessment of this student. Prof. DreBilquis Shabbir MBBS, MCPS, FCPS (Medicine) Consultant Medical Specialist Professor of Medicine Head of Department of Medicine Sir Ganga Ram Hospital, Lahore, Pakistan Cr Fatima Jinnah Me S|Page