LOG BOOK

ILMU PENYAKIT DALAM

PROGRAM STUDI PENDIDIKAN DOKTER

UNIVERSITAS JAMBI
Mahasiswa : _____________________________________________
NIM : _____________________________________________
Waktu Rotasi : _____________________________________________
Tanda Tangan : _____________________________________________

Foto
(3x4 berwarna)

Preseptor :
Tanda Tangan :
I. BED SIDE TEACHING (BST)

Nama/No.MR
No. Diagnosis Tgl Tanda Tangan
Pasien

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

Pendidikan Profesi Dokter PSPD UNJA 2

 17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

Bed side teaching dimulai minggu pertama

Minimum tiga (3) kasus/minggu
Satu Pasien untuk dua (2) orang mahasiswa
Selama siklus satu (1) mahasiswa dapat minimal dua (2) kali,
Maksimal tiga (3) kali

II. CASE REPORT SESSION (CRS)

Pendidikan Profesi Dokter PSPD UNJA 3

 Nama/No.MR
No. Diagnosis Tgl Tanda Tangan
Pasien

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Satu (1) mahasiswa minimal dapat satu (1) kasus

Satu (1) kasus untuk dua (2) tiga (3) mahasiswa
Satu minggu hanya satu (1) kegiatan case report

III. CLINIK SCIENCE SESSION (CSS)

Pendidikan Profesi Dokter PSPD UNJA 4

 No. Topik Tgl Tanda Tangan
1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Satu (1) siklus mahasiswa mendapat minimal satu (1) topik

Satu (1) topik untuk dua (2) tiga (3) mahasiswa
Topik ditentukan oleh koordinator pendidikan atau kepala bagian

IV. PEMERIKSAAN DAN PROSEDUR YANG TELAH

DIKERJAKAN (kompetensi 3 dan 4)

Pendidikan Profesi Dokter PSPD UNJA 5

No. Pemeriksaan/Prosedur Tanggal Supervisor Nilai/TT
1. Anamnesis
- Riwayat penyakit sekarang
- Riwayat penyakit dahulu
- Riwayat penyakit keluarga
- Heteroanamnesis
- Interaksi dengan keluarga
pasien sakit keras

2. Pemeriksaan fisik
- Keadaan umum : tanda
vital (TD, nadi, RR, T);
penilaian kesadaran; BB;
TB; derajat dehidrasi

3. Pemeriksaan Fisik kepala

dan leher
- Inspeksi mata (konjungtiva,
sklera), hidung, mulut,
tenggorokan
- Palpasi kelenjar ludah,
tiroid, limfonodi leher
- Menilai JVP

4. Pemeriksaan fisik thoraks

- Inspeksi dada
- Palpasi fremitus, denyut
apeks
- Perkusi paru, ukuran
jantung
- Auskultasi jantung dan paru

5. Pemeriksaan fisik abdomen

- Inspeksi dinding/
permukaan abdomen

Pendidikan Profesi Dokter PSPD UNJA 6

 - Palpasi dinding abdomen
- Perkusi hepar dan lien
- Auskultasi usus dan bising
usus
- Menilai nyeri abdomen dan
rebound tenderness
- Menilai pekak alih (shifting
dullnes)
- Menilai fluid thrill
- Menilai renal tenderness

6. Pemeriksaan fisik
ekstremitas
- Inspeksi kulit, kuku, tonus,
sendi
- Palpasi kulit, tendon, sendi,
edema
- Menilai denyut kapiler/
arteri
- Deteksi bising

7. Melakukan uji rumple leede

8. Pungsi vena

9. Tes prick

10. Menginterpretasikan hasil

pemeriksaan darah rutin

11. Menginterpretasikan hasil

pemeriksaan urin dan feses
rutin

12. Menginterpretasikan hasil

gas darah

13. EKG

Pendidikan Profesi Dokter PSPD UNJA 7

14. Pemasangan NGT

15. Pemasangan infus

16. Memberi nasehat tentang

gaya hidup sehat

17. Merencanakan diet

18. Subkutan
Melakukan injeksi
- Subkutan
- Intramuskuler
- intravena

19. Memberikan insulin

20. Resusitasi kardioplumoner

21. Resusitasi cairan

22. Resusitasi koma

23. Kateter kandung kemih

24. Transfusi

Minimum ................. pemeriksaan dan Prosedur

Penilaian oleh konsulen non preseptor
V. PROSEDUR YANG PERNAH DIOBSERVASI
(kompetensi 1 dan 2)

Pendidikan Profesi Dokter PSPD UNJA 8

No. Prosedur Tanggal Dokter Nilai/TT
1. Pungsi arteri

2. Membaca foto thorak

3. Spirometri

4. Endoskopi

5. Bronkoskopi

6. USG abdomen

7. Treadmill test

8. Ekokardiografi

9. Biopsi ginjal dan hepar

10. Pungsi cairan ascites

11. Pungsi cairan pleura

12. Pungsi cairan sendi

13. Renal dialysis/ CAPD

14. Sclerothrapy untuk

varises dan ligasi
15. BMP
16. Kanulasi intravena
Minimum ....... Prosedur
Penilaian oleh konsulen non preseptor dan residen tahap III ke atas
yang sudah di subbagian tersebut.
VI. OPERASI YANG PERNAH DIOBSERVASI

Pendidikan Profesi Dokter PSPD UNJA 9

No. Prosedur Tanggal Dokter Nilai/TT
1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

Minimum ................ Operasi

Penilaian oleh konsulen non preseptor dan residen yang bertindak
sebagai operator.

Pendidikan Profesi Dokter PSPD UNJA 10

 BED SIDE TEACHING
Date :
Diagnosis/Patients problem(s) :
Setting : a. Out-patient b. In-Patient c. Emergency Deptd. Other
Patients information : Age: Sex: New/Follow up:
Focus : a. Data gathering b. Diagnosis c. Therapy d. Counseling

Final Result
N Students name NIM 1 2 3 4 5 6 7 (average 1-7)
o.
1.
2.
3.
4.
5.
6.
7.
8.

Items to be evaluated :
1. Medical interviewing Skiils : Patents history
2. Physical Examination Skiils : patients physical examination

Pendidikan Profesi Dokter PSPD UNJA 11

3. Humanistic Qualities/Profesionalism
4. Clinical Judgement & Information gathering
5. Counseling
6. Organization / Efficiancy
7. Overall Clinical Competence
: Profesionalism to patients to other health care team, peers.
: Encompasses fund of knowledge AND ability to interpret and
synthesize data into an assessment and plan.
: Interpersonal & communication Skills.
: Management-recording and presenting data gatherd from
history and physical exam.
: Self-assessment; reading, critical appraisal, and use of
information echnology to enhance clinical skiils patients care;
recognizing arrors and fro mistakes.

Scale : LOW 1 2 3 4 5 6 7 8 9 HIGH

56 60 64 68 73 78 80 90 100
C C+ C++ B B+ B++ A

Pendidikan Profesi Dokter PSPD UNJA 12

MINI CLINICAL EVALUATION EXERCISE (MINI-CEX) FORM
Students Name :
Date :
Diagnosis/Patients problem (s) :
Setting : a. Out-patient b. In-Patient c. Emergency Dept
Patients information :
Age : Sex : New/Follow up :
Focus : a. Date gathering b. Diagnosis c. Therapy d. Counseling

1. Medical interviewing Skiils : Not Observed

1 2 3 4 5 6 7 8 9
UNSATISFACTORY SATISFACTORY SUPERIOR
2. Physical Examination Skiils : Not Observed
1 2 3 4 5 6 7 8 9
UNSATISFACTORY SATISFACTORY SUPERIOR
3. Humanistik Qualities/Profesionalsm : Not Observed
1 2 3 4 5 6 7 8 9
UNSATISFACTORY SATISFACTORY SUPERIOR
4. Clical Judgement & informasi gathering : Not Observed
1 2 3 4 5 6 7 8 9
UNSATISFACTORY SATISFACTORY SUPERIOR
5. Counseling : Not Observed
1 2 3 4 5 6 7 8 9
UNSATISFACTORY SATISFACTORY SUPERIOR
6. Organizatin/Efficiency : Not Observed
1 2 3 4 5 6 7 8 9
UNSATISFACTORY SATISFACTORY SUPERIOR
7. Overall Clinical Competence : Not Observed
1 2 3 4 5 6 7 8 9
UNSATISFACTORY SATISFACTORY SUPERIOR

Mini CEX time : Observing :minutes, Feedback :minutes

Evaluator :
LOW 1 2 3 4 5 6 7 8 9 HIGH
Student :
LOW 1 2 3 4 5 6 7 8 9 HIGH

Pendidikan Profesi Dokter PSPD UNJA 13

Comments
:_____________________________________________________________

Signatur,

____________________ _____________________
Student : Evaluator :

Pendidikan Profesi Dokter PSPD UNJA 14

 CASE EVALUATION

Date :
Diagnosis/Patients Problem (s) :
Setting : a. Out-patient b. In-Patient c. Emergency Dept
Patients information :
Age : Sex : New/Follow up :
Focus : a. Date gathering b. Diagnosis c. Therapy d. Counseling

1. How is the patoents problems presented by the studens ?

a. By then selves b. By guiding c. Not presented at all

2. How is the procedure examination conducted by the students ?

a. Appropriate b. Need more practice

3. How is the management plan of this patients ?

a. Appropriate B. Inapprooriate

4. How is the learning issues discussed by the students ?

a. By then selves b. By guiding c. Not presented at all

5. How is the time allocated for this problems ?

a. Adequate b. Inadequate

6. How is the time allocated for this problems ?

a. Appropriate b. Too Long c. Naad more time

Comments:
_____________________________________________________________

Preceptor,

____________________

Pendidikan Profesi Dokter PSPD UNJA 15

Pendidikan Profesi Dokter PSPD UNJA 16
 CASE REPORT SESSION
Date :
Case :
Presenter :

Final
N Name NIM 1 2 3 4 5 6 7 8 Result
o.
1.
2.
3.
4.
Items to be evaluated :
1. Ability to present a succinct overview of the CASE
2. Ability to identify and discuss the essential element of patients problem(s)
3. Ability to identify and discuss the major mechanism(s) involved
4. Ability to associate, ultilize, and integrate basic science information into the overall exaplanation of the
patients major problem(s)
5. Ability to discriminate between cause and effect events of patients problems
6. Ability to verbalize their knowledge during the presentation
7. Overall organization and completeness of their critical analysis
8. Students performance : systematic, attitude, communication.
Audience

Pendidikan Profesi Dokter PSPD UNJA 17

 Final
Name NIM 1 2 3 4 5 6 7 8 Result
No.
1.
2.
3.
4.
5.
6.
7.
Items to be evaluated :
1. Partisipation during discussion
2. Ability to verbalizer know ledge during the presentation
3. Students performance : attitude, communication
4. Ability to identify and discuss the major mechanism (s) involved

Scale : LOW 1 2 3 4 5 6 7 8 9 HIGH

56 60 64 68 73 78 80 90 100
C C+ C++ B B+ B++ A

CLINICAL/COMMUNITY SCIENCE SESSION

Date :
Case :

Pendidikan Profesi Dokter PSPD UNJA 18

Presenter :

Final
N Students name NIM 1 2 3 4 5 6 Result
o.
1.
2.
3.
4.

Items to be evaluated :
1. Ability to write scientific paper systematically ( Incluiding the bibliography )
2. Ability to implement EBM in informasi gathering and citation.
3. Self- directed lerning
4. Ability to identify and discuss the major mechanism (s) involved.
5. Ability to verbalizer their know ledge during the presentation
6. Students performance : attitude, communication.

Audience

Final
Name NIM 1 2 3 4 Result
No.
1.

Pendidikan Profesi Dokter PSPD UNJA 19

 2.
3.
4.
5.
6.
7.

Items to be evaluated :
1. Partisipation during discussion
2. Ability to verbalizer know ledge during the presentation
3. Students performance : attitude, communication
4. Ability to identify and discuss the major mechanism (s) involved

Scale : LOW 1 2 3 4 5 6 7 8 9 HIGH

56 60 64 68 73 78 80 90 100
C C+ C++ B B+ B++ A

Pendidikan Profesi Dokter PSPD UNJA 20

Final Examination

Students Nama :
Date :
Patients problems / diagnosis :
General Comment :

Result :

_______________________
Name :

Pendidikan Profesi Dokter PSPD UNJA 21

General Comment for Student
Name : NIM : NIM :

Name : NIM :

Pendidikan Profesi Dokter PSPD UNJA 22