DEPARTMENT OF INTERNAL MEDICINE gy FATIMA JINNAH MEDICAL COLLEGE SIR GANGA RAM HOSPITAL an 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 I 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 emale 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 toa 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 « 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 ta 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 topics, 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. I Geni® aa Prof Dr. Saleema Qaisra MBBS, FCPS (Mein) Breleeor at Motieint Fatima Jinnah imiversi Lahore Sir Ganga Ram Hospital, Lahore, Pakistan On foOhmusdunk RLInternal Medicine St ructured Evaluation Letter for Residency Program Applicant Name: Rabia Zameer AAMC ID: 16020320 Institution: Fatima Jinnah Medical University, Lahore Primary Evaluator Name: Prof. Dr. Saleema Quisra, 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, Laliore Primary evaluator contact information: in{o@{jmu.edu.pk A Primary Evaluator Information 1, How long have you known the applicant? Three Years (3" Year, 4 Yeur & S* Year) 2, Nature of contact with applicant: (Cheek all that apply) ¥ Residency Advisor © Direct observation of patient care + Direct observation in extramural settings e.g, learning communities, informal groups) ct observation during didactcs, small groups, simulations Indirect through others / evaluations Other: Evaluation Details 1. Student evaluations included in this letter are from the ¥ Inpatient ngs: (check all that apply) ¥ Outpat ¥ Cri ¥ Classroom ¥ Other: ER, Skill Lab, Procedure Room 2. Student evaluations included in this letter were obtained from these observers: (check all that apply) » Faculty v Residents Interprofessional team members (nurses, advanced practice practitioners, therapists, ec.) » Patients ¥ Other : Peers Core Medicine Clerkship and Cardiology Clerkship J. Duration: Six months 2. Settings: The Internal 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 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 and emergency departments.4. Student roles and responsibilities: During her rotation in our department, Rabia Zameer ‘was assigned duties indifferent settings in the Intemal 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 inthe 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 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 catheters and NG tubes. 4. Student’s Grades for the rotation: (include a chart with final grade/percentage and separate components) Final Grade / Percentage 633% | Clinical Grade/OSCE rade Percentage 90% Remarks High Pass 5. Grading Policies: ‘©The clinical exam comprises 45% of the 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 clinical examination ©The written exam comprises 45% of the grading criteria which includes problem-based questions and MCQs. © Infemal assessment comprises 10% of the grading criteria and includes the student's performance throughout his academic year including punctuality and attendance, © Cute-off for Distinction or Honors is 70% (Rabia Zameer secured 64.33%, hence met the criteria of Honors) ; ATL. 6 Grade Distribution: 2|Page7. Performance Description: Rabia Zameer 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 (o secure High Pass in Internal Medicine, especially in the OSCE part ofthe 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-Specifie 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 reuched in each of the settings(s). Remove any setting notapplicable to this student. a. Outpatient setting i) Low complexity patients with common a © 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 diagnosticstudies and recognition of need for additional guidance in patient care). High complexity patients with multiple chronic conditions or urgenVemergency conditions in the settingof ehronic comorbidities: © 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 diagnosticstudies and recognition of need for additional guidance in patient care) st or chronic conditions: Ward setting ‘Low complexity patients with a common or single compla © 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). b ) fi) High complexity patients with multisystem disease and comorbid conditions: © Leamer accurately recited observations. © Inclusive of above; leamer reported a hypothesis-driven history and physical and provided anappropristely 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 iil) Patients with critical eare needs: © Leamer accurately revited 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 learner developed appropriate treatment plans (including further diagnosticstudies and recognition of need for additional guidance in patient care). 2. Teamworl/ Accountability b 3 ‘a. How often did the learner use language and non-verbal behavi did the learner perform patient care ss 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 How _ often the learner perform administrative tasks in a timely manner? (Milestones 2.0 PROF 3 — Level 2) (© Always without prom prompting ‘ORarely without prompting © Not assessed Usually without prompting — OSometimes without to establish rapport and ensure patientand caregiver comfort? (Adapted from Milestones 20 ICS 1 —Level 1) @ Always OUsually OSometimes © Rarely O Not assessed How often did the learner use language and non-verbal behavior to effectively ‘communicate ailments andtreatment plans (o patients and caregivers? @ Always Usually Sometimes © Rarely O Not assessed How often did the learner use verbal and non-verbal communication that values all members of thehealthcare team? (Adapted from Milestones 2.0 ICS 2~ Level 1) @ Always Usually Sometimes _© Rarely © Not assessed 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 © Rarely O Not assessed 9. Commitment 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 Milestones 2.0 PBLI2 - Level 2) @ Always OUsually Sometimes _© Rarely © Not assessed 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 Usually OSometimes © Rarely © Not assessed, a|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 @ 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 belie that Rabia Zameer will prosper and be a strength to your residency program. APPENDICES APPENDIX A. This letter of evaluation was prepared upon request ofthe 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. bor bas 5 beet Prof. Dr. Saleema Qaisra Professor of Medicine Fatima Jinnah Medical College, Lahore, Pakistan Sir Ganga Ram Hospital, Lahore, Pakistan Email: info@Himmeduok i, Registrar [| —$ma Jinnah Medice! University, Lahore S|Page plier?