Pathology

The TN Dr.M.G.R Medical University, Chennai

The TN Dr. M.G.R. Medical University
Chennai

Under Graduate Academic Record

Department of Pathology

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 Thanking....

“I thank all the illustrious faculty of Pathology in the Medical

Schools of this University for their conscientious effort”

Dr. Sudha Seshayyan

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 Preface
The new GMER attempts to stand on the shoulder of the contributions and the efforts of resource
persons, teachers and students (past and present). It intends to carry forward the process of
learning to enable the Indian Medical Graduate, a consummate provider of health care aligned to
the evolving needs of the patients in every socio- economic setting. The thrust in the new
regulations is the continuation and evolution of thought in medical education making it more
learner-centric, patient-centric, gender sensitive, outcome -oriented and environment
appropriate. The result is an outcome driven curriculum which conforms to global trends.
Emphasis is made on alignment and integration of subjects both horizontally and vertically
while respecting the strengths and necessity of subject-based instruction and assessment. The
importance of ethical values, responsiveness to the needs of the patient and acquisition of
communication skills is underscored by providing dedicated curriculum time in the form of a
longitudinal program based on Attitude, Ethics and Communication (AETCOM) competencies.
Great emphasis has been placed on collaborative and interdisciplinary teamwork,
professionalism, altruism and respect in professional relationships with due sensitivity to
differences in thought, social and economic position and gender. In addition to the above, an
attempt has been made to allow students from diverse educational streams and backgrounds to
transition appropriately through a Foundation Course. Dedicated time has been allotted for self-
directed learning and co-curricular activities. With this view in mind the log book has been
designed as per the guidelines of competency-based curriculum. This Academic Record for
Undergraduate Medical Students is to be maintained by the student and is part of the learner's
personal progress assessment toolkit. The learner shall present the Academic Record to the
staff facilitator / mentor at the end of all class room learning / practical sessions / integrated
learning sessions / ECE / SDL / AETCOM sessions and feedback sessions as called for by the
faculty facilitators / mentors. The progress shall be recorded in the various segments of the
record and signed by the facilitator / mentor.

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 Certificate

This is to certify that

Mr. / Ms. ___________________________________________________________

University Roll No: _____________________________________________

Has satisfactorily attended and completed all academic activities as assigned in

this record under the guidelines prescribed under the Tamil Nadu Dr. M.G.R.

Medical University for the subject of Pathology.

Head of Department

Date:
Place

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 Content
No Content Page

1 Background of the Course

2 Curriculum Vitae

3 Time Table

4 Clinical Pathology Record

5 Histopathology slides Record

6 Hematology and cytology Slides Record

7 Gross Specimens Record

8 Assignment Response Record

9 Case Based Learning

10 Record of Integrated Sessions

11 Self Directed Learning

12 AETCOM Sessions

13 Formative Feed back

14. Formative Assesment

15. Certification of Skills

16. Project Record

17. Photo Gallery

18. Co-curricular activities

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 1. Background of the Course
GOAL AND OBJECTIVES

GOAL
The broad goal of the teaching of undergraduate student in Pathology is to provide
the students with a comprehensive knowledge of the mechanisms and causes of
disease, in order to enable him/her to achieve complete understanding of the
natural history and clinical manifestations of disease.
OBJECTIVES
a) KNOWLEDGE
At the end of the course, the student should be able to:-
1. Describe the structure and ultrastructure of a sick cell, mechanisms of cell
degeneration, cell death and repair and be able to correlate structuraland
functional alterations.
2. Explain the pathophysiological processes which govern the maintenance of
homeostasis, mechanisms of their disturbance and the morphological and
clinical manifestations associated with it.
3. Describe the mechanisms and patterns of tissue response to injury such that
she/he can appreciate the pathophysiology of disease processes and their
clinical manifestations.
4. Correlate normal and altered morphology (gross and microscopic) of different
organ systems in common diseases to the extent needed for understanding of
disease processes and their clinical significance.
b) SKILLS
At the end of the course, the student should be able to:-
1. Describe the rationale and principles of technical procedures of the diagnostic
laboratory tests and interpretation of the results.
2. Perform simple bed-side tests on blood, urine and other biological fluid sample.
3. Draw a rational scheme of investigations aimed at diagnosing and managing the
cases of common disorders.
4. Understand biochemical / physiological disturbances that occur as a result of
disease in collaboration with preclinical departments.
c) INTEGRATION
At the end of training he/she should be able to integrate the causes of disease and
relationship of different etiological factors (social, economic and environmental)
and that contribute to the natural history of diseases most prevalent in India.

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 2. Curriculum Vitae

1. Name of the Student

2. Date of Birth
3. Permanent Address

4. Contact Details
i. Residential Address

ii. Mobile No
iii. Land Line No
iv. Email ID
5. Name of Parent/Guardian
6. Residential Address

7. Land Line No (Home)

8. Mobile No Parents/Guardian

Signature

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 3. Time Table

Week Mon Tue Wed Thur Fri Sat Sun

Vacation Days:

to

to

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 4. Clinical Pathology Lab Record
Note:
1. This section captures the attainment of the various competency mile-stones
attained through hematology and clinical pathology lab work.
2. The learner shall make observation in the lab and makes entries as mandated in
the concerned record book
3. The record books shall be verified by the faculty facilitator periodically / at the
end of each session or module and the completion of each such activity shall be
recorded in this section by the learner and signed by the facilitator.
4. The end of each session shall be appended by an end of training formative
assessment in the topic / session / module. eg: OSPE. Such sessional outcomes
and feed for such outcomes may be suitably entered in the concerned documents.
No Test / Procedure / Experiment Date of Initials of
Completion Facilitator
1

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 5. Histopathology Lab Record
Note
1. This section includes academic mile stones attained through microscopic observation
of histopathology slides
2. The learner shall make observation entries as mandated in the record book
3. The record note books shall be verified by the faculty facilitator at the end of each
session or module.
4. The completion of each such activity shall be recorded in this section by the learner
and signed by the facilitator
5. The end of each session shall be appended by an end of training formative
assessment in the topic / session / module. eg: OSPE, DOPS etc. Such sessional
outcomes and feed for such outcomes may be suitably entered in the concerned
documents.
No Histopathology slides Date of Initials of
Demonstration Facilitator
1

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 6. Haematology & Cytology Record
Note
1. This section includes academic mile stones attained through microscopic observation
of hematology and cytology slides.
2. The learner shall make observation entries as mandated in the record book
3. The record note books shall be verified by the faculty facilitator at the end of each
session or module.
4. The completion of each such activity shall be recorded in this section by the learner
and signed by the facilitator
5. The end of each session shall be appended by an end of training formative
assessment in the topic / session / module. eg: OSPE, DOPS etc. Such sessional
outcomes and feed for such outcomes may be suitably entered in the concerned
documents.
Haematology Slides Record
No Haematology Slides Date of Initials of
Demonstration Facilitator
1

10

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 Cytology Slides Record

No Cytology slides Date of Initials of

Demonstration Facilitator
1

10

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 7. Gross Pathology Record
Note
1. This section includes academic mile stones attained through observation and
diagnosing pathological conditions by demonstration of gross specimens
2. The learner shall make observation entries as mandated in the record book
3. The record note books shall be verified by the faculty facilitator at the end of each
session or module.
4. The completion of each such activity shall be recorded in this section by the learner
and signed by the facilitator
5. The end of each session shall be appended by an end of training formative
assessment in the topic / session / module. eg: OSPE, DOPS etc. Such sessional
outcomes and feed for such outcomes may be suitably entered in the concerned
documents.
No Gross Specimens Date of Initials of
Demonstration Facilitator
1

10

11

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 8. Assignment Record
Note
1. This section includes academic milestones attained through assignments / out
of class academic work.
2. The learner shall be given an assignment based on the “Nice to know” areas of
the curriculum and any other such topics as deemed necessary.
3. The learner shall submit the assignment in the offline / online module as
deemed by the individual institutions, which shall be assessed and graded by
the faculty facilitator.
4. The completion of such activity shall be recorded in this section by the learner
and signed by the facilitator
No Title of Assignment Date of Initials of
Submission Facilitator
1

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 9. Case Based Learning Record
Note:
Objectives of Case Based Learning for the phase II graduate medical student are
1. Recognize the relevance of basic sciences in diagnosis, patient-care and treatment
2. Provide a concept that will enhance clinico-pathological correlation,
3. Relate to experience of patients as a motivation to learn,
4. Recognize attitude, ethics and professionalism as integral to the doctor-patient
relationship,
5. Understand the socio-cultural context of diseases through the study of humanities.
Elements of CBL
1. Provision of clinical correlation to pathological mechanisms
2. Integration of morphology and clinical features
3. Bridging the gap between laboratory and clinical practice

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CASE BASED LEARNING SESSION: 1
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 2
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 3
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 4
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 5
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 6
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 7
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 8
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 9
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 10
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 11
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 12
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 13
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 14
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 15
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 16
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 17
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 18
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 19
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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CASE BASED LEARNING SESSION: 20
Date Time Initial of Facilitator

Objective of
CBL Session
Synopsis of Learning
Clinical History:

Laboratory Findings:

Gross Findings:

Microscopic Findings:

Reflections:

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 10. Integrated Learning Record
Note
1. This section includes academic milestones attained through horizontal and vertical
integrated sessions.
2. The learner shall attend all such integrated sessions and observe, interact and understand
the topic.
3. The learner shall submit the end of session assessment (eq: MCQ session of 15- 20 MCQ
questions)
4. The completion of such activity shall be recorded in this section by the learner and signed by
the facilitator
No Topic of the Integrated Date of Initials of
Session Session Facilitator
1

10

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 11. Self-Directed Learning Record
SDL helps in empowering the student to perform an objective self-assessment of knowledge
and skills, continue learning, refine existing skills and acquire new skills, to apply newly gained
knowledge or skills to the care of the patient, to introspect and utilize experiences, to enhance
personal and professional growth and learning, to search (including through electronic means),
and critically evaluate the medical literature and apply the information in the care of the patient
and to identify and select an appropriate career pathway that is professionally rewarding and
personally fulfilling.
Note:
1. This section includes academic milestones attained through self-directed learning.
2. The learner shall be assigned a specific learning objective for each session.
3. The learner shall be given an assignment based on the “Desirable to know” areas of the
curriculum and any other such topics as deemed necessary.
4. They shall record a detailed synopsis of the learning in this section. The student shall also
record a list of the books/journals referred in Vancouver format.
5. The completion of such activity shall be recorded in this section by the learner and signed by
the facilitator

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SDL Session 01:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 02:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 03:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 04:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 05:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 06:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 07:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 08:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 09:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 10:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 11:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 12:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 13:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 14:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 15:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 16:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 17:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 18:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 19:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 20:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 21:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 22:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 23:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 24:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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SDL Session 25:
Date Time Initial of Facilitator

Topic of SDL

Synopsis of the Study

Bibliography

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 12. Attitudes Ethics & Communication
Record
The “Indian Medical Graduate” (IMG) shall possess requisite knowledge, skills, attitudes, values
and responsiveness, so that he or she may function appropriately and effectively as a doctor of
first contact of the community while being globally relevant. In order to fulfill this goal, the IMG
must be able to function in the following ROLES appropriately and effectively:
1. Clinician who understands and provides preventive, promotive, curative, palliative and
holistic care with compassion.
2. Leader and member of the health care team and system with capabilities to collect, analyse,
synthesize and communicate health data appropriately.
3. Communicator with patients, families, colleagues and community.
4. Lifelong learner committed to continuous improvement of skills and knowledge.
5. Professional, who is committed to excellence, is ethical, responsive and accountable to
patients, community and profession.
Note:
1. This section includes academic mile stones attained AETCOM learning. The learner shall be
assigned a specific learning objective for each session.
2. The learner shall be given an assignment based on the AETCOM topics of the curriculum.
3. They shall record a detailed synopsis of the skill learnt in this section. The student shall also
record a reflection of the learning and learning process.
4. The completion of such activity shall be recorded in this section by the learner and signed by
the facilitator

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AETCOM Session 01:
Date Time Initial of Facilitator

Topic of AETCOM

Synopsis of the Skill Learnt

Reflections

74
AETCOM Session 02:
Date Time Initial of Facilitator

Topic of AETCOM

Synopsis of the Skill Learnt

Reflections

75
AETCOM Session 03:
Date Time Initial of Facilitator

Topic of AETCOM

Synopsis of the Skill Learnt

Reflections

76
AETCOM Session 04:
Date Time Initial of Facilitator

Topic of AETCOM

Synopsis of the Skill Learnt

Reflections

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AETCOM Session 05:
Date Time Initial of Facilitator

Topic of AETCOM

Synopsis of the Skill Learnt

Reflections

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AETCOM Session 06:
Date Time Initial of Facilitator

Topic of AETCOM

Synopsis of the Skill Learnt

Reflections

79
AETCOM Session 07:
Date Time Initial of Facilitator

Topic of AETCOM

Synopsis of the Skill Learnt

Reflections

80
AETCOM Session 08:
Date Time Initial of Facilitator

Topic of AETCOM

Synopsis of the Skill Learnt

Reflections

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AETCOM Session 09:
Date Time Initial of Facilitator

Topic of AETCOM

Synopsis of the Skill Learnt

Reflections

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AETCOM Session 09:
Date Time Initial of Facilitator

Topic of AETCOM

Synopsis of the Skill Learnt

Reflections

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 13. Formative Feedback Record
Note:
1. This section captures the process of formative support of the faculty mentors
of the department during the learning and at the end of each section of study /
module of learning.
2. The mentor shall peruse the academic performance, progression and specific
academic needs of the learner.
3. The learner shall record in this section the type of formative assessment, topic
for which it was done, the performance and the feedback given by the learner
to the mentor on the performance, problems in learning, remedial required if
any and the feedback of the mentor.

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Formative Feedback Session No:
Date Time Initial of Facilitator

Type of Formative Assessment 1. Classroom Learning [ ]

2. Assignment [ ]
3. Integrated Learning [ ]
4. Early Clinical Exposure [ ]
5. Self-Directed Learning [ ]
6. AETCOM [ ]
Formative Assessment Done For:
(Topic / Section / Module of
Learning)

Feedback Given by the Learner

Feedback given by the Facilitator

85
Formative Feedback Session No:
Date Time Initial of Facilitator

Type of Formative Assessment 1.Classroom Learning [ ]

2.Assignment [ ]
3.Integrated Learning [ ]
4.Early Clinical Exposure [ ]
5.Self-Directed Learning [ ]
6.AETCOM [ ]
Formative Assessment Done For:
(Topic / Section / Module of
Learning)

Feedback Given by the Learner

Feedback given by the Facilitator

86
Formative Feedback Session No:
Date Time Initial of Facilitator

Type of Formative Assessment 1.Classroom Learning [ ]

2.Assignment [ ]
3.Integrated Learning [ ]
4.Early Clinical Exposure [ ]
5.Self-Directed Learning [ ]
6.AETCOM [ ]
Formative Assessment Done For:
(Topic / Section / Module of
Learning)

Feedback Given by the Learner

Feedback given by the Facilitator

87
Formative Feedback Session No:
Date Time Initial of Facilitator

Type of Formative Assessment 1.Classroom Learning [ ]

2.Assignment [ ]
3.Integrated Learning [ ]
4.Early Clinical Exposure [ ]
5.Self-Directed Learning [ ]
6.AETCOM [ ]
Formative Assessment Done For:
(Topic / Section / Module of
Learning)

Feedback Given by the Learner

Feedback given by the Facilitator

88
Formative Feedback Session No:
Date Time Initial of Facilitator

Type of Formative Assessment 1.Classroom Learning [ ]

2.Assignment [ ]
3.Integrated Learning [ ]
4.Early Clinical Exposure [ ]
5.Self-Directed Learning [ ]
6.AETCOM [ ]
Formative Assessment Done For:
(Topic / Section / Module of
Learning)

Feedback Given by the Learner

Feedback given by the Facilitator

89
Formative Feedback Session No:
Date Time Initial of Facilitator

Type of Formative Assessment 1.Classroom Learning [ ]

2.Assignment [ ]
3.Integrated Learning [ ]
4.Early Clinical Exposure [ ]
5.Self-Directed Learning [ ]
6.AETCOM [ ]
Formative Assessment Done For:
(Topic / Section / Module of
Learning)

Feedback Given by the Learner

Feedback given by the Facilitator

90
Formative Feedback Session No:
Date Time Initial of Facilitator

Type of Formative Assessment 1.Classroom Learning [ ]

2.Assignment [ ]
3.Integrated Learning [ ]
4.Early Clinical Exposure [ ]
5.Self-Directed Learning [ ]
6.AETCOM [ ]
Formative Assessment Done For:
(Topic / Section / Module of
Learning)

Feedback Given by the Learner

Feedback given by the Facilitator

91
Formative Feedback Session No:
Date Time Initial of Facilitator

Type of Formative Assessment 1.Classroom Learning [ ]

2.Assignment [ ]
3.Integrated Learning [ ]
4.Early Clinical Exposure [ ]
5.Self-Directed Learning [ ]
6.AETCOM [ ]
Formative Assessment Done For:
(Topic / Section / Module of
Learning)

Feedback Given by the Learner

Feedback given by the Facilitator

92
Formative Feedback Session No:
Date Time Initial of Facilitator

Type of Formative Assessment 1.Classroom Learning [ ]

2.Assignment [ ]
3.Integrated Learning [ ]
4.Early Clinical Exposure [ ]
5.Self-Directed Learning [ ]
6.AETCOM [ ]
Formative Assessment Done For:
(Topic / Section / Module of
Learning)

Feedback Given by the Learner

Feedback given by the Facilitator

93
Formative Feedback Session No:
Date Time Initial of Facilitator

Type of Formative Assessment 1.Classroom Learning [ ]

2.Assignment [ ]
3.Integrated Learning [ ]
4.Early Clinical Exposure [ ]
5.Self-Directed Learning [ ]
6.AETCOM [ ]
Formative Assessment Done For:
(Topic / Section / Module of
Learning)

Feedback Given by the Learner

Feedback given by the Facilitator

94
Formative Feedback Session No:
Date Time Initial of Facilitator

Type of Formative Assessment 1.Classroom Learning [ ]

2.Assignment [ ]
3.Integrated Learning [ ]
4.Early Clinical Exposure [ ]
5.Self-Directed Learning [ ]
6.AETCOM [ ]
Formative Assessment Done For:
(Topic / Section / Module of
Learning)

Feedback Given by the Learner

Feedback given by the Facilitator

95
Formative Feedback Session No:
Date Time Initial of Facilitator

Type of Formative Assessment 1.Classroom Learning [ ]

2.Assignment [ ]
3.Integrated Learning [ ]
4.Early Clinical Exposure [ ]
5.Self-Directed Learning [ ]
6.AETCOM [ ]
Formative Assessment Done For:
(Topic / Section / Module of
Learning)

Feedback Given by the Learner

Feedback given by the Facilitator

96
Formative Feedback Session No:
Date Time Initial of Facilitator

Type of Formative Assessment 1.Classroom Learning [ ]

2.Assignment [ ]
3.Integrated Learning [ ]
4.Early Clinical Exposure [ ]
5.Self-Directed Learning [ ]
6.AETCOM [ ]
Formative Assessment Done For:
(Topic / Section / Module of
Learning)

Feedback Given by the Learner

Feedback given by the Facilitator

97
Formative Feedback Session No:
Date Time Initial of Facilitator

Type of Formative Assessment 1.Classroom Learning [ ]

2.Assignment [ ]
3.Integrated Learning [ ]
4.Early Clinical Exposure [ ]
5.Self-Directed Learning [ ]
6.AETCOM [ ]
Formative Assessment Done For:
(Topic / Section / Module of
Learning)

Feedback Given by the Learner

Feedback given by the Facilitator

98
Formative Feedback Session No:
Date Time Initial of Facilitator

Type of Formative Assessment 1.Classroom Learning [ ]

2.Assignment [ ]
3.Integrated Learning [ ]
4.Early Clinical Exposure [ ]
5.Self-Directed Learning [ ]
6.AETCOM [ ]
Formative Assessment Done For:
(Topic / Section / Module of
Learning)

Feedback Given by the Learner

Feedback given by the Facilitator

99
 14. A. Formative Assessment Record - Theory
Note:
1. This section captures the process of Assessment data of the learner at the
end of each section of study / module of learning.
2. The learner shall record their performance and get it verified by the facilitator
No Assessment Total Marks / Marks / Grade Initials of the
Topic Grade Scored Facilitator

4
5
6

10

11

12

13
14
15

16

100
 14. B. Formative Assessment Record – Practical

Note:
1. This section captures the process of Assessment data of the learner at the
end of each section of study / module of learning.
2. The learner shall record their performance and get it verified by the facilitator
No Assessment Total Marks / Marks / Grade Initials of the
Topic Grade Scored Facilitator

4
5
6

10

11

12

13
14
15

16

101
 15. Certification of Skills
Note:
1. This section captures the skills and competencies obtained by the learner
during the course work in the department.
2. The facilitator shall assess the learner for the specific certifiable competency
and those certifiable competencies which the learner has acquired shall be
entered in this section. A record of these is also maintained in the assessment
record. (certifiable competencies for which the learner has not successfully
passed the assessment shall not be recorded here)
No List of Skills to be certified Initials of
the
Facilitator
1

102
Certification of Skills - Competency PA: __
Type of Skill

Type of Assessment

Performance of Student

Feed Back of Learner

Feed Back of Facilitator

Remedial Action Suggested

Remedial Assessment 1 Date

Performance of Student

Remedial Assessment 2 Date

Performance of Student

Remedial Assessment 3 Date

Performance of Student

Remedial Assessment 4 Date

Performance of Student

Remedial Assessment 5 Date

Performance of Student

103
Certification of Skill (COS) Certified Not Certified
Date of COS
Signatures Learner Facilitator Professor

104
Certification of Skills - Competency PA: __
Type of Skill

Type of Assessment

Performance of Student

Feed Back of Learner

Feed Back of Facilitator

Remedial Action Suggested

Remedial Assessment 1 Date

Performance of Student

Remedial Assessment 2 Date

Performance of Student

Remedial Assessment 3 Date

Performance of Student

Remedial Assessment 4 Date

Performance of Student

Remedial Assessment 5 Date

Performance of Student

105
Certification of Skill (COS) Certified Not Certified
Date of COS
Signatures Learner Facilitator Professor

106
Certification of Skills - Competency PA: __
Type of Skill

Type of Assessment

Performance of Student

Feed Back of Learner

Feed Back of Facilitator

Remedial Action Suggested

Remedial Assessment 1 Date

Performance of Student

Remedial Assessment 2 Date

Performance of Student

Remedial Assessment 3 Date

Performance of Student

Remedial Assessment 4 Date

Performance of Student

Remedial Assessment 5 Date

Performance of Student

107
Certification of Skill (COS) Certified Not Certified
Date of COS
Signatures Learner Facilitator Professor

108
Certification of Skills - Competency PA: __
Type of Skill

Type of Assessment

Performance of Student

Feed Back of Learner

Feed Back of Facilitator

Remedial Action Suggested

Remedial Assessment 1 Date

Performance of Student

Remedial Assessment 2 Date

Performance of Student

Remedial Assessment 3 Date

Performance of Student

Remedial Assessment 4 Date

Performance of Student

Remedial Assessment 5 Date

Performance of Student

109
Certification of Skill (COS) Certified Not Certified
Date of COS
Signatures Learner Facilitator Professor

110
Certification of Skills - Competency PA: __
Type of Skill

Type of Assessment

Performance of Student

Feed Back of Learner

Feed Back of Facilitator

Remedial Action Suggested

Remedial Assessment 1 Date

Performance of Student

Remedial Assessment 2 Date

Performance of Student

Remedial Assessment 3 Date

Performance of Student

Remedial Assessment 4 Date

Performance of Student

Remedial Assessment 5 Date

Performance of Student

111
Certification of Skill (COS) Certified Not Certified
Date of COS
Signatures Learner Facilitator Professor

112
Certification of Skills - Competency PA: __
Type of Skill

Type of Assessment

Performance of Student

Feed Back of Learner

Feed Back of Facilitator

Remedial Action Suggested

Remedial Assessment 1 Date

Performance of Student

Remedial Assessment 2 Date

Performance of Student

Remedial Assessment 3 Date

Performance of Student

Remedial Assessment 4 Date

Performance of Student

Remedial Assessment 5 Date

Performance of Student

113
Certification of Skill (COS) Certified Not Certified
Date of COS
Signatures Learner Facilitator Professor

114
Certification of Skills - Competency PA: __
Type of Skill

Type of Assessment

Performance of Student

Feed Back of Learner

Feed Back of Facilitator

Remedial Action Suggested

Remedial Assessment 1 Date

Performance of Student

Remedial Assessment 2 Date

Performance of Student

Remedial Assessment 3 Date

Performance of Student

Remedial Assessment 4 Date

Performance of Student

Remedial Assessment 5 Date

Performance of Student

115
Certification of Skill (COS) Certified Not Certified
Date of COS
Signatures Learner Facilitator Professor

116
Certification of Skills - Competency PA: __
Type of Skill

Type of Assessment

Performance of Student

Feed Back of Learner

Feed Back of Facilitator

Remedial Action Suggested

Remedial Assessment 1 Date

Performance of Student

Remedial Assessment 2 Date

Performance of Student

Remedial Assessment 3 Date

Performance of Student

Remedial Assessment 4 Date

Performance of Student

Remedial Assessment 5 Date

Performance of Student

117
Certification of Skill (COS) Certified Not Certified
Date of COS
Signatures Learner Facilitator Professor

118
 16. Record of Projects
Note:
1. The learner may undertake a scholastic project of 1-2 months in the form of a
clinical project or community project or research project.
2. These are based on the preferences of individual institutes.
3. The projects are voluntary activity and not included for internal assessment.

Clinical Project [ ]
Type of Project Community Project [ ]
Research Project [ ]
Title of Project

Synopsis of the Work

119
Signature of
Facilitator

120
 17. Photo Story
Note:
1. This section shall include the important moments of the process of
development which shall be documented for the student and the department
2. These may be eg: prizes won, competitions attended, department activities
etc.
3. These are based on the preferences of individual institutes.
4. The projects are voluntary activity and not included for internal assessment.

121
 18. Record of Co-Curricular Activities
Note:
1. This section shall include the important co-curricular activities in which the
student is involved during the academic year which shall be documented for
the student and the department
2. These may be eg: prizes won, competitions attended, etc.
3. These are based on the preferences of individual institutes.
4. The projects are voluntary activity and not included for internal assessment.

122