Document Format for Subject Expert for Creating Checklist for Assessment of Students/Interns

Subject Expert Name: (prof.) Dr. Mohit Mathur & Dr. Dilip Nandha
Subject: Practice of Medicine
BHMS Professional Year/Internship: IV BHMS and Internship
Assessment Supposed to
Setting Duration be
Level of
Miller’s (Practical required for completed
Experiments or difficulty:
S. Level Laboratory or Skill demonstrati by which
Procedures or Source easy / Grades
No. (Show How Laboratory or on Term of the
moderate /
Competency (Maximum Concerned
& Does) Simulation Lab or difficult
Bedside & Clinical 15 Minutes) BHMS
Setting) Professional
I) Limb examination Hutchison’s KH & D Bedside & clinical 5-7 mins IV BHMS Difficult 18
II) Head, Face and Neck clinical KH & D setting 5-7 mins IV BHMS Moderate 12
III) Abdomen methods, KH & D 5-7 mins IV BHMS Moderate 10
IV) Chest 24th edition KH & D 5-7 mins IV BHMS Moderate 18
V) Eyes Bedside KH & D 5-7 mins IV BHMS Difficult 09
VI) Genitals, Groin & Anus clinics in KH & D 5-7 mins IV BHMS Difficult 11
Nose, Ears, Mouth, Medicine KH & D 10-12 mins IV BHMS Moderate
VII) 25
Throat by Arup
VIII) Head Circumference Kumar KH & D 2-3 mins IV BHMS Easy
Kundu, 02
th
Neurological 6 edition KH & D 8-10 mins IV BHMS Difficult
IX) 18
examination
X) Height KH & D IV BHMS Easy Refer as per
XI) Weight KH & D IV BHMS Moderate General
XII) Blood pressure KH & D IV BHMS Moderate examination

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Dept. of Practice of Medicine – Practical Assessment Checklist
XIII) Temperature KH & D IV BHMS Easy
stated
earlier

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Dept. of Practice of Medicine – Practical Assessment Checklist
 BED-SIDE – GENERAL EXAMINATION OF CHILD
Basic requirements:
Type of subject on which the competency should be tested:
1. Children and adolescents
2. New born
Serial Yes COMPETENCY
Steps to be performed Grades
No. / No SKILLS
1 Establishes rapport with the child [Observe
how student is establishing rapport with the 1 Professionalism
child and whether he is able to do so or not] Ethical Values
2 Briefly explains the procedure to the parent 1 Preparedness
3 Takes verbal consent from parent 1 Safety
4 Hands are sanitized 1
I] THE LIMBS [18]
1 Lower limbs - Student examines the lower
limbs by inspecting limbs as per the following
[8]
points and should identify and write positive
or negative findings
a) Look for the Presence of deformities /
1
bony abnormalities
b) Look for the Presence of muscle wasting 1
c) Look for the Presence of tenderness of
1
muscles of the lower limbs
d) Assessment of the muscles tone of lower
2
limbs [0-V grade] – right and left
e) How is the movements of knee 1
f) How is the movements of ankle 1
g) Palpate for warmth of the skin of lower
1
limbs
h) Palpate for dryness or moistness of skin of
1
lower limbs
2 Upper limbs – Student should examine the
arms, shoulders and hands for the following
[10]
points and should identify and write positive
or negative findings.
a) Look for the Presence of clubbing 1
b) Look for the Presence of single palmar
1
crease
c) Look for the Presence of upper limb
1
abnormalities

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Dept. of Practice of Medicine – Practical Assessment Checklist
 Serial Yes COMPETENCY
Steps to be performed Grades
No. / No SKILLS
d) Assessment of the muscles tone of upper
2
limbs [0-V grade] – right and left
e) Presence of tenderness of muscles of the
1
lower limbs
f) Palpate for warmth of the skin of upper
1
limbs
g) Palpate for dryness or moistness of skin of
1
upper limbs
h) Observe for the widening of epiphysis at
1
wrist.
i) Student checks the pulse 1

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Dept. of Practice of Medicine – Practical Assessment Checklist
 Serial Yes COMPETENCY
Steps to be performed Grades
No. / No SKILLS
II] THE HEAD, FACE AND NECK [12]
1 FACE: Student should inspect the face for the
following points and then write whether it is [3]
normal or abnormal facial appearance.
a) Tongue – Normal or large 1
b) Position of the ear: Normal or low-set or
1
abnormal
c) Any other abnormal facial appearance 1
2 HEAD: Student should examine the head for
the following points and should write the [4]
positive or negative findings.
a) Student should inspect the front, sides and
above the head to look for abnormalities. -
1
Shape of the head: Normal / Microcephalic
/ Globular / Plagiocephalic.
b) Student palpates the head to look for:
i.) Anterior fontanelle: Closed / Open
1
or delayed; Bulging / Sunken
ii.) Posterior fontanelle 1
iii.) Ridging of sutures (craniostenosis) 1
3 NECK: Student should examine the neck for
the following points and should write the [5]
positive or negative findings.
a) Inspects the neck for presence of the
1
torticollis
b) Palpates for the lymph nodes and state
whether it is palpable and enlarged or not
i.) Anterior triangle of the neck:
1) Palpable or not 2
2) Enlarged or not
ii.) Posterior triangle of the neck:
3) Palpable or not 2
4) Enlarged or not

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Dept. of Practice of Medicine – Practical Assessment Checklist
 Serial Yes COMPETENCY
Steps to be performed Grades
No. / No SKILLS
III] ABDOMEN [10]
1 Position of the patient while examining
abdomen: Mother’s lap, on examination table, 2
placing infant over their mother’s shoulder
2 Student ensures that the child is not crying.
Student should examine the abdomen for the
1
following points and should write the positive
or negative findings.
INSPECTION: Student inspects abdomen for:
i.) Distension
ii.) Visible Peristalsis 4
iii.) Position of Umbilicus
iv.) Hernia.
PALPATION: Examiner shall observe and
assess the method and technique of palpation
done by student. Student palpates:
3
i.) Abdomen wall for tenderness
ii.) Palpation of liver
iii.) Palpation of spleen

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Dept. of Practice of Medicine – Practical Assessment Checklist
 Serial Yes COMPETENCY
Steps to be performed Grades
No. / No SKILLS
IV CHEST [18]
Student should examine the Chest for the
following points and should write the positive
or negative findings.
1 INSPECTION: Student observes for: [8]
i.) Chest asymmetry 1
ii.) Scars 1
iii.) Swelling 1
iv.) Breathing movements 1
v.) Use of accessory muscles of breathing 1
vi.) Chest deformities 1
vii.) Anteroposterior diameter of chest 1
viii.) Costochondral junctions. 1
2 Student should count Respiratory rates (for
1
entire one minute)
3 PALPATION: [3]
i.) Student palpates for anterior chest
wall for the location of:
2
a. Cardiac apex beat
b. Presence of Thrills
ii.) Student palpates axillary lymph nodes 2
4 PERCUSSION: Student percuss the chest
directly without intervening fingers (to be [1]
performed only in older children)
5 AUSCULTATION: [6]
i.) Student is using which part of
stethoscope should be observe by
examiner. [Small bell chest piece is 1
suitable for auscultation of the child’s
chest]
ii.) Student auscultates back of chest and
listens for:
a. Breath sounds 2
b. Adventitious sounds – present
or absent
iii.) Student auscultates the front of chest 3
to listen the
a. Heart sounds
b. Additional sounds if any
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Dept. of Practice of Medicine – Practical Assessment Checklist
 Serial Yes COMPETENCY
Steps to be performed Grades
No. / No SKILLS
present or not
c. Student counts the heart rate

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Dept. of Practice of Medicine – Practical Assessment Checklist
 Serial Yes COMPETENCY
Steps to be performed Grades
No. / No SKILLS
V EYES [9]
1 Student inspects the eye for:
i.) Ptosis,
ii.) Conjunctivitis,
5
iii.) Cataracts,
iv.) Congenital defects
v.) Nystagmus.
2 Student looks for squint:
i.) Student shines a light in the eyes from
in front of the face and observing the
2
position of the light reflex.
ii.) Student perform the cover test (in
older children)
3 Student note the pupillary accommodation
2
and light reactions

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Dept. of Practice of Medicine – Practical Assessment Checklist
 Serial Yes COMPETENCY
Steps to be performed Grades
No. / No SKILLS
VI GENITALS, GROINS AND ANUS [11]
Student should do examination for the
following points and write down positive or
negative findings.
Examination of Male Child: [5]
A) Inspection of Penis for:
1
i.) Retraction of foreskin
B) Check for the hernial orifices and inspect
2
whether testes have been descended or not
1
C) Palpation of testes for its location
i.) Method and technique of examination
of the location 2
ii.) Location of the testes: In inguinal canal
or In Scrotum
Examination of Female Child: [5]
A) Inspect the vulva for:
i.) Soreness
ii.) Discharge
2 5
iii.) Any abnormalities like:
a. Polyps
b. Fusion of labia
c. Enlargement of clitoris
Student palpate for the inguinal lymph nodes
– whether it is
3 i.) Palpable or not; 3
ii.) Enlarged or not
iii.) Tender or not
Student palpate the femoral artery and note
4 down whether femoral artery is palpable or 1
not.
Examination of the anal margin:
Method and technique: Student carry out anal
examination by gently separating the buttocks 1
5
with one hand on either side.
Look for the presence or absence of:
1
Fissures

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Dept. of Practice of Medicine – Practical Assessment Checklist
 Serial Yes COMPETENCY
Steps to be performed Grades
No. / No SKILLS
VII] NOSE, EARS, MOUTH & THROAT [25]
Student should do examination for the
following points and write down positive or
negative findings.
NOSE EXAMINATION:
Student should look for:
a) Nasal Patency
1 3
b) Presence of any deviation of the nasal
septum
c) Presence of Polyp or not
2 EARS EXAMINATION: [17] Application of
 Position of the child for ear examination: theory to
Child should be held by the mother in such practical
1
way that child can be kept still long
enough for the eardrums to be inspected.
Correct steps of Otoscopic examination:
 Use otoscope with largest ear speculum
that inserts easily in to the canal.
 Position the patient ‘s head so that you
can see comfortably through the otoscope.
 To straighten the ear canal grasp the
auricle firmly but gently and pull it
upward, backward and slightly away from
the head. 5
 Holding the otoscope handle between
your thumb and fingers brace your hand
against the patient’s face your hand and
instrument can then follow unexpected
movements by the patient
 Insert the speculum gently in to the ear
canal, directing it somewhat down and
forward and through the hairs if any
Look for the following points:
A] INSPECTION:
a) Auricle:
1) Deformities 1
2) Discharge (Purulent, Bloody, Foetid Etc) 1
3) Inflammation: Red / Swelling etc. 1

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Dept. of Practice of Medicine – Practical Assessment Checklist
 Serial Yes COMPETENCY
Steps to be performed Grades
No. / No SKILLS
c) Ear canal Examination: [through Otoscope]
1) Discharge (Purulent, Bloody, Foetid etc.) 1
2) Redness 1
3) Swelling 1
4) foreign bodies 1
5) Tenderness while examining 1
d) Ear drum Examination: [through Otoscope] 1
B] PALPATION:
1) Mastoid & tragus: Tenderness 1
2) Pre & Post auricular area examination 1
MOUTH EXAMINATION: Student should
examine following point in mouth:
 Tongue
4 3
 Teeth
 Gums
 Buccal Mucosa
THORAT EXAMINATION: Student should
examine following point in throat:
5 2
 Tonsils
 Pharyngeal wall

Serial Yes COMPETENCY

Steps to be performed Grades
No. / No SKILLS
VIII HEAD CIRCUMFERENCE
Method of measurement of head
circumference by student:
1 1
 Occipitofrontal circumference is the
standard measurement
Student is able to correlate the measurement
2 finding of head circumference with the normal 1
age, sex and height, weight in to the chart.

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Dept. of Practice of Medicine – Practical Assessment Checklist
 Serial Yes COMPETENCY
Steps to be performed Grades
No. / No SKILLS
IX NEUROLOGICAL EXAMINATION [18]
1 Student observes for the posture of the child
1
and notes down any abnormalities.
2 Student observes the gait of the child and
1
notes down any abnormalities.
3 Student observes for abnormal movements
1
like tics, chorea etc.
4 Student observes for spinal abnormalities like
scoliosis, kyphosis, tuft of hair, café au lait 1
spots etc.
5 Student observes for coordination by
watching the child at playing, doing up shoe 1
laces etc.
6 Student checks for muscle tone by lifting the
child up or observing the ability of the child to 1
lift when it is playing with toys
7 Student checks for neck stiffness by testing
1
resistance to passive neck flexion
8 Student tests for cranial nerves by
i. Testing for eye movements by moving
a toy in different directions in front of
child’s face (for testing oculomotor,
trochlear, abducens nerve)
ii. Student poke out his tongue at the
child and looks for child copying the
4
same (for testing hypoglossal nerve)
iii. Student observes the child when it is
smiling or crying to look for asymmetry
(for testing facial nerve)
iv. Student observes whether child is able
to bite anything (for testing trigeminal
nerve)
9 Student tests for reflexes with finger instead
1
of knee hammer
10 Student tests for plantar response 1
11 Student tests for primitive reflexes 5
i. Student test the rooting reflex by

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Dept. of Practice of Medicine – Practical Assessment Checklist
 Serial Yes COMPETENCY
Steps to be performed Grades
No. / No SKILLS
touching the baby’s cheek and looks
whether the head is turned to the side
of the stimulus
ii. Student observes the sucking
movements of the child and notes
down
iii. Student test the palmar and plantar
grasp by placing a finger across the
child’s palm or plantar surface of the
foot and looks for flexion and grasping
of the fingers.
iv. Student test for stepping reflex by
lowering the child onto a hard surface
and looks whether the foot presses
down and the other leg flexes at the
hip and knee in a stepping movement
v. Student test for Moro’s reflex by
dropping the head of the child a few
centimeters and observing whether
the upper limbs abduct and extend
symmetrically and flex.

Performance Index Level – 1 Level – 2 Level – 3 Level - 4

Score 0-40% 41% to 60% 61% to 80% > 80%

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Dept. of Practice of Medicine – Practical Assessment Checklist