LOG-BOOK. for Students in their Clinical-Practical Year (CPY) Valid from

LOG-BOOK for Students in their Clinical-Practical Year (CPY) Valid from This log-book belongs to Student ID Number: First name: Surname: 1

Compulsory module: Surgery Surgical discipline Hospital Mentor CPY-period from to My absences days Student s signature Doctor s signature Stamp of Clinic Weekly timetable Time Monday Tuesday Wednesday Thursday Friday 2

I attended the following lectures/training units: No. Topic/Content Date I worked on the following problems/cases: Case Demonstrated/ received feedback I have studied the following topics/cases (self-study): Appointments with the mentor: Date Content/Agreement Closing meeting 3

Assessment of student by mentor during the CPY module Criteria I. I. Life Long Learning 1.1 Willingness to acquire new knowledge - - below expectations - borderline 100% meets expectations + above expectations ++ outstanding (please indicate relevant) Comment/ Other information 1.2 Willingness to deal with evidencebased literature [EBM- steps, scientific papers ] II. Social Skills 2.1 Empathy 2.2 Teamwork - Collegiality [dealing with special assignments, giving assistance ] 2.3 Communication Skills III. Medical expertise 3.1 Exchange of information [willingness to obtain information and to pass on information ] 3.2 Working accuracy [careful performance of tasks, handling of mistakes and deficiences...] 3.3 Commitment - Personal initiative [personal effort, acceptance of responsibility, contribution of ideas ] 3.4 Time management Work organisation [to deliver within the agreed time, priorisation of tasks ] 3.5 Health and safety in the workplace [hygiene standards, patient safety ] Anything especially good? Suggestions for development: Student s signature Assessor s signature 4

Notes 5

Compulsory module: Internal medicine Subspeciality Clinic Mentor CPY-period from to My absences days Student s signature Doctor s signature Stamp of Clinic Weekly timetable Time Monday Tuesday Wednesday Thursday Friday 6

I attended the following lectures/training units: No. Topic/Content Date I worked on the following problems/cases: Case Demonstrated/ received feedback I have studied the following topics/cases (self-study): Appointments with the mentor: Date Content/Agreement Closing meeting 7

Assessment of student by mentor during the CPY module Criteria IV. I. Life Long Learning 1.1 Willingness to acquire new knowledge - - below expectations - borderline 100% meets expectations + above expectations ++ outstanding (please indicate relevant) Comment/ Other information 1.2 Willingness to deal with evidencebased literature [EBM- steps, scientific papers ] V. Social Skills 2.1 Empathy 2.2 Teamwork - Collegiality [dealing with special assignments, giving assistance ] 2.3 Communication Skills VI. Medical expertise 3.1 Exchange of information [willingness to obtain information and to pass on information ] 3.2 Working accuracy [careful performance of tasks, handling of mistakes and deficiences...] 3.3 Commitment - Personal initiative [personal effort, acceptance of responsibility, contribution of ideas ] 3.4 Time management Work organisation [to deliver within the agreed time, priorisation of tasks ] 3.5 Health and safety in the workplace [hygiene standards, patient safety ] Anything especially good? Suggestions for development: Student s signature Assessor s signature 8

Notes 9

For the elective module Discipline / Subspeciality Hospital Mentor CPY-period from to My absences days Student s signature Doctor s signature Stamp of Clinic Weekly timetable Time Monday Tuesday Wednesday Thursday Friday 10

I attended the following lectures/training units: No. Topic/Content Date I worked on the following problems/cases: Case Demonstrated/ received feedback I have studied the following topics/cases (self-study): Appointments with the mentor: Date Content/Agreement Closing meeting 11

Assessment of student by mentor during the CPY module Criteria VII. I. Life Long Learning 1.1 Willingness to acquire new knowledge - - below expectations - borderline 100% meets expectations + above expectations ++ outstanding (please indicate relevant) Comment/ Other information 1.2 Willingness to deal with evidencebased literature [EBM- steps, scientific papers ] VIII. Social Skills 2.1 Empathy 2.2 Teamwork - Collegiality [dealing with special assignments, giving assistance ] 2.3 Communication Skills IX. Medical expertise 3.1 Exchange of information [willingness to obtain information and to pass on information ] 3.2 Working accuracy [careful performance of tasks, handling of mistakes and deficiences...] 3.3 Commitment - Personal initiative [personal effort, acceptance of responsibility, contribution of ideas ] 3.4 Time management Work organisation [to deliver within the agreed time, priorisation of tasks ] 3.5 Health and safety in the workplace [hygiene standards, patient safety ] Anything especially good? Suggestions for development: Student s signature Assessor s signature 12

Notes 13