King George’s Medical University

LUCKNOW 226003 (U.P.)

INTERN'S LOG BOOK

Year: 20....... to .........

Name:.....................................................................................

Batch:.....................................................................................

Provisional Reg. No:..............................................................

Period From:................................... to:................................

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

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 Intern’s Full Name and Signature : _

Home Address Including Phone No.:

E-mail Address: _ _ _

Local Address in Lucknow : _

including Phone Nos. :

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

2
 Skills in General Medicine
Done under Able to do
Skill Observed Assisted Remarks
supervision independently
/Comments

Date No Date No Date No Date No

Venipuncture (I)

Intramuscular injection (I)

Intradermal injection (D)

Subcutaneous injection (I)

Intra Venous (IV)

injection(I)

Setting up IV infusion andcalculating

drip rate (I)

Blood transfusion (O)

Urinary catheterization (D)

Basic life support (D)

(Anesthesia Posting)
Oxygen therapy (I)

Aerosol therapy /
nebulization (I)

Ryle’s tube insertion (D)

Lumbar puncture (O)

Pleural and asciticfluidaspiration

(O)

Cardiac resuscitation (D)

(Anesthesia Posting)
Peripheral blood smear
interpretation (I)

Bedside urine analysis (D)

Microbiology (02days)

Applied Biochemistry (02days)

Pharmacology (02 days)
Prescription Writing

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

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 Skills in Microbiology

Done under Able to do

Skill Observed Assisted Remarks
supervision independently
/Comments

Date No Date No Date No Date No

Gram’s stained smear interpretation (I)

KOH examination of scrapings for

fungus (I)
Dark ground illumination (O)

ZN stained smear interpretation (I)

Wet mount examination of

stool for ova and cysts (I)

Identification of blood parasites on PBS

(I)

Skills in Applied Biochemistry

Done under Able to do

Skill Observed Assisted Remarks
supervision independently
/Comments

Date No Date No Date No Date No

Estimate glucose, creatinine, urea and

total proteins, A:G ration in serum (D)
Estimate serum total cholesterol, HDL
cholesterol, triglycerides (D)
Estimate serum bilirubin,
SGOT/SGPT/alkaline phosphatase (D)
Estimate calcium and phosphorous (D)

Skills in Pharmacology

Done under Able to do

Skill Observed Assisted Remarks
supervision independently
/Comments

Date No Date No Date No Date No

Writing a prescription (D)

Audit of a given prescription (D)

Recognize an adverse drug reaction (I)

Be able to prepare a list of essential

drugs for a healthcare facility

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

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 INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.

FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

5
 Skills in Anesthesiology

Observed Assisted Done under Able to do

supervision independent Remarks
Skill
ly /Comments
Date No Date No Date No Date No
Basic Life Support
(D)
Cardiac resuscitation (D)

INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning

PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:

Needs further training.
FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK
6
 Skills in General Surgery

Observed Assisted Done under Able to do Remarks

Skill supervision independently
/Comments
Date No Date No Date No Date No
Basic suturing (I)
Basic wound care (I)
Basic bandaging(I)
Incision and drainage of
superficial abscess(I)
Early management of
trauma (I) and trauma
life support(D)
Pathology (02 days)
Applied Anatomy (02days)
Skills in Pathology

Observed Assisted Done under Able to do Remarks

Skill supervision independently
/Comments
Date No Date No Date No Date No
Peripheral blood smear
preparation, staining and
interpretation (I)
Urine routine and microscopy
examination (I)
Manual blood sugar estimation (I)

CSF examination (I)

Blood grouping (I)
Saline cross match method (I)

Skills in Applied Anatomy

Observed Assisted Done under Able to do Remarks

Skill supervision independently
/Comments
Date No Date No Date No Date No
Identification of structures
on X-rays/ultrasound

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

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 INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.

FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

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 Skills in Orthopedics
Done under Able to do
Observed Assisted Remarks
Skill supervision independently
/Comments
Date No Date No Date No Date No
Application of basic
splints and slings(I)
Basic fracture and
dislocation management(O)
Compression bandage (I)

INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days has been assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.
FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK
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 Skills in Obstetrics & Gynecology

Observed Assisted Done under Able to do Remarks

Skill supervision independently
/Comments
Date No Date No Date No Date No
Obstetric
examination(I)
Episiotomy(I)
Normal labor and
delivery (including
partogram) (I)
Per Speculum (PS)
and Per Vaginal (PV)
examination(I)
Visual Inspection of
Cervix with Acetic
Acid (VIA) (O)
Pap Smear sample
collection &
interpretation (I)
Intra- Uterine
Contraceptive Device
(IUCD) insertion &
removal(I)
Applied Physiology (02
days)
Skills in Applied Physiology

Observed Assisted Done under Able to do Remarks

Skill supervision independently
/Comments
Date No Date No Date No Date No
Perform, analyze, and
interpret pulmonary function
(e.g. FVC, MVV) (O)
Perform, analyze, and
interpret measurements of
cardiac and vascular function
(e.g. HR, BP, ECG) (D)
Interpret blood parameters
(e.g. hematocrit/red blood
cell count, lactate, glucose)
(I)
Perform, analyze, and
interpret CNS function (e.g.
nerve conduction velocity,
EMG, cranial nerve
examination) (D)

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

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 INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.

FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

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 Skills in Pediatrics

Observed Assisted Done under Able to do

supervision independent Remarks
Skill
ly /Comments
Date No Date No Date No Date No
Neonatal resuscitation(D)
Setting up Pediatric IV
infusion and calculating
drip rate (I)
Setting up Pediatric
Intraosseous line (O)
Nasogastric tube insertion (I)

Anthropometry (I)

Development Assessment
(O)
Vitals Monitoring (I)

Oxygen Therapy (O)

Counseling (O) & Consent

for Procedures (O)
Blood component transfusion
(O)

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

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 INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.

FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

13
 Skills in Forensic Medicine

Observed Assisted Done under Able to do

supervision independent Remarks
Skill
ly /Comments
Date No Date No Date No Date No
Documentation and
certification of trauma (I)
Diagnosis and
certification of death(D)
Legal documentation
related to emergency
cases (D)
Certification of medical-
legal cases e.g. Age
estimation, sexual assault
etc.(D)

Establishing
communication in
medico-legal cases with
police, public health
authorities, other
concerned departments,
etc (D

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

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 INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.

FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

15
 Skills in Otorhinolaryngology

Observed Assisted Done under Able to do

supervision independent Remarks
Skill
ly /Comments
Date No Date No Date No Date No
Anterior nasal packing
(D)
Otoscopy (I)
Tracheostomy assistance
Ear Canal Syringing

Punch Biopsy (oralcavity

growth)

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

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 INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.

FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

17
 Skills in Ophthalmology

Observed Assisted Done under Able to do

supervision independent Remarks
Skill
ly /Comments
Date No Date No Date No Date No
Visual acuity testing (I)
Digital tonometry(O)
Direct Ophthalmoscopy (O)

Epilation (O)

Eye irrigation(I)

Instillation of eye
medication (I)

Ocular bandaging(I)
Counseling for Visual
Rehabilitation

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

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 INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.

FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

19
 Skills in Dermatology

Observed Assisted Done under Able to do Remarks

supervision independent
Skill
ly /Comments
Date No Date No Date No Date No
Slit skin smear for
leprosy(O)
Skin biopsy(O)
Gram’s stained smear
interpretation (I)
KOH examination of
scrapings for fungus (D)

Dark ground
illumination (O)

Tissue smear (O)

Cautery - Chemical and

electrical (O)

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

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 INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.

FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

21
 Skills in Community Medicine

Observed Assisted Done under Able to do

supervision independent Remarks
Skill
ly /Comments
Date No Date No Date No Date No
Biomedical Waste
Management (02
days)
Skills in Biomedical Waste Management

Observed Assisted Done under Able to do

supervision independent Remarks
Skill
ly /Comments
Date No Date No Date No Date No
Segregation and
disposal of sharps,
plastics, OT
material,
HIV/HBsAG/HCV
/corona virus
infected material
(O)
Color coding
Sharps disposal

Blood bag disposal

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

22
 INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.

FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

23
 Skills in Psychiatry

Observed Assisted Done under Able to do

supervision independent Remarks
Skill
ly /Comments
Date No Date No Date No Date No

INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.
FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK
24
 Skills in Emergency Medicine

Observed Assisted Done under Able to do Remarks

supervision independent
Skill
ly /Comments
Date No Date No Date No Date No
Control
Hemorrhage
Intubate
Basic Adult Resuscitation
Basic Pediatric
Resuscitation

Draw blood
Use vacutainer

Canulate vein
Set up IV infusion

Monitor IV infusion

Give IM injection

Give SC injection

Give IV injection

Fill Requisition Form

Order grouping/cross
matching
Order blood/blood
products
Set up transfusion

Draw blood for culture

aseptically
Immediate assessment of
chest pain
Immediate assessment of
abdominal pain
Immediate assessment of
unconscious patient
Immediate assessment of
stroke
KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK
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Immediate assessment of
trauma
Control hypotension

Triage

Perform actions necessary

in the first few minutes of
arrival of a sick patient
Seek help appropriately

Manually handle/lift/shift
patients
Prepare for emergency
surgery/procedures
Monitor patients requiring
oxygen
Appropriately use mask,
Non invasive ventilation
Monitor sick patients in
HDU

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

26
 INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.

FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

27
 Elective-1

Observed Assisted Done under Able to do

supervision independent Remarks
Skill
ly /Comments
Date No Date No Date No Date No

INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.
FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

28
 Elective-2

Observed Assisted Done under Able to do

supervision independent Remarks
Skill
ly /Comments
Date No Date No Date No Date No

INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.
FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

29
 Elective-3

Observed Assisted Done under Able to do

supervision independent Remarks
Skill
ly /Comments
Date No Date No Date No Date No

INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.
FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK
30
 Elective-4
Observed Assisted Done under Able to do
supervision independent Remarks
Skill
ly /Comments
Date No Date No Date No Date No

INTERNSHIP ASSESSMENT
Certified that Student / Intern ID:
Supervisor: Department/ Specialty:
Unit: Dates: / / to / / Leaves:
days hasbeen assessed as follows:
Attribute / RATING Score given
Knowledge
Patient Care
Procedural Skills
Communication Skills
Team Member Skills
Professionalism
Life-long Learning
PLEASE RATE ON A SCALE OF A, B, C, D WITH, A Outstanding, B: Good, C: Average, D:
Needs further training.
FEED-BACK FORM
Strengths:-

Areas of Improvement needed:

Comments:

Students Signature:- Date:-

Faculty Signature:- Date:-

KGMU, LUCKNOW, MBBS INTERNSHIP LOGBOOK

31