DEPARTMENT OF INTERNAL MEDICINE eye FATIMA JINNAH MEDICAL COLLEGE SIR GANGA RAM HOSPITAL = LETTER OF RECOMMENDATION AND INTERNAL MEDICINE STRUCTURED EVALUATION LETTER FOR RESIDENCY PROGRAM It gives me great pleasure to write these lines about Miss Rabia Zameer d/o Zameer Ahmad whom | know as a medical student of MBBS during her clinical clerkship at Fatima Jinnah Medical College, Lahore. Fatima Jinnah Medical College, Lahore is the premier institute of Medical Education in Pakistan and also 1* Female Women Medical College 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 of patients dealt with each year giving him good clinical exposure to a variety of clinical cases, Some of the salient features of her performance are described here. A detailed evaluation is given in the following pages. * She secured High Pass in the Internal Medicine Objective Structured Clinical Evaluation Examination at the end of her clerkship, ‘© She secured High Pass 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 due to his, excellent communication and leadership skills. She used her communication skills to provide the best care for her patients and delivered presentations on multiple topies, especially cardiovascular diseases. «She possesses a strong moral character. She executed her duties with honesty. She was punctual and never late to come to the ward. Si Aoenis i Prof. Dr. Saleema Quisra MBBS, FCPS (Medicine) Professor of Medicine Fatima Jinnah Med! Fatima Jinnah Medical College, Lahore, Pakistan Sie Ganga Ram Hospital, Lahore, Pakistan Email: info@fimuedu.pk (/y- (versity, Lahore (4 OnInternal Medicine Structured Evaluation Letter for Residency Program Applicant Name: Rabia Zameer AAMC ID: 16020320 Institution: Fatima Tinnah Medical University, Lahore Primary Evaluator Name: Prof. Dr. Saleema Qaisra, Professor of Internal Medicine Department, Fatima Jinnah Medical College/ Sir Ganga Ram Hospital, Lahore Secondary Evaluator Name(s): Prof. Dr. Muhammad Nadeem, Dean of Medicine, Fatima Jinnah Medical University/Sir Ganga ram Hospital, Lahore Primary evaluator contact information: info@fjmu.cdu.pk A. Primary Evaluator Information 1. How long have you known the applicant? Three Years (3° Year, Year & 5 Year) 2. Nature of contact with applicant: (Check all that apply) v Residency Advisor ¥ Direct observation of patient eare Direct observation in extramural settings (e.g, learning communities, informal groups) 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 v Other: ER, Skill Lab, Procedure Room 2. Student evaluations included in this letter were obtained from these observers: (check all that apply) v Faculty v Residents © Imerprofessional team members (nurses advanced practice practitioners, therapists, tc.) ~ Patients Y Other : Peers Core Medicine Clerkship and Cardiology Clerkship. 1. Duration: Six months 2. Settings: ‘The Intemal Medicine Core Clerkship for Rabia Zameer 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-affiliated Sir Ganga Ram 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 a learning environment, patient exposure and clinical skills practice in multiple settings including inpatient, outpatient (including rheumatology, dietetic and endocrine clinies), critical care and emergency departments. 1] Page3. Student roles and respons During her rotation in our department, Rabia Zameer ‘was assigned duties in different settings in the Internal Medicine and Cardiology ward, she ‘was responsible for taking care of 2-3 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 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 @ thorough evaluation. She ‘would then suggest appropriate investigations and prescribe treatment for the 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. 4 Student’s Grades for the rotation: (include a chart with final grade/percentage and separate components) Final Grade / Percentage 64.33% Clinical Grade/OSCE Grade Percentage 90% Remarks High Pass 5S. Grading Poli + The clinical exam comprises 45% ofthe grading criteria, and includes long cases, short cases and OSCE (Objective Structured Clinical evaluation) and judges the student on professionalism, case presentations, history taking and clinica examination +The writen exam comprises 45% of the grading erteia which includes problem-based auestions and MCQs + Intemal assessment comprises 10% of the grading criteria and includes the student’s performance throughout his academie yea including punctuality and attendance. + Cute-off for Distinetion or Honors is 70 % (Rabia Zameer secured 64.33%, hence met the criteria of Honors) i nl 6 Grade Distributior 2|Page7. Performance Description: Rabia Zamecr was scrupulous during her Internal 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 High Pass 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-Specific 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 ny setting notapplicable to this student. 2, Outpatient setting i) Low complexity patients with common acute or chronic condi © Leamer accurately recited observations. © Inclusive of above; leamer reported « hypothesis-driven history and physical and provided anappropriately prioritized differential diagnosis. @lnclusive of above and learner developed appropriate treatment plans (including further diagnosticstudies and recognition of need for additional guidance in patient care). ii) High complexity patients with multiple chronic conditions or urgent/emergency conditions in the settingof chronic 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 leamer developed appropriate treatment plans (including further diagnosticstudies and recognition of need for additional guidance in patient care), b. Ward setting i) Low complexity patients with a common or single comp! © Leamer accurately recited observations. © Inclusive of above; leamer 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). fi) 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 eare iii) Patients with © Learner accurately recited observations. © Inclusive of above; leamer reported a hypothesis-driven history and physical and 3[Pageprovided an appropriately 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). 2. Teamwork/Accountabi ‘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 OSometimes without prompting ORarely without prompting © Not assessed 3. Communication ‘2. How often did the learner use language and non-verbal behavior to establish rapport and ensure patientand caregiver comfort? (Adapted from Milestones 2.0 ICS 1 ~Level 1) @ Always OUsually Sometimes _O Rarely © Not assessed How often did the learner use language and non-verbal behavior to effectively communicate ailments andtreatment plans to patients and caregive @ Always OUsually Sometimes © Rarely © Not assessed c. How often did the learner use verbal and non-verbal communication that values all members of thehealthcare team? (Adapted from Milestones 2.01CS2- Level 1) @ Always OUsually Sometimes © Rarely © Not assessed d, How often did the learner engage in shared decision making with consideration of patient values andpsychosocial determinants? (Adapted from Milestones 2.0 SBP3 ~Level 1) @ Always OUsually Sometimes _O Rarely © Not assessed 9. Commi :ment to personal growth How often did the learner demonstrate openness to performance data (feedback and other input) to inform personal and professional goals? (Adapted from lestones 2.0 PBLI 2 -Level 2) © Always OUsually OSometimes © Rarely © 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 PBLI 2 ~Level |) @ Always OUsually Sometimes © Rarely © Not assessed 4|PageWritten Comments: Rabia Zameer 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. Rabia 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, Rabia takes the requirements of the leader. She is fully invested in taking care of her patients, prioritizing their wellbeing and comfort above all else. Rabia 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 Rabia as a vital and unrivaled component of any team she is a part of. We have the strong belief that Rabia Zamecr will prosper and be a strength to your residency program. APPENDICI APPENDIX A. ‘This letter of evaluation was prepared upon request of the student in support of an application to ‘your resideney program. The student has waived their right to review this letter. The letter was the revised 2021- AAIM Guideli Structured Evaluative Letter, composed by the student's primary evaluator. The content of this, ‘written in accordance +s for the Department of Medicine 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, tlre Sib Prof. Dr. Saleema Qaisra Profesor of Medicine - Fatima Jinnah Medical College, Lahore, Pakistan Registrar Sir Ganga Ram Hospi Lore, Pakistan pal aren Ema infg@fimeduk & a Fema Jinnah Medic! Univepty, Lahore S|Page plan