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Pediatrics
Logbook
2
3
وب ردتايسلس ب ردس و فشارس و تسيفشتسملا
فشس وب ردا فشس وب ردا
يفشتسس فابس وب ردا يفشتسس فابس وب ردا (ميفس ل لااس و فشار)
(ميفس ل لااس و فشار)
ىايشسمياشس وب ردا ىايشسمياشس وب ردا
فشس وب ردا فشس وب ردا
يفشتسس فابس وب ردا (ميفس ل لااس و فشار)
يفشتسس فابس وب ردا (ميفس ل لااس و فشار)
ىايشسمياشس وب ردا ىايشسمياشس وب ردا
متالايسمنعتةسصخس وب فشت
س سفش
سياشالس وبتات
سسس وينف ا
سسشششسيبىتلس د لوةس وبلنة
سشششس و اتدفا
سشششس وب بفر
سس ووبافس اود بللت
سسس و نعل
سسياشالس وةوفرسماود اوةس وبعباة
ةيصخش ةروص
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Topic page
Instructions for the use of the logbook 7
Patients’ cases Log 9
Case registry tables 19
Neonatology 20
Emergency 26
Infectious diseases 32
Nutrition 36
Allergy 40
Respiratory 44
Cardiac 48
Gastroenterology 52
Nephrology 54
Endocrine 56
Hematology 58
Genetics 60
Metabolic 62
Neurology 64
Psychiatry 66
Ophthalmic 68
Dermatology 70
Rheumatology 72
Procedures log 75
Procedures registration tables 81
Academic activities 91
Interesting cases 99
Rotation proof 107
CONTENTS...
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Instructions for the use of logbook
Aim of the logbook
The purpose of the logbook is to provide one source of evidence for the specialty scientific council that you attained
the desired level of competency required for licensure. It is the place where you are going to document experiences
and skills you attained during your training.
The logbook is divided into several sections. These instructions will help you completing those sections correctly.
Personnel information
Please fill in all your personnel information required. This will help the Egyptian Fellowship Administrators to proc-
ess your logbook during scientific council evaluation yearly and finally before sitting for the final exam. Your person-
nel photo should be attached to the logbook and you should sign the personnel information page
Clinical case log
1. You will find lists with all required cases in the curriculum. Your level of participation in each case will be deter-
mined by your trainer
2. Please fill in the following information for each case you register in the logbook:
Name, age, hospital serial number, summary of clinical presentations, summery of diagnostic workup, man-
agement , patient final diagnosis and outcome of treatment
3. For each case write the date of the interview
4. Each case should be counter signed by your trainer. His signature is the proof of your actual participation
Procedures’ log
1. The logbook contains tables for required procedures during different stages of training and the level of desired
performance at each stage.
2. You will also find empty tables to write down :
The patient’s name and hospital number
Diagnosis and indications for the procedure
Name of the performed procedure
Level of trainee participation ( Observer, Perform under supervision, Perform independently)
3. You should write the date of the procedure and your trainer should countersign each procedure to document the
event
Academic activities
1. Academic activities that must be documented are journal clubs, lecture, morbidity and mortality meetings and
workshops or conferences attended.
2. You will find a list of required journal clubs in your curriculum. Some scientific councils prefer that you and your
trainer determine the scientific content of the journal club based on your learning needs. In that situation you will
find empty tables, where you will record the topic and date of the journal club and it should be signed by trainer/
supervisor.
3. Workshops and conferences tables are the place where you will record your CME activities whether inside or out-
side the training center. Any attended activity must be signed by the workshop or conference organizer/
coordinator
Rotation Proof
Your scientific council has determined specific rotations in subspecialties that you must go through during the
training period (see your curriculum for details). After you finish each rotation sign its block by the Hospital/
training center manager and stamp officially.
Assessment of logbook activities
1. Your trainer will assess your logbook weekly for completion and provide feedback
2. Your educational supervisor will assess your logbook monthly or every two months, provide verbal or written
feedback and counter sign important activities
3. The examination committee of the scientific council will revise your logbook:
A) Annually before you progress from one year of training to another
B) At the end of training before the final exam
To be noted that unsatisfactory completion of the logbook would lead to delay of training progression.
Unsatisfactory logbook at the end of training will prevent you from entering the final exam
Important Notice:
It is your responsibility to maintain accurate and completed logbook and to regularly update your records. Shall you
meet any difficulty; you must contact your trainer or your specialty administrator at the Egyptian Fellowship Board.
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Patients' Case Log
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Case description
Minimum
Number
of cases
Neonatology
Digestive system Normal neonate at delivery room 30
Necrotizing enterocolitis 10 Premature infants at different age ranges 30
Neonatal jaundice 30 Intrauterine growth retardation 20
Duodenal Artesia, GIT anomalies & dia-
phragmatic hernia 5 Large for gestational age 20
Blood disease Post-term infants 20
Hemorrhagic disease of the
newborn 10 Erbs’ paralysis 5
Haemolytic disease of newborn 20 Neonatal visceral injuries 3
Neonatal anaemia 5 Neonatal skeletal injuries 3
Neonatal thrombocytopenia 5 Neonatal renal anomalies 3
Endocrine and metabolic disorders Hydrocephalus 5
Infant of diabetic mother 01 Myelomeningocele 3
Hypoglycaemia 01 Hypoxic-ischemic
encephalopathy 10
Hypocalcaemia 01 Neonatal respiratory and cardiac problems
Infections Hyaline membrane disease 15
Neonatal sepsis & meningitis 20 Apnoea and Transient
tachypnea of the newborn 30
Congenital infections 10 Meconium aspiration 10
Other neonatal problems Persistent pulmonary
hypertension of the newborn 3
Dysmorphic neonates 10 Neonatal pneumonia 20
Neonatal convulsions 20 Pulmonary haemorrhage 2
Neonatal hypotension and
hypertension 10 Congenital emphysema 2
Neonatal hypothermia and
hyperthermia 10 Neonatal cyanosis 20
12
Case description
Minimum
Number
of cases
Emergency Medicine
Metabolic emergencies Respiratory emergencies
Electrolyte disturbances with or without dehydra-
tion 30 Stridor 20
Acid-base disturbances 20 Wheezy infants and bronchial asthma 30
Diabetic ketoacidosis 10 Pneumonia , effusion and
pneumothorax 40
Addisonian crises 3 Foreign body inhalation 5
Urea cycle defects 1 Respiratory failure due to various causes 10
Aminoacidopathies 1 Cardiac emergencies 5
Hepatic coma 5 Arrhythmias 5
Hematological emergencies Cyanotic spell 10
Acute hemolytic crises 10 Heart failure 5
Sickle cell anemia in crises 5 Cardiogenic shock 2
Febrile neutropenia 2 Neurological emergencies
Severe pallor for D.D 5 Coma 15
Hypercoagulable conditions and DIC 5 Convulsions 30
Other emergencies Stroke 3
Childhood injuries 10 Sudden weakness/ paralysis 3
Burns and surgical emergencies 10 Increased intracranial tension 5
Shock due to different causes 15 Hypertensive encephalopathy 2
Sepsis 10 4 5
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Minimum
Number of cases Pediatric infections
30 Febrile children with and without focus
30 Febrile infants with and without focus
10 Septicemia and septic shock
5 Febrile neutropenia
30 Tonsillitis, pharyngitis, croup and other upper respiratory tract infections
30 Bronchitis , Pneumonia and bronchiolitis
20 Gastroenteritis
10 Urinary tract infection
20 Conjunctivitis and Otitis media
10 Meningitis and encephalitis
5 Congenital infection
2 Infective endocarditis
2 Infection related to central venous line
5 Fever of unknown origin
20 Fever with rash
Minimum
Number of cases Allergy and Immunology
30 Bronchial asthma
10 Allergic rhinitis
5 Cow milk allergy
2 Angioedema
10 Urticaria
10 Atopic dermatitis
10 Insect bite allergy
15 Recurrent infections
14
Minimum
Number of cases Gastroenterology and Hepatology cases
30 Abdominal pain (acute and chronic)
40 Acute & chronic diarrhea with and without dehydration
30 Vomiting in infants, neonates and children
20 Gastroesophageal reflux
20 Abdominal distension
15 Constipation
5 Dysphagia
5 Malabsorption
10 GIT bleeding
5 GIT congenital malformation
10 Cholestatic Jaundice in neonates, infants and children
20 Hepatomegaly for differential diagnosis
10 Portal hypertension and GIT bleeding
5 Liver cell failure
Minimum
Number of cases Cardiology Cases
20 Neonates and children with cyanotic heart disease
20 Child with rheumatic heart disease
5 Infant with arrhythmia
10 Infants and Children with non cyanotic congenital heart disease
5 Child with innocent murmur
5 Child with non-renal hypertension
5 Child with chest pain
5 Infants and children with heart failure
Minimum
Number of cases Pediatric respiratory problems
50 Sore throat, pharyngitis, tonsillitis and cervical lymphadenopathy
20 Croup and stridor
15 Snoring and obstructive sleep apnea
20 Earache
30 Bronchial asthma and the wheezy infant
15 Chronic cough, congenital anomalies and pleural space disorders.
30 Lower respiratory tract infections including bronchiolitis and pneumonia
20 Chronic lung problems including cystic fibrosis, bronchiectasis, interstitial lung diseases & chronic chest infections
15
Minimum
Number of cases Rheumatology cases
10 Joint swelling
10 Joint or bony pains
5 Limping
5 Back pain
3 Bow legs and knock knees
2 torticollis
5 juvenile rheumatoid arthritis
5 systemic lupus erythematosus
10 fever of unknown origin
5 Henoch Schönlein purpura
2 Mediterranean fever
5 Other connective tissue disorders
Minimum
Number of cases Nephrology/ Urology cases
15 Nephrotic syndrome
10 Acute nephritis
10 Acute renal failure
5 Chronic renal failure
5 Hypertension
20 Voiding disorders including nocturnal enuresis, dysuria, frequency and polyuria
20 Urinary tract infection
2 Tubular disorders
10 Hematuria for differential diagnosis
5 Proteinuria for differential diagnosis
5 Congenital anomalies of the kidney and urogenital system
Minimum
Number of cases Metabolic diseases
2 Phenylketonuria
2 Homocystinuria
2 Galactosemia
2 Organic acidopathies
2 Urea cycle defect
5 glycogen storage disease
2 Mucopolysaccaridosis
16
Minimum
Number of cases Neurology cases
30 Seizures in infants and children
30 Headache due to various causes
20 Hydrocephalus and microcephaly
10 Neural tube defects
10 Coma and altered level of consciousness
5 CNS trauma
5 Acute focal neurological signs
15 Cerebral palsy
5 Neurodevelopment regression
5 Acute flaccid paralysis
5 Hypotonia , myopathies and neuropathies
15 CNS infections (meningitis, encephalitis and brain abscess)
10 Chorea, ataxia and other movement disorders
Minimum
Number of cases Hematology cases
30 Nutritional anemia
10 Sickle cell anemia
10 Thalassemia
10 Hemophilia
2 Von Willebrand disease
2 Christmas disease
10 Immune thrombocytopenia (ITP)
2 Platelet function defect
2 Bone marrow failure
2 Fanconi anemia
20 G6PD deficiency
Minimum
Number of cases Genetic Disorders
15 Down syndrome (trisomy 21)
2 Trisomy 18
2 Trisomy 13
2 Turner syndrome
1 Klienfilter syndrome
2 Fragile X syndrome
2 Achondroplasia
1 Neurofibromatosis
2 Marfan syndrome
5 Multiple congenital malformations
5 Dysmorphic features
17
Minimum
Number of cases Endocrinology cases
10 Child with diabetes
5 DKA
5 Normal variant short stature
5 Syndromes with obesity
5 Growth hormone deficiency
5 Turner syndrome
5 Hypothyroidism
3 Delayed Puberty
1 Graves’ disease
1 Precocious puberty
5 Tall stature
5 Obesity
2 Diabetes insipid us
5 Ambiguous genitalia
1 Addison disease
Minimum
number of cases Psychiatric problems
3 Autism
5 Attention deficit hyperactivity disorders
3 Antisocial behavior (conduct disorders)
3 Suspected child abuse
5 Sleep disorders and nocturnal enuresis
3 Learning disabilities
Minimum
number of cases Eye Problems
20 Red eye
10 Possible squint
5 Ptosis
3 Proptosis
5 Abnormal eye movement
2 Congenital cataracts
5 Eye trauma and injury
3 Visual impairment due to various causes
1 Eye tumors (retinoblastoma)
18
Minimum
Number of cases Dermatology cases
30 Bacterial skin infection
30 Diaper rash and other fungal skin infection
20 Fever with Maculo-papular rash
10 Chicken pox and other vesicular eruptions
2 Kawasaki syndrome
5 Steven Johnson syndrome and other cutaneous drug reactions
2 Staphylococcal scalded skin syndrome
2 Epidermolysis bullosa
10 Eczema
10 Acne
2 Erythema nodosum
10 Seborrheic dermatitis and cradle cap
5 Hyper-pigmented skin lesions
Minimum
Number of cases Nutrition
30 Nutritional assessment in apparently normal infants
20 Nutritional assessment in apparently normal child
20 Rickets due to various causes
15 Marasmus
5 kwashiorkor
20 Infants with breast feeding problems
20 Iron deficiency anemia
10 Cases with nutritional problems due to various systemic disorders
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Case Registration Tables
20
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
21
Neonatology
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
22
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
23
Neonatology
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
24
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
25
Neonatology
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
26
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
27
Pediatric emergency
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
28
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
29
Pediatric emergency
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
30
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
31
Pediatric emergency
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
32
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
33
Pediatric infectious diseases
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
34
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
35
Pediatric infectious diseases
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
36
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
37
Nutrition and nutritional problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
38
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
39
Nutrition and nutritional problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
40
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
41
Allergic diseases
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
42
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
43
Allergic diseases
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
44
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
45
Respiratory problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
46
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
47
Respiratory problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
48
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
49
Cardiac problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
50
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
51
Cardiac problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
52
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
53
Gastroenterology problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
54
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
55
Nephrology problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
56
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
57
Endocrine problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
58
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
59
Hematology problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
60
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
61
Genetic problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
62
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
63
Metabolic problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
64
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
65
Neurology problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
66
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
67
Psychiatry problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
68
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
69
Ophthalmic problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
70
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
71
Dermatology problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
72
Patients’ case Log
Patient’s Name & age Hospital
Number Summary of Clinical Findings Diagnostic Workup
73
Rheumatology problems
Summary of Management Final Diagnosis Outcome Trainer’s Signature
& date
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Procedures' Log
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Neonatology
Procedures Year-1 Year-2 Year-4 Year-3
Neonatal resuscitation in the
delivery room
Observe(10), Performs under supervision (10)
then perform independently (20)
Neonatal resuscitation in the
nursery and NICU
Observe(10), Performs under supervision (10)
then perform independently (20)
Stabilization and transport
after resuscitation
Observe(5), Performs under supervision (5)
then perform independently (20)
Assessment of maturity stage
& anthropometric measure-
ment
Observe(5), Performs under supervision (5)
perform independently (20)
Intravenous line insertion Observe (5), perform under supervision (5) then
perform independently (10)
Nasal-gastric tube insertion Observe (5), perform under supervision (5) then
perform independently (10)
Oro- pharyngeal suction Observe (5), perform under supervision (5) then
perform independently (10)
Supra-pubic tab for urine
analysis and culture
Observe (2), perform under supervision (2)
perform independently (2)
Fluid therapy Observe (5), perform under supervision (10)
then perform independently (10)
Blood product transfusion Observe (5), perform under supervision (10)
then perform independently (10)
Total parenteral nutrition Observe (2), perform under supervision (2)
Endotracheal intubation Observe(10), Performs under supervision (10) then perform independently (10)
Phototherapy Observe(5), Performs under supervision (5) then perform independently (10)
capillary sample by heel prick
& arterial blood gas sample Observe(5), Performs under supervision (5) then perform independently (5)
Central venous line insertion Observe(5), Performs under supervision (5)
Mechanical ventilation Observe(10), Performs under supervision (10) then perform independently (10)
Exchange transfusion Observe(3), Performs under supervision (3) then perform independently (3)
78
Emergency & ICU procedures Year-1 Year-2 Year-3 Year-4
Cardiopulmonary resuscitation Observe(10), Performs under supervision (10) then perform
independently (10)
Intravenous line insertion Observe (5), perform under supervision (5) then perform
independently (10)
Nasal-gastric tube insertion Observe (5), perform under supervision (5) then perform
independently (10)
Oro- pharyngeal suction Observe (5), perform under supervision (5) then perform
independently (10)
Urinary catheter application Observe (5), perform under supervision (5) then perform
independently (10)
Fluid therapy Observe (2), perform under supervision (10) then perform
independently (10)
Blood product transfusion Observe (2), perform under supervision (10) then perform
independently (10)
Endotracheal intubation Observe(10), Performs under supervision (10) then perform
independently (10)
Cardio version Observe(10), Performs under supervision (10) then perform
independently (10)
Arterial sample Observe(5), Performs under supervision (3) then perform
independently (3)
Central venous line insertion Observe(3), Performs under supervision (3)
Mechanical ventilation Observe(10), Performs under supervision (10) then perform
independently (10)
Ascites tap Observe(5), Performs under supervision (5) then perform
independently (5)
Venous cut down Observe(10), Performs under supervision (5)
Wound dressing Observe (5) perform under supervision(5) and perform in-
dependently (5)
Simple Suturing Observe(10), Performs under supervision (10) then perform independently (10)
Chest tube insertion Observe(10), Performs under supervision (10) and perform independently (3)
79
Infection control procedures Year-1 Year-2 Year-3 Year-4
Practice scrupulous aseptic techniques Observe (5), Performs under supervision (5) then perform independently (20)
Respiratory procedures Year-1 Year-2 Year-3 Year-4
Spirometry interpretation Observe (5) Performs under supervision (5) then perform and interpret independently
(20)
Immunology procedures Year-1 Year-2 Year-3 Year-4
Administration of vaccination Observe (5)Performs under supervision (5) then perform independently (10)
Administer Intravenous immunoglobulin Observe (2)Performs under supervision (2) then perform independently (2)
Cardiology Procedures Year-1 Year-2 Year-3 Year-4
Perform and interpret EKG Performs under supervision (5) then perform and interpret independently (20)
Echocardiography Observe (10)
Gastroenterology
procedures Year-1 Year-2 Year-3 Year-4
Fluid replacement therapy Observe (10) Performs under supervision (5) then perform independently (20)
Upper and lower endoscopy Observe (5)
Haematology Procedures Year-1 Year-2 Year-3 Year-4
Blood product transfusion Observation (5) and supervised performance (5) and independent performance
all through after that (20)
Procedures related to nutrition Year-1 Year-2 Year-3 Year-4
Weight , length and height measurement
according to Egyptian growth curves
Observe (10) Performs under supervision (10) then perform and interpret inde-
pendently (30)
80
Rheumatology Procedures Year-1 Year-2 Year-3 Year-4
Joint aspiration in septic arthritis Observation (2)
Nephrology Procedures Year-1 Year-2 Year-3 Year-4
Blood pressure measurement in all four limbs Observation (5) and supervised performance (5) and independent
performance all through after that (20)
Peritoneal dialysis Observation (5) and supervised
performance (5)
Renal imaging and renal biopsy Observation (5)
Neurology
Procedures Year-1 Year-2 Year-3 Year-4
Cerebrospinal fluid tap Observation (5) and supervised performance (5) and independent performance
all through after that (20)
Interpretation of CT
and EEG
Observation 10, supervised
interpretation 20
Ophthalmology Year-1 Year-2 Year-3 Year-4
Measurement of visual acuity Observe (10) Performs under supervision (10) then perform inde-
pendently (10)
Assessment of visual acuity Observe (10) Performs under supervision (10) then perform inde-
pendently (10)
81
Registration Tables
82
Patients’ Procedures Log
Patient’s Name & age Hospital
Number Diagnosis and indications for the procedure
83
Patients’ Procedures Log
Procedure Name
Level of Trainee’s Performance
Trainer’s Signature
& date Observed
Performed
under
Supervision
Performed
Independently
84
Patients’ Procedures Log
Patient’s Name & age Hospital
Number Diagnosis and indications for the procedure
85
Patients’ Procedures Log
Procedure Name
Level of Trainee’s Performance
Trainer’s Signature
& date Observed
Performed
under
Supervision
Performed
Independently
86
Patients’ Procedures Log
Patient’s Name & age Hospital
Number Diagnosis and indications for the procedure
87
Patients’ Procedures Log
Procedure Name
Level of Trainee’s Performance
Trainer’s Signature
& date Observed
Performed
under
Supervision
Performed
Independently
88
Patients’ Procedures Log
Patient’s Name & age Hospital
Number Diagnosis and indications for the procedure
89
Patients’ Procedures Log
Procedure Name
Level of Trainee’s Performance
Trainer’s Signature
& date Observed
Performed
under
Supervision
Performed
Independently
90
91
Academic Activities Log
92
93
Clinical & Staff Rounds
Title of the meeting Location Date Signature of the
meeting coordinator
94
Courses / conferences / workshops
Title of the meeting/ course Location Date Signature of the
meeting organizer
95
Journal Club Title Date Trainer signature
96
Journal Club Title Date Trainer signature
97
Lecture Title Date Instructor signature
98
Lecture Title Date Instructor signature
99
Interesting Cases Log
100
101
Case 1
Date: ………………………………………………………………………………………………………….
Interesting case description:
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Trainer’s/Supervisor’s Comment:
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Trainer’s Signature Educational Supervisor’s Signature
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102
Case 2
Date: ………………………………………………………………………………………………………….
Interesting case description:
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Case 3
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104
Case 4
Date: ………………………………………………………………………………………………………….
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105
Case 5
Date: ………………………………………………………………………………………………………….
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106
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Rotations finished during the training year
Hospital manager signature after the end of rotation and the signature must be stamped.
Rotation 1 Rotation 2 Rotation 3
Rotation Name
Date
Hospital manager’s
signature
Hospital Stamp
