DR.

BABA SAHEB AMBEDKAR MEDICAL COLLEGE & HOSPITAL

Government of NCT of Delhi (GGSIP University)

COMPULSORY ROTATORY MEDICAL INTERNSHIP (CRMI)

LOG BOOK

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 INTERN’S DETAILS

Name___________________________________________

Father's Name____________________________________

AdmissionYear___________________________________

Internship Serial No. & Sub-batch_____________________

Phone Number____________________________________

Email id _________________________________________

Permanent Address______________________________________________________
______________________________________________________________________
______________________________________________________________________

Date of commencement of Internship_________________________________________

Provisional Registration Number____________________________________________

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 COMPULSORY ROTATORY MEDICAL INTERNSHIP (CRMI)

Internship is a phase of training wherein a graduate is expected to learn methods/modalities

for actual practice of medical and health care and acquire skills under supervision so that
he/she may become capable of functioning independently.

OBJECTIVES

(1) Diagnose clinical common disease conditions encountered in practice and make
timely decisions for referral to a higher level.
(2) Use discreetly the essential drugs, infusions, blood or its substitutes and laboratory
services.
(3) Manage all types of emergencies- Medical, Surgical, Obstetric, Neonatal and
Pediatric, by rendering first level care.
(4) Demonstrate skills in monitoring of the National Health Programme and schemes,
oriented to providing preventive and promotive health care services to the
community.
(5) Develop leadership qualities to function effectively as a leader of the health team
organized to deliver the health and family welfare service in existing socio-
economic, political and cultural environment.
(6) Render services to chronically sick and disabled (both physical and mental) and to
communicate effectively with patients and the community.

INTERNSHIP REGULATIONS

These regulations are as per National Medical Commission (Compulsory Rotatory

Medical Internship) Regulations, 2021 vide gazette notification No. UGMEB/NMC/Rules
& Regulations/2021/580 dated 18 Nov, 2021.

1. Eligibility criteria for Compulsory rotatory medical internship (CRMI)

The following requirements need to be fulfilled to be eligible for CRMI.

(a) Indian Medical Graduates

(i) The applicant should have successfully completed the MBBS course of any
University from a college or institution approved and recognized by the
Commission and listed by the Undergraduate Medical Education Board under the
provisions of section 35 of the Act.
(ii) The qualifying examination for Indian Medical Graduates shall be in accordance
with the applicable rules and regulations of the Commission at the time of
commencement of internship;
a) The Final MBBS Examination of various Universities or institutions of India;

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 b) The National Exit Test (NExT) Step-1 held under sub-section (1) of section 15
of the Act whenever this examination becomes operational;
c) Any other requirement as may be regulated or notified by the Central
Government or, as the case may be, the Commission.
(iii)All Indian Medical Graduates shall complete their entire period of compulsory
rotating internship training (CRMI) in the institution where they have pursued and
completed their Bachelor of Medicine and Bachelor of Surgery (MBBS i.e. Dr.
BSA Medical College and Hospital, Delhi.
(iv) One-year approved service in the Armed Forces Medical Services, after passing
the final MBBS examination shall be considered as equivalent to the pre-
registration training detailed above; and such training shall, as far as possible, be
at the Base or General Hospital. The training in Community Medicine should
fulfill the norms of the NMC as proposed above. However NExT step 2 will be
mandatory for these candidates also.

(b) Foreign Medical Graduates

(i) All Foreign Medical Graduates, as regulated by the National Medical Commission
(Foreign Medical Graduate Licentiate) Regulations, 2021, are required to undergo
internship at par with Indian Medical Graduates if they desire to seek Permanent
Registration to practice Medicine in India.
(i) All Foreign Medical Graduates, unless otherwise notified shall be required to
undergo CRMI at par with Indian Medical Graduates after the National Exit Test
Step-1 after NExT becomes operational.
(ii) Indian citizens (including overseas Indian citizens) who are Foreign Medical
Graduates who do not fall under the purview of the National Medical Commission
(Foreign Medical Graduate Licentiate) regulations, 2021shall be regulated by the
provisions of sub-section (3) of section 13 of the Indian Medical Council Act,
1956 (102 of 1956) in accordance with the Advisory no MCI-203(1)(Gen)/2020-
Regn./118239, dated the 2nd September, 2020 and shall be required to complete
CRMI in India if they have not undergone such practical training after obtaining
such qualification as may be required by the rules and regulations in force in the
country granting such qualification or has not undergone any practical training in
that country.
(iii)Foreign Medical Graduates who require to complete a period of Internship shall
do so only in medical colleges or institutions approved for providing CRMI to
Indian Medical Graduates;
(i) Foreign Medical Graduates may be posted first in colleges which have been newly
opened and have yet to be recognized;
(ii) May be posted to different medical colleges or institutions through a counseling or
seat allocation process based on the merit;
(iii)Medical colleges or institutions may allow up to 7.5 per cent of their permitted
quota of interns to accommodate internship by Foreign Medical Graduates.

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 (iv) The college or institution and its affiliated hospitals and Community Health
Centres shall be recognized by the Commission for conducting the CRMI
programme.

2. Temporary Registration in DMC with respect to Internship:

All the students who are eligible to start the Internship have to apply to the Delhi
Medical Council for temporary registration and submit a copy of the receipt of
the application submitted by them in Delhi Medical Council with the Academic
Registrar within 15 days of declaration of their result, failing which appropriate
action can be initiated including cancellation of their internship.
With respect to those students who pass in the supplementary examination, the above
rule will also be applicable which will be from the date of the result of the
supplementary examination.

3. General Instructions
(i) All interns must report to the respective departments on the 1st day of their
posting, even if it is a Sunday or a holiday.
(ii) Intern should bring their essential instruments and should wear white coat on
duty.
(iii) The intern should sign the attendance register at the time of arrival and departure
from duty.
(iv) Orders/notes/certificates made by interns must be signed with legible name with
date and time.

4. Duties

(i) The Intern shall participate as a team member in total health care programme of
an individual including appropriate follow-up and social rehabilitation. The
intern will work as a Doctor undergoing training and expected to work for the
wellbeing of the patient under his/her.
(ii) The Intern shall be entrusted with clinical responsibilities under supervision of a
Faculty/Residents .He/ she shall not work independently.
(iii) An Intern will not issue a Medical Certificate or a Death Certificate or a Death
Certificate or any other medico legal documents under his signature.
(iv) Intern will participate in total patient care by maintaining patients’ records,
participate in Ward rounds and other academic activities of the departments
posted.

5. Total Duration
Every student will be required after passing the final MBBS examination/ National
Exit Exam to undergo Compulsory Rotational Internship to the satisfaction of the
College Authorities and GGSIP University for a period of 12 months so as to be
eligible for the award of the Degree of Bachelor of Medicine and Bachelor of Surgery
(MBBS).
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6. Internship – Time Distribution:
As per National Medical Commission (Compulsory Rotatory Medical Internship)
Regulations, 2021 vide gazette notification No. UGMEB/NMC/Rules &
Regulations/2021/580 dated 18 Nov, 2021

Community Medicine 12 Weeks

General Medicine 06 Weeks
Psychiatry 02 Weeks
Pediatrics 03 Weeks
General Surgery 06 Weeks
Anesthesiology and critical care 02 Weeks
Obst/Gynaecology including Family Welfare & Planning 07 Weeks
Orthopedics including PM&R 02 Weeks
Emergency/ Trauma/ Casualty 02 Weeks
Forensic Medicine & Toxicology 01 Week
Dermatology, Venereology and Leprology 01 Week
ENT 02 Weeks
Ophthalmology 02 Weeks
Elective Postings including Indian system of medicine 04 Weeks
Subjects for Elective posting will be as follows:
(i) Respiratory medicine and DOTS Center
(ii) Radio-Diagnosis
(iii)Lab Medicine
(iv) Geriatric Medicine
(v) Indian system of medicine (ISM): Ayurveda, Yoga, Unani, Siddha,
Homoeopathy, and Sowa Rigpa

Note: The schedule of posting of interns is notified before the starting of the
internship.

7. Leave Entitlements of Interns

A. Normal Leave:
(i) Interns shall be permitted a maximum of fifteen days leave with prior
permission, during the entire period of internship.
(ii) The entire period of fifteen days cannot be availed during any of the one
week or two weeks postings applicable to a single department or specialty

B. Maternity Leave:
Lady Interns may be permitted Maternity Leave according to prevailing rules and
regulations of the Central Government or State Government, as may be applicable

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 C. Paternity Leave:
Male interns may be permitted paternity leave for two weeks either in
continuation or in intervals of one week each within one year of internship.

D. Medical Leave:
(i) Medical Leave shall be included within the fifteen days of normal leave.
(ii) Any medical leave beyond this period shall be recommended only by a duly
constituted Medical Board

8. Extension of Internship

The minimum duration of compulsory rotating medical internship may be extended/

repeated (in part or in total) appropriately by a reasonable period on recommendation
by the College or University for reasons including but not limited to:

1) Insufficient period of attendance: The internship shall be extended if the leave of

absence of any kind exceeds beyond this period: The period of extension shall be
equivalent to the period beyond permissible fifteen days of leave.
2) Unsatisfactory performance.
3) Prolonged illness. Medical Certificate must be validated by a Medical Board set up
by the Institution, where rotator internship is being undertaken.
4) Any exigency such as disasters or unforeseen circumstances in the country as
notified by the Government of India or any competent authority duly authorized to
do so.
5) The internship shall be repeated only in the department or specialty wherein the
above extension is necessary.
6) No hostel accommodation shall be provided for the repeat period. However, in
extra ordinary circumstances the institute may provide accommodation only if it is
available.

9. Period for completion of internship:

1) The Internship shall be completed within two years of passing the final MBBS or
Foreign Medical Graduate Examination (FMGE) or NExT Step-1 examination,
whenever in force.
2) An intern must ordinarily complete his/her Internship during the scheduled period
of 11th March 2024 to 10th March 2025 for Regular Batch
3) The duration of internship may be curtailed or temporarily suspended or even
withdrawn or canceled at any time by the institution or University according to the
prevailing rules or regulations of the relevant authority, provided
a) the registrant, due to any reason whatsoever, desires not to pursue CRMI; or
b) the registrant is not found to have fulfilled eligibility requirements; or
c) there are proven acts of indiscipline; or
d) there are proven acts of professional misdemeanor or misconduct; or
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 e) any other acts or actions including those violating the law of the land.

10. ASSESSMENT

a. Log Book:
(i) The intern shall maintain a record of work done/ skills learnt, and get
completed assessment and feedback formats in the log book, verified and
certified by the unit incharge under whom he/she works.
(ii) Leaves must be entered in the internship booklet and signed by the unit
incharge.
(iii) The bonafied entries of the task/ skills/ assessment and feedback formats
mentioned in the logbook is entirely the responsibility of the intern.
(iv) Final assessment rating will be given on the scale of A (Outstanding), B
(Good), C (Average), D (Needs further training) on the basis of performance
in the domains i.e. knowledge, patient care, procedural skills, independent
care, communication skills, system based practice, professionalism, and
lifelong learning.
(v) Responsibility of the safe custody of the Internship booklet rests on the
interns.
(vi) Logbook must be surrendered to the Director Principal Office before taking
the Internship certificate.
(vii) No dues: To avoid any unnecessary delay in clearance, a signed ‘No Dues’
certificate should be taken by the Intern at the end of the posting from the
concerned department.

b. Apart from scrutiny of the record of work, assessment and evaluation of training
shall be undertaken by an objective approach using situation tests in knowledge,
skills and attitude during and at the end of the training;
(i) The assessments shall predominantly test clinical/ practical skills.
(ii) Feed-back mechanisms must be in place so that progress and deficiencies are
conveyed to interns such that measures for correction and improvement can
be instituted early and effectively.
(iii) Based on the record of work and objective assessment at the end of each
posting, the respective Head of the Unit and Head of the Department shall
certify satisfactory completion of the posting.
(iv) The Dean/Principal shall issue cumulative certificate of satisfactory
completion of training at the end of internship.
(v) Interns shall have to undergo an eligibility licentiate test/ NExT step-2
whenever duly notified as a requisite to granting of Permanent Registration/
license to practice.

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11. Stipend

a) All interns shall be paid stipend as fixed by the appropriate authority applicable to
the institution/ University or State.
b) Stipend may not be paid during any period of extension except in the case of
maternity or paternity leave or medical leave, as may be recommended and
approved by the Medical Board. Total stipend paid for the entire internship may
be for fifty-two weeks (Twelve months) only.

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Interns' Weekly Duty Roster (from 11th March 2024 to 10th March 2025)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52

We 29 27 29 26 30 28 25 2 30 27 24
11 17 25 15 22 10 17 24 15 22 12 19 16 23 14 21 11 18 16 23 13 20 10 17
1- 8- AP 6- M 3- 1- 8- JU 5- AU 2- 9- SE 7- OC 4- NO DE 9- DE 6- JA 3- FE 3-
ek - - - - - 13 20 - - - - - - - - - - - - - - - - - - -
7 14 R- 12 AY 9 7 14 L- 11 G- 8 15 P- 13 T- 10 V- C- 15 C- 12 N- 9 B- 10
& 17 24 31 21 28 - - 16 23 30 21 28 18 25 22 29 20 27 17 24 22 29 19 26 16 23
Da AP AP 5 M -2 JU JU JU 4 AU 1 SE SE 6 OC 3 NO 1 8 DE 5 JA 2 FE 2 M
M M M AP AP 19 26 JU JU JU JU JU AU AU SE SE OC OC NO NO DE DE JA JA FE FE
tes R R M AY JU N L L AU G SE P P OC T NO V DE DE C JA N FE B M AR
AR AR AR R R M M N N N L L G G P P T T V V C C N N B B
20 20 AY 20 N 20 20 20 G 20 P 20 20 T 20 V 20 C C 20 N 20 B 20 AR 20
20 20 20 20 20 AY AY 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20
24 24 20 24 20 24 24 24 20 24 20 24 24 20 24 20 24 20 20 24 20 25 20 25 20 25
24 24 24 24 24 24 24 24 24 24 24 24 24 24 24 24 24 24 24 24 25 25 25 25
24 24 24 24 24 24 24 24 25 25 25

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Abbreviations:

Mandatory Exclusive Departments/ Specialty

Complete name Abbreviation
Community medicine CM
General surgery SR
Orthopedics including physical medicine and rehabilitation OR
Anesthesiology and critical care AN
Emergency/ trauma/ casualty ED
General medicine MD
Psychiatry PS
Dermatology DR
Pediatrics PD
Obstetrics and gynecology including family welfare and planning OG
Family welfare and planning FW
Forensic medicine and toxicology FM
Otorhinolaryngology (ENT) EN
Ophthalmology OP

Elective Exclusive Departments/ Specialty

Complete name Abbreviation
Broad Specialties Respiratory medicine RESP.MED
Radiodiagnosis RADIO
Laboratory Medicine LAB.MED
Geriatric medicine GER.MED
Indian System of
Ayurveda AYUSH.AYU
Medicine/ AYUSH
Homeopathy AYUSH.HOM

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 COMMUNITY MEDICINE

General Surgery
Place of Posting: District Hospital/Community health Center/ Rural health
Center/Urban Health Center/ Primary Health Center …………………………………
Skills learnt:
Ob Ass Do Abl Re
ser iste ne e to ma
ved d und do rks
er ind /
sup epe Co
ervi nde m
S.No Skill
sio ntly me
n nts
D N D N D N D N
a o a o a o a o
t . t . t . t .
e e e e
1 Acquire competence in diagnosis and management of
common ailments.
2 Demonstrate knowledge on ‘Essential drugs’ and their
usage
3 Recognize medical/Surgical emergencies, resuscitate and
institute initial treatment and refer to a suitable
institution/ suggest to the patient an alternative health
care facility if he/she wants to know about the same.
4 Cases seen in OPD
5 Cases worked up in ward
1.
2.
3.
4.
6 Investigations done
1.
2.
3.
4.

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7 Procedures done:
1.
2.
3.
4.
8 Case /discharge summaries made

9 Any other:
…………………………………………………………
…………………………..

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

16
 Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: __________________________Posting Period:____/___/_____to____/___ /____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

17
 Obstetrics & Gynecology
Place of Posting: District Hospital/Community health Center/ Rural health
Center/Urban Health Center/ Primary Health Center …………………………………
Skills learnt:
Ob Ass Do Abl Re
ser iste ne e to m
ved d und do ar
er ind ks/
sup epe Co
ervi nde m
S.No Skill sio ntly m
n en
ts
D N D N D N D N
a o a o a o a o
t . t . t . t .
e e e e
1 Acquire competence in diagnosis and management of
common Obstetrics and gynecological problems.
2 Acquire proficiency in Family Welfare Programmes:
1. antenatal care
2. normal delivery
3. contraception
3 Learn skills in family welfare planning procedures:
1. IUD Insertion
2.
3.
4 Recognize medical emergencies, resuscitate and institute
initial treatment and refer to a suitable institution/
suggest to the patient an alternative health care facility if
he/she wants to know about the same.

5 Familiarity with all National Health Programmes (e.g.

RCH, FP, ANC, and others)

6 Provided health education to an individual/community

on:
1. small family, spacing, use of appropriate
contraceptives;
2. applied nutrition and care of mothers and children;
3. Immunization.
7 Cases seen in OPD

8 Cases worked up in ward

18
9 Investigations done:
1.
2
3.
10 Any other:
…………………………………………………………..

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

19
 Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

20
 General Medicine
Place of Posting: District Hospital/Community health Center/ Rural health
Center/Urban Health Center/ Primary Health Center …………………………………
Skills learnt:
R
e
Do m
Abl
ne ar
e to
und ks
Obs Ass do
er /
erve iste ind
sup C
d d epe
S. ervi o
Skill nde
No sio m
ntly
n m
en
ts
D N D N D N D N
a o a o a o a o
t . t . t . t .
e e e e
1 Participate in family composite health care (birth to
death),
2 Participate in use of the modules on field practice for
community health, e.g., safe motherhood, nutrition
surveillance and rehabilitation, diarrheal disorders, etc
3 Participate in and maintain documents related to
immunisation and cold chain;
4 Acquire competence in diagnosis and management of
common ailments e.g. malaria, tuberculosis, enteric
fever, congestive heart failure, hepatitis, meningitis
acute renal failure, etc.
5 Acquire proficiency in Family Welfare Programmes
(antenatal care, normal delivery, contraception, etc.)
6 Participate in Infectious Diseases Surveillance and
Epidemic Management activities along with the medical
officer.
7 Demonstrate knowledge on ‘Essential drugs’ and their
usage;

21
8 Recognize medical emergencies, resuscitate and
institute initial treatment and refer to a suitable
institution/ suggest to the patient an alternative health
care facility if he/she wants to know about the same.
9 An intern must be familiar with all National Health
Programmes (e.g. RCH, UIP, CDD, ARI, FP,
ANC, Tuberculosis, Leprosy and others), as
recommended by the Ministry of Health and Family
Welfare.
10 Expertise in immunization against infectious disease

R
e
Do Abl
m
ne e to
ar
Obser Assist und do
ks
ved ed er indep /
S. super enden
Skill
No Co
vision tly
mm
ents
D D D
Da N N N N
at at at
te o. o. o. o.
e e e
11 Participate in programmes related to prevention and
control of locally prevalent endemic diseases including
nutritional disorders;
12 Learn skills in family welfare planning procedures.

13 capabilities to conduct programmes on health education;

14 capabilities to use Audio visual aids

15 Acquire capability of utilization of scientific

information for promotion of community health.

16 An intern should be capable of establishing linkages

with other agencies as water supply, food distribution
and other environmental or social agencies.
17 Managerial skills including delegation of duties to and
monitoring the activities of paramedical staff and other
health care professionals.

22
18 Provided health education to an individual/community
on:
(a) tuberculosis;
(b) small family, spacing, use of appropriate
contraceptives;
(c) applied nutrition and care of mothers and children;
(d) immunization.
19 Attended school health programme
20 Any other:
…………………………………………………………
…………………………………………………………
………………………………………………….

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

23
 Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ____________________________Posting period: ____/___ /_____ to____ /___ /____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

24
 Community Medicine
Place of Posting: District Hospital/Community health Center/ Rural health
Center/Urban Health Center/ Primary Health Center …………………………………
Skills learnt:
R
e
Do m
Abl
ne ar
e to
und ks
Ob Ass do
er /
ser iste ind
sup C
ved d epe
S. ervi o
Skill nde
No sio m
ntly
n m
en
ts
D D D D
N N N N
a a a a
o o o o
t t t t
. . . .
e e e e
Participate in family health advisory programme
1
(FHAP)
Participate in use of the modules on field practice for
2 community health, e.g., safe motherhood, nutrition
surveillance and rehabilitation, diarrheal disorders, etc
Provided health education to an individual/community
on:
(a) tuberculosis;
3 (b) small family, spacing, use of appropriate
contraceptives;
(c) applied nutrition and care of mothers and children;
(d) immunization.
Participate in and maintain documents of preventive,
4 therapeutic and administrative task
Participate in Infectious Diseases Surveillance and
5 Epidemic Management activities along with the
medical officer.

25
 An intern must be familiar with all National Health
Programmes (e.g. RCH, UIP, CDD, ARI, FP,
6 ANC, Tuberculosis, Leprosy and others), as
recommended by the Ministry of Health and Family
Welfare.
Participate in programmes related to prevention and
7 control of locally prevalent endemic diseases
including nutritional disorders;
Capabilities to conduct programmes on health
8 education;

9 Capabilities to use Audio visual aids

R
e
Do m
Abl
ne ar
e to
und ks
Ob Ass do
er /
ser iste ind
sup C
ved d epe
S. ervi o
Skill nde
No sio m
ntly
n m
en
ts
D D D D
N N N N
a a a a
o o o o
t t t t
. . . .
e e e e
Acquire capability of utilization of scientific
10 information for promotion of community health.
An intern should be capable of establishing linkages
11 with other agencies as water supply, food distribution
and other environmental or social agencies.
Managerial skills including delegation of duties to and
12 monitoring the activities of paramedical staff and
other health care professionals.
13 Attended school health programme
Coordination with local and national epidemic
14
management plans

26
 Any other:
………………………………………………………
15
………………………………………………………
………………………………………….

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

27
 Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

28
 Dr.Baba Saheb Ambedkar Medical College and Hospital
DEPARTMENT OF COMMUNITY MEDICINE
Centre wise Compiled Assessment Summary

Sr. No. Place of posting Grade Scored by the Signature of Faculty

intern Incharge

1) General Surgery
2) Obstetrics & Gynecology
3) General Medicine
4) Community Medicine

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

29
 Internship Assessment Certificate

Name: ___________________________ Internship Serial No:_________________________

Supervisor: ______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training
⮚ Scoring may be based on
(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

30
 Dr.Baba Saheb Ambedkar Medical College and Hospital

GENERAL MEDICINE DEPARTMENT

Obs Assis Do Abl R

erve ted ne e to e
d und do m
er ind ar
sup epe ks
ervi nde /C
sio ntly o
S.
Skill n m
No.
m
en
ts
D N D N D N D N
a o a o a o a o
t . t . t . t .
e e e e
1 Clinical diagnosis based on history physical examination
and relevant laboratory investigation of common diseases
(parasitic, bacterial or viral infections, nutritional
disorders, including d ehydration and electrolyte
disturbances).
2 Management and prognosis of acute & chronic illnesses
3 Participate as a team member in providing comprehensive
healthcare.
4 Counselling sessions for patients
5 Death declaration
6 Coordination with local and national epidemic
management plans
7 Diagnostic procedures:
i. Urethral catheterization
ii Proctoscopy
iii Indirect laryngoscopy
8 Insertion of Ryle’s Tube,

9 Pleural fluid aspiration

10 Ascitic fluid aspiration

11 Cerebrospinal Fluid (CSF) aspiration,

12 Air way tube installation

13 Oxygen administration

25
 Dr.Baba Saheb Ambedkar Medical College and Hospital

14 Biopsy Procedures:
1. Liver
2. Kidney
3. Skin
4. Nerve
5. Lymph node
6. Muscle biopsy
7. Bone marrow aspiration
8. Biopsy of Malignant lesions on surface
9. Nasal/nerve/skin smear for leprosy.
Obs Assis Do Abl R
erve ted ne e to e
d und do m
er ind ar
sup epe ks
ervi nde /C
sio ntly o
S.
Skill n m
No.
m
en
ts
D N D N D N D N
a o a o a o a o
t . t . t . t .
e e e e
15 Life-saving procedures:
1. use of aspirator
2. respirator & defibrillator
3. cardiac monitor
4. blood gas analyser
16 Urinary catheterization
17 Venipuncture
18 Intramuscular injection
19 Intradermal injection
20 Subcutaneous injection
21 Intra Venous (IV) injection
22 Setting up IV infusion and calculating drip rate

23 Blood transfusion

24 Basic life support

25 Oxygen therapy/ Aerosol therapy

26
 Dr.Baba Saheb Ambedkar Medical College and Hospital

26 Nebulization

27 Ryle’s tube insertion

28 Lumbar puncture

29 Pleural and ascetic fluid aspiration

30 Cardiac resuscitation

31 Peripheral blood smear interpretation

32 Bedside urine analysis

33 Writing a prescription

34 Audit of a given prescription

35 Recognize an adverse drug reaction

36 demonstrate awareness of pharmaco-vigilance, antibiotics

policy, prescription audit
37 prepare a list of essential drugs for a healthcare facility

38 Perform, analyze, and interpret pulmonary function (e.g.

FVC, MVV)

Obs Assis Do Abl R

erve ted ne e to e
d und do m
er ind ar
sup epe ks
ervi nde /C
sio ntly o
S.N
Skill n m
o.
m
en
ts
D N D N D N D N
a o a o a o a o
t . t . t . t .
e e e e
39 Perform, analyze, and interpret measurements of cardiac
and vascular function (e.g. HR, BP, ECG)
40 Perform, analyze, and interpret CNS function (e.g. nerve
conduction velocity,
EMG, cranial nerve examination)

27
 Dr.Baba Saheb Ambedkar Medical College and Hospital

41 Order, sampling & interpretation of Laboratory

investigations:
1. Blood: Routine hematology smear and blood grouping
(manual), saline cross-matching; Complete blood count
including Platelet count, peripheral blood smear
preparation and examination including malarial
parasites
2. Urine: Routine chemical and microscopic
3. Stool: for ova/cyst and occult blood
4. Sputum and throat swab for gram stain or acid fast
stain
5. Cerebrospinal Fluid (CSF) for proteins, sugar and
smear
6. Performing blood sugar test by glucometer
7. Correctly collect and transport samples and specimens
for blood tests, culture, histopathology and
8. cytopathology investigations
9. Fill requisition forms appropriately.

42 Any other:
……………………………………………………………
……………………………………………………………
……………………………………………..

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Student: _______________________Date:___________
Faculty: _______________________Date:__________
28
 Dr.Baba Saheb Ambedkar Medical College and Hospital

Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________
⮚ Please rate on a scale of A, B, C, D with:
A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

29
 Dr.Baba Saheb Ambedkar Medical College and Hospital

PSYCHIATRY DEPARTMENT

Obser Assist Do Able Re

ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 Identification, diagnosis and developing
management plan for common psychiatric
disorders.
2 Identify and manage psychological reactions
3 Diagnose and manage behavioral disorders in
medical and surgical patients
4 Identification, diagnosis, invitation of treatment
for severe mental disorders and child adolescent
mental Health disorders and threshold for
referral
5 Suicide risk assessment and Basic management
6 ECT administration
7 Indoor Cases (worked up)
8 De-Addiction Cases
9 Therapeutic counselling and follow-up
10 Any other:
…………………………………………………
…………………………………………………
…………………………………………

30
 Dr.Baba Saheb Ambedkar Medical College and Hospital

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

31
 Dr.Baba Saheb Ambedkar Medical College and Hospital

Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

32
 Dr.Baba Saheb Ambedkar Medical College and Hospital

PAEDIATRICS DEPARTMENT
Obser Assist Do Able Re
ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 Diagnosis and management and explain
prognosis of acute and chronic common
paediatric illnesses
2 Institute early management with special
reference to paediatric
dosage and oral rehydration therapy
3 Screening of new born babies & detect
congenital abnormalities
4 use of aspirator
5 Use of respirator
6 vital monitoring, & temperature monitoring
7 Use of cardiac monitor,
8 Use of blood gas analyser
9 Thoracocentesis.
10 Ascitic tap.
11 Lumbar puncture.
12 I.V. FLUID administration.
13 Setting up Pediatric Intraosseous line
14 Intravenous injection.
15 IV cannulation.
16 Blood transfusion with its management.
17 Taking blood samples.

33
 Dr.Baba Saheb Ambedkar Medical College and Hospital

18 nasogastric tube insertion

19 suprapubic aspiration of urine
20 Umbilical venous cannulation.
21 Immunization
22 Tuberculin testing.
Obser Assist Do Able Re
ved ed ne to do mar
S.
und indepe ks
No Skill
er ndentl /Com
.
super y ments
vision
23 Neonatal Resuscitation D N D N D N D No
at o. at o. at o. at .
e e e e
24 Care of children receiving intensive care.
25 Status epilepticus.
26 Common pediatric emergencies.
27 Assess growth and nutrition status of children.
28 Recognise growth abnormalities
29 Recognise anomalies of psychomotor
development
30 detection and follow-up of deficiency disorders
such as:
protein-energy malnutrition,
deficiencies of vitamins especially A, B, C and
D,
Iron deficiency
31 Breastfeeding counseling.
32 Any other:
…………………………………………………
…………………………………………………
……………………………………

34
 Dr.Baba Saheb Ambedkar Medical College and Hospital

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

35
 Dr.Baba Saheb Ambedkar Medical College and Hospital

Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

36
 Dr.Baba Saheb Ambedkar Medical College and Hospital

DEPARTMENT Of GENERAL SURGERY

Obser Assist Do Able Re
ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 Diagnose surgical illness including emergencies.
2 Resuscitate a critically injured patient and a
severe burns patient.
3 Control surface bleeding and manage open
wound.
4 Basic wound care
5 Incision and drainage of superficial abscesses/
Perform Wound Debridement.
6 Suturing of wound.
7 Basic bandaging
8 Wound dressings and application of splints;
9 Early management of trauma and trauma life
support
10 Monitor patients of head, spine, and chest,
abdominal and pelvic injury
11 Perform venesection
12 Assist elective surgeries e.g.
Cholecystectomy/Hernia repairs.
13 Assist Emergency Surgeries e.g.
Laparotomy/Appendectomy.
14 Assist Laparoscopic/ Minimally Invasive surgery
15 Perform vasectomy.
16 Assist Lymph node biopsy
17 Biopsy of surface tumours

37
 Dr.Baba Saheb Ambedkar Medical College and Hospital

18 Excision of superficial swellings e.g. Lipoma/

Cysts

Obser Assist Do Able Re

ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
19 Perform/Assist in circumcision procedure.
20 Perform/Assist in chest tube insertion.
21 Perform care of patients with ostomy/ open
wounds
22 Catheterization of patients with acute retention
or trocar cystostomy
23 Ryles tube insertion
24 Tracheostomy
25 Endotracheal intubation
26 Advise about prognosis of acute and chronic
surgical illnesses, head injury, trauma, burns and
cancer. Counsel patients regarding the same
27 Advise about rehabilitation of patients after
surgery and assist them for early recovery
28 Should be able to demonstrate understanding of
World Health Organisation cause of death
reporting
and data quality requirements
29 Should be able to demonstrate understanding of
the use of national and state/ local cause of death
statistics.

38
 Dr.Baba Saheb Ambedkar Medical College and Hospital

30 Any other:
…………………………………………………
…………………………………………………
………………………………….

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

39
 Dr.Baba Saheb Ambedkar Medical College and Hospital

Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

40
 Dr.Baba Saheb Ambedkar Medical College and Hospital

ANESTHESIOLOGY AND CRITICAL CARE DEPARTMENT

Obser Assist Do Able Re

ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 Perform Pre-anesthetic Checkup and Prescribe
Pre-anesthetic Medications
2 Anaesthesia for major and minor surgical and
other procedures.
3 Monitor Patients During Anesthesia and Post-
operative Period.
4 Recognize and Manage Problems Associated
with Emergency Anesthesia
5 Venipuncture and Set Up Intravenous Drip.
6 Laryngoscopy And Endotracheal Intubation.
7 Lumbar Puncture, Spinal Anesthesia and Simple
Nerve Blocks.
8 Simple General Anesthetic Procedures.
9 Cardio-pulmonary Brain Resuscitation
(C.P.B.R.)
10 Other procedure:
…………………………………………………
…………………………………………………
………..………………………

41
 Dr.Baba Saheb Ambedkar Medical College and Hospital

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

42
 Dr.Baba Saheb Ambedkar Medical College and Hospital

Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

43
 Dr.Baba Saheb Ambedkar Medical College and Hospital

OBSTETRICS AND GYNAECOLOGY (& FWP) DEPARTMENT

Obser Assist Do Able Re
ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 Diagnosis of early pregnancy and provision of
ante-natal care.
2 Obstetric examination
3 Antenatal pelvic assessment and
detection of cephalo-pelvic disproportion
4 Detection of high risk pregnancy cases and give
suitable advice e.g. PIH, hydramanios,
antepartum haemorrhage, multiple pregnancies,
abnormal presentations and intra-uterine growth
retardation etc
5 Diagnosis of pathology of pregnancy related to:
abortion; ectopic pregnancy;
tumours complicating pregnancy;
acute abdomen in early pregnancy;
hyperemesis gravidarum
6 Induction of labor and amniotomy under
supervision
7 Conduct normal vaginal delivery.
8 Suture Episiotomy and repair of perennial tears
9 Intrapartum pelvic assessment.
10 Medicolegal examination in Gynecology and
obstetrics.
11 To evaluate and prescribe oral contraceptives
12 Dilation and curettage and fractional curettage.
13 Endometrial biopsy.
14 Endometrial aspiration;

44
 Dr.Baba Saheb Ambedkar Medical College and Hospital

15 Urethral catheterization

Obser Assist Do Able Re

ved ed ne to do mar
und indepe ks
er ndentl /Com
S.
Skill super y ments
No.
vision
D N D N D N D No
at o. at o. at o. at .
e e e e
16 Pap Smear sample collection & interpretation
17 Intra- Uterine Contraceptive Device (IUCD)
insertion & removal
18 Assist Second trimester Medical Termination of
Pregnancy (MTP) procedures e.g. Emcredyl
Prostaglandin instillations
19 Mini-lap ligation
20 Suture removal in postoperative cases.
21 Cervical punch biopsy.
22 Assist in forceps delivery.
23 Assist In vacuum delivery.
24 Assist in caesarean section and postoperative
care.
25 Assist Major abdominal and vaginal surgery
cases
26 Assist in Pre op care.
27 Assist in postop care.
28 Detection and management of abnormalities of
lactation
29 Per speculum, per vaginum and per rectal
examination for detection of common
congenital,
inflammatory, neoplastic and traumatic
conditions of vulva, vagina, uterus and ovaries

45
 Dr.Baba Saheb Ambedkar Medical College and Hospital

30 Visual Inspection of Cervix with Acetic Acid

(VIA)
31 Any other:
……………

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

46
 Dr.Baba Saheb Ambedkar Medical College and Hospital

Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

47
 Dr.Baba Saheb Ambedkar Medical College and Hospital

ORTHOPAEDICS AND PMR DEPARTMENT

Obser Assist Do Able Re
ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 Application of basic splints and slings
2 Compression bandage
3 Manual reduction of common fractures and
dislocations.
4 Plaster cast application for undisplaced fractures
of arm, forearm, leg and ankle.
5 Open Reduction and Internal fixation of fractures
of long bones.
6 Application of external fixation.
7 Emergency care of a multiple in jury patient.
8 Precautions about transport and bed care of
spinal cord injury patients.
9 Any other procedure like CTEV Cast, Hip Spica.
10 Drainage for acute osteomyelitis.
11 Sequestrectomy in chronic osteomyelitis.
12 Advise about prognosis of poliomyelitis, cerebral
palsy, CTEV and CDH
13 Advise about rehabilitation of amputees and
mutilating traumatic and leprosy deformities of
hand.
14 Diagnosing and managing with competence
clinical diagnosis and management based on
detailed history and assessment of common
disabling conditions like poliomyelitis, cerebral
palsy, hemiplegia, paraplegia, amputations, etc.;

48
 Dr.Baba Saheb Ambedkar Medical College and Hospital

Obser Assist Do Able Re

ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
15 Participation as a team member in total
rehabilitation including appropriate follow up of
common disabling conditions
16 Procedures of fabrication and repair of artificial
limbs and appliances
17 Use of self-help devices and splints and mobility
aids
18 Accessibility problems and home-making for
disabled
19 Simple exercise therapy in common conditions
like prevention of deformity in polio, stump
exercise in an amputee, etc.
20 Therapeutic counselling and follow-up.
21 Any other:
…………………………………………………
…………………………………………………
……………………………..

49
 Dr.Baba Saheb Ambedkar Medical College and Hospital
FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

50
 Dr.Baba Saheb Ambedkar Medical College and Hospital
Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

51
 Dr.Baba Saheb Ambedkar Medical College and Hospital

ACCIDENTS AND EMERGENCY DEPARTMENT

Obser Assist Do Able Re

ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 Identification of acute emergencies in various
disciplines of medical practice
2 Management of acute anaphylactic shock;
3 Management of peripheral-vascular failure and
shock
4 Management of acute pulmonary edema and Left
Ventricular Failure (LVF)
5 Emergency management of drowning, poisoning
and seizure
6 Emergency management of bronchial asthma
and status asthmaticus
7 Emergency management of hyperpyrexia
8 Emergency management of comatose patients
regarding airways, positioning, prevention of
aspiration and injuries
9 Assessment and administering emergency
management of burns
10 Assessing and implementing emergency
management of various trauma victims
11 Identification of medico-legal cases and learn
filling up of forms as well as complete other
medico legal formalities in cases of injury,
poisoning, sexual offenses, intoxication and other
unnatural conditions

52
 Dr.Baba Saheb Ambedkar Medical College and Hospital

Obser Assist Do Able Re

ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
12 Advise about prognosis of acute surgical
illnesses, head injury, trauma and burns.
(i) Counsel patients regarding the same;
(ii) Electrocardiogram (ECG)
(iii) Routine radiographs of chest, abdomen,
skull, etc.
13 Resuscitation of critical patients;
(ii) documentation medico legal cases;
(iii) management of bleeding and application of
splints
14 Any other:
………………………
………………………
……………………

53
 Dr.Baba Saheb Ambedkar Medical College and Hospital

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

54
 Dr.Baba Saheb Ambedkar Medical College and Hospital
Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ____________________________Dates: ____/___ /______ to____ /___ /________
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding B: Good C: Average D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

55
 Dr.Baba Saheb Ambedkar Medical College and Hospital

FORENSIC MEDICINE AND TOXICOLOGY DEPARTMENT

Obser Assist Do Able Re
ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 To identify medico legal problem in a hospital
and general practice.
2 To identify and learn medicolegal
responsibilities of a medical man in various
hospital situations.
3 To be able to diagnose and learn management of
basic poisoning conditions in the community.
4 To learn how to handle cases of sexual assault.
5 Documentation and certification of trauma
6 Certification of medical-legal cases e.g. Age
estimation, sexual assault, etc.
7 To be able to prepare medico-legal reports in
various medico legal situations
8 Diagnosis and certification of death
9 To learn various medicolegal post-mortem
procedures and formalities during its
performance by police.
10 Establishing communication in medico-legal
cases with police, public health authorities, other
concerned departments, etc
11 Any other:
…………………………………………………
…………………………………………………
……………………………………

56
 Dr.Baba Saheb Ambedkar Medical College and Hospital

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

57
 Dr.Baba Saheb Ambedkar Medical College and Hospital
Internship Assessment Certificate
Name:___________________________ Internship Serial No:_________________________
Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

58
 Dr.Baba Saheb Ambedkar Medical College and Hospital
DERMATOLOGY AND VENEREOLOGY DEPARTMENT
Obser Assist Do Able Re
ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 Conducting proper clinical examination, elicit
and interpret clinical findings and diagnose
common dermatological disorders and
emergencies
2 Conducting proper clinical examination and
diagnose common STIs
3 Conducting proper clinical examination and
diagnosing Leprosy.
4 Manage common diseases recognizing the need
for referral for specialized care in case of
inappropriateness of therapeutic response.
5 Preparing KOH mount for fungus, Gram stain
and Tzank smear.
6 Preparation of slit smears and staining for AFB
7 Perform a skin biopsy for diagnostic purpose
8 Prepare a smear for DGI examination
9 Counsel a STI patient
10 Dark ground illumination
11 Tissue smear
12 Cautery - Chemical and electrical
13 Any other:
…………………………………………………
………….

59
 Dr.Baba Saheb Ambedkar Medical College and Hospital

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

60
 Dr.Baba Saheb Ambedkar Medical College and Hospital
Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

61
 Dr.Baba Saheb Ambedkar Medical College and Hospital
OTORHINOLARYNGOLOGY (ENT) DEPARTMENT
Obser Assist Do Able Re
ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 Comprehensive diagnosis of common Ear, Nose
and Throat (ENT) diseases including the
emergencies.
2 Use of head mirror
3 Use of otoscope
4 Indirect laryngoscopy
5 First line of management of common Ear Nose
and Throat (ENT) problems.
6 Knowledge of various ENT rehabilitative
programs and Participate as a team member in the
community rehabilitative processes.
7 Aware of National programme on prevention of
deafness
8 Ear syringing, and packing of the external canal.
9 Nasal douching, antrum puncture
10 Anterior & posterior nasal Packing of the nose for
epistaxis
11 Removing foreign bodies from the nose and ear
12 Various endoscopic procedures
13 Trachesotomy
14 Incision and drainage of various head & neck
abscess.
15 Suturing of head and neck wounds.
16 Any other:
…………………………………………

62
 Dr.Baba Saheb Ambedkar Medical College and Hospital
FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

63
 Dr.Baba Saheb Ambedkar Medical College and Hospital
Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding B: Good C: Average D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

64
 Dr.Baba Saheb Ambedkar Medical College and Hospital
OPHTHALMOLOGY DEPARTMENT
Obser Assist Do Able Re
ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 Diagnose and manage common
ophthalmological conditions
2 Visual acuity testing
3 Carry out assessment of refractive errors and
advise its correction.
4 Diagnose ocular changes in common systemic
disorders
5 Perform investigative procedures such as
tonometry/ Digital tonometry
6 Syringing/ Eye irrigation
7 Direct ophthalmoscopy
8 Indirect ophthalmoscopy
9 Subjective refraction
10 Fluorescin staining of cornea.
11 Advice regarding methods for rehabilitation of
the blind.
12 Subconjunctival injection.
13 Ocular bandaging
14 Removal of concretions.
15 Epilation and electrolysis
16 Corneal foreign body removal.
17 Cauterization of corneal ulcers.
18 Chalazion removal.

65
 Dr.Baba Saheb Ambedkar Medical College and Hospital
Obser Assist Do Able Re
ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
19 Entropion correction.
20 Suturing conjunctival tears.
21 Lids repair.
22 Glaucoma surgery (assisted).
23 Enucleation of eye in cadaver.
24 Instillation of eye medication
25 Epilation
26 Any other:
…………………………………………………
…………………………………………………
……………………………..

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________
Faculty: _______________________Date:__________

66
 Dr.Baba Saheb Ambedkar Medical College and Hospital

Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
Leaves: ___________________ days ; Absent: ____________________________ days
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding B: Good C: Average D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

67
 Dr.Baba Saheb Ambedkar Medical College and Hospital

ELECTIVE POSTING
RESPIRATORY MEDICINE (& DOTS) DEPARTMENT
Obser Assist Do Able Re
ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 Conducting proper clinical examination, elicit
and interpret clinical findings and diagnose
common respiratory disorders and emergencies
2 Interpret and manage various blood gases and
pH abnormalities in various respiratory diseases
3 Sputum collection.
4 Examination for etiological organism like AFB
5 Interpretation of chest X-rays, nose and ear
6 Respiratory function tests
7 Laryngoscopy
8 Pleural aspiration
9 Respiratory physiotherapy.
10 Pneumo-thoracic drainage aspiration
11 Laryngeal intubation
12 Therapeutic counselling and follow up
13 Any other:
…………………………………………………
…………………………………………………
…………………………………

68
 Dr.Baba Saheb Ambedkar Medical College and Hospital

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

69
 Dr.Baba Saheb Ambedkar Medical College and Hospital
Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
Leaves: ___________________ days ; Absent: ____________________________ days
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

70
 Dr.Baba Saheb Ambedkar Medical College and Hospital
ELECTIVE POSTING
RADIODIAGNOSIS DEPARTMENT

Obser Assist Do Able Re

ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 Identification of structures on X-rays/ ultrasound
2 Necessary skill to assess the need of various
investigative modalities According to patients
need (e.g. X-ray, Ultrasound, C.T., MRI,
Radionuclide Scan, etc.)
3 To know all aspects of ‘Emergency Room’
Radiology like:
(a) All acute abdominal conditions;
(b) All acute traumatic conditions with
emphasis on head injuries;
(c) Differentiation between Medical and surgical
radiological Emergencies.
4 To know Basic hazards and precautions in
Radio-diagnostic practices.
5 Demonstrating awareness of the various laws
like Pre-conception and Prenatal Diagnostic
Techniques (Prohibition of Sex Selection) Act
6 Any other:
…………………………………………………
…………………………………………………
…………………………………….

71
 Dr.Baba Saheb Ambedkar Medical College and Hospital

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

72
 Dr.Baba Saheb Ambedkar Medical College and Hospital
Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

73
 ELECTIVE POSTING
LABORATORY MEDICINE

Obser Assist Do Able Re

ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 Peripheral blood smear preparation, staining and
interpretation
2 Urine routine and microscopy examination
3 Manual blood sugar estimation
4 CSF examination
5 Blood grouping
6 Saline cross match method
7 Blood Issued
8 Donor's Bled
9 Donation Group attended.
10 Special Tests Seen i.e., HIV, HBSAG,
11 Segregation and disposal of sharps, plastics, OT
material, HIV/ HBsAg/ HCV/
12 corona virus infected material
13 Gram’s stained smear interpretation
14 KOH examination of scrapings for fungus
15 Dark ground illumination
16 ZN stained smear interpretation
17 Wet mount examination of stool for ova and
cysts
18 Identification of blood parasites on PBS
19 Estimate glucose, creatinine, urea and total
proteins, A:G ratio in serum

74
20 Estimate serum total cholesterol, HDL
cholesterol, triglycerides
Obser Assist Do Able Re
ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
21 Estimate serum bilirubin, SGOT/SGPT/alkaline
phosphatase
22 Estimate calcium and phosphorous
23 Any other:
………………………………………………..
………………………………………………..
………………………………………………

FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________
75
 Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

76
 ELECTIVE POSTING
GERIATRIC MEDICINE

Obser Assist Do Able Re

ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 Acquire competence in diagnosis and
management of common geriatric health
problems
2 Recognize medical emergencies of geriatric age
group, resuscitate and institute initial treatment
and refer to a suitable
institution
3 Cases seen in OPD
4 Any other:
…………………………………………………
…………………………………………………
…………………………………..

77
 FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

78
 Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

79
 ELECTIVE POSTING

AYUSH: ________________________

Obser Assist Do Able Re

ved ed ne to do mar
und indepe ks
S. er ndentl /Com
No Skill super y ments
. vision
D N D N D N D No
at o. at o. at o. at .
e e e e
1 History taking, Diagnosis and management of
common health problems
2 Any other:
…………………………………………………
………………..

3 Any other:
…………………………………………………
………………..

80
 FEED-BACK
Strengths:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Areas of Improvement needed:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Student: _______________________Date:___________

Faculty: _______________________Date:__________

81
 Internship Assessment Certificate

Name:___________________________ Internship Serial No:_________________________

Supervisor:_______________________ Department/ Specialty:________________________
Unit: ___________________________Posting Period: ____/___ /______ to____ /___ /_____
RATING: _______________________

⮚ Please rate on a scale of A, B, C, D with:

A: Outstanding, B: Good, C: Average, D: Needs further training

⮚ Scoring may be based on

(a) Knowledge, (b) Patient Care, (c) Procedural Skills, (d) Independent care
(e) Communication Skills, (f) System Based Practice, (g) Professionalism
(h) Life-long Learning

Signature of the Head of Unit with Stamp Signature of the Head of Dept. with Stamp

Date: Date:

82
 LEAVES RECORD

S. No Name of Department No. of days Signature of Signature of Head

of leave Head of unit of Department
1 Community Medicine:
(i) General Surgery
(ii)Obstetrics & Gynecology
(iii)General Medicine
(iv)Community Medicine
2 General Medicine
3 Psychiatry
4 Pediatrics
5 General Surgery
6 Anesthesiology and critical care
7 Obstetrics and Gynecology & FWP
8 Orthopedics & PMR
9 Emergency/ Casualty
10 Forensic Medicine and toxicology
11 Dermatology
12 E.N.T.
13 Ophthalmology
14 Elective Posting:
(i)
(ii)
(iii)
(iv)

83
 NO DUES CERTIFICATE

S. No Name of Department Remark Signature of Signature of Head

Head of unit of Department
1 Community Medicine:
(i) General Surgery
(ii)Obstetrics & Gynecology
(iii)General Medicine
(iv)Community Medicine
2 General Medicine
3 Psychiatry
4 Pediatrics
5 General Surgery
6 Anesthesiology and critical care
7 Obstetrics and Gynecology & FWP
8 Orthopedics & PMR
9 Emergency/ Casualty
10 Forensic Medicine and toxicology
11 Dermatology
12 E.N.T.
13 Ophthalmology
14 Elective Posting:
(i)
(ii)
(iii)
15 Library
16 Secretary Student Union
17 Wardens girls /boys Hostel
18 Sports Section
19 Account Branch
20 Academic Section

84
 DR.BABA SAHEB AMBEDKAR MEDICAL COLLEGE AND HOSPITAL
INTERNSHIP ASSESSMENT CERTIFICATE
ELECTIVE POSTING – AYUSH

Certified that Dr_________________________________ was posted to the

Department of ______________________ from_________________ to
_______________ and completed the posting.

Signature of the Head of Unit with Stamp

Date:

85