LOGBOOK

Outgoing Student Elective Programme

Faculty of Medicine, Public Health, and Nursing

..
Universitas Gadjah Mada

rStudent Name ••

Student N umber ••

Host University ••

Department 1 ••

D ate (
Department 2
)
••

D ate (
Supervising D octor 1 :
)

Supervising D octor 2 :

..Expertise

..
••

----------------------------
Note:
Please fill in this logbook during your elective programme to find and identify the benefit of the
programme academically. This logbook then must be submitted at the
Faculty of Medicine, Public Health, and Nursing UGM.

International Relations Office

Faculty of Medicine, Public Health, and Nursing - Universitas Gadjah Mada
JI. Farmako, Sekip Utara, Yogyakarta, 55281, Indonesia

http://fkkmk.ugm.ac.id/
My expectations before elective programme:

I would like to learn the following

I would like to learn the following procedures

My knowledge of the practice on this

specialty: 1 2 3 4 5
(1= very little, 5 = almost everything)
 Fill in one row each day!

Week 1
Time spent in the hospital
hours/ field visit for lecture Topic and results of discussion/Most important
Date and/ journal reading or learning experience
discussion

Supervisor’s Signature

________________________
 Fill in one row each day!

Week 2
Time spent in the hospital
hours/ field visit for lecture Topic and results of discussion/Most important
Date
and/ journal reading or learning experience
discussion

Supervisor’s Signature

________________________
 Fill in one row each day!

Week 3
Time spent in the hospital
hours/ field visit for lecture Topic and results of discussion/Most important
Date
and/ journal reading or learning experience
discussion

Supervisor’s Signature

________________________
 Fill in one row each day!

Week 4
Time spent in the hospital
hours/ field visit for lecture Topic and results of discussion/Most important
Date
and/ journal reading or learning experience
discussion

Supervisor’s Signature

________________________
My opinion about my learning after elective programme
I learned the following:

Was it enough? Yes / No

I got practical experience on:

Was it enough? Yes / No

My knowledge of the practice on this

specialty: 1 2 3 4 5
(1= very little, 5 = almost everything)

Overall, did you learn enough during your stay?

Summary
What did you gain during this elective
programme? (please write below)
Assessments from the supervising doctor:

On scale 1 to 5 (1= very little; 5 = much) how would you assess the student in the following area:

The student showed interest in the everyday work 12345

The student communicated adequately in English 12345

The student was active and asked questions 12345

The students had good theoretical knowledge of the field 12345

Question for non‐operative departments:

The students participated in rounds 12345

The student participated in meetings 12345

Questions for operative departments:

The student dressed adequately to the operating 12345
theater and was familiar with sterility regulations

The student could assist in the operations 12345

Comments from the supervising doctor:

Supervisors’ signature
Students’ signature
(Host University)

Supervisors’ signature
(Home University)