This Electives Log Book belongs to
Photograph of the
student
Authenticated by
the Dean
Name of the Student :
University Registration Number :
Academic year :
Signature of the Student :
2
ELECTIVES BLOCK -1
CERTIFICATE
This is to certify that Ms / Mr ________________________________________ of
Srinivas Institute of Medical Sciences & Research Centre, Mangaluru, has
participated in the National Medical Commission mandated sessions, as a part of the
Competency Based Medical Education Curriculum of Block -1 Electives , on
______________________________________________________________ during
the period ______________ to __________________.
Recording of the contents in this Log Book is a bonafide work of the said student.
Internal preceptor Head of Department
Name: Name:
Date:
Place:
3
ELECTIVES BLOCK -2
CERTIFICATE
This is to certify that Ms / Mr ________________________________________ of
Srinivas Institute of Medical Sciences & Research Centre, Mangaluru, has
participated in the National Medical Commission mandated sessions, as a part of the
Competency Based Medical Education Curriculum of Block -2 Electives , on
______________________________________________________________ during
the period ______________ to __________________.
Recording of the contents in this Log Book is a bonafide work of the said student.
Internal preceptor Head of Department
Name: Name:
Date:
Place:
4
GENERAL INSTRUCTIONS
1) Log book is the record of all the relevant academic/co-curricular activities
undertaken by the student in a particular elective.
2) The student is responsible for getting the entries in the logbook verified by the
Faculty in charge regularly.
3) Entries in the logbook will reflect the activities undertaken in the department and
have to be scrutinized by the Internal preceptor and counter-signed by the Head of
the Department.
4) The logbook is a record of various activities by the student like:
a. Overall participation & performance
b. Attendance
c. Participation in sessions
d. Record of completion of pre-determined activities.
e. Acquisition of selected competencies
5) The logbook is the record of work done by the candidate in that Electives and should
be verified by the college before submitting the application of the students for the
University examination.
5
INDEX
Page Numbers
Sl.
Type of activity
No.
From To
Block-1 Activities
1.
Elective Module for Block-1
2.
Formative Assessment marks in Block-1
3.
Attendance of Block-1 Elective Posting
Block-2 Activities
4.
Elective Module for Block-2
5.
Formative Assessment marks in Block-2
6.
Attendance of Block 2 Elective Posting
6
ELECTIVE MODULE FOR BLOCK-1
Name of the elective
Competency for the
elective
Objectives
Department /
Location
Name of Internal
Preceptor
Name of external
Preceptor (if any)
7
Activities done during the Elective Posting
(Reflections/Feedback)
a. What Happened?
b. So What?
c. What Next?
8
Activities done during the Elective Posting
(Reflections/Feedback)
a. What Happened?
b. So What?
c. What Next?
9
Activities done during the Elective Posting
(Reflections/Feedback)
a. What Happened?
b. So What?
c. What Next?
10
Activities done during the Elective Posting
(Reflections/Feedback)
a. What Happened?
b. So What?
c. What Next?
11
Activities done during the Elective Posting
(Reflections/Feedback)
a. What Happened?
b. So What?
c. What Next?
12
Activities done during the Elective Posting
(Reflections/Feedback)
a. What Happened?
b. So What?
c. What Next?
13
Activities done during the Elective Posting
(Reflections/Feedback)
a. What Happened?
b. So What?
c. What Next?
14
ELECTIVES BLOCK -1 Assessment
Completed (C)
{on 1st attempt}
Sl. Date of
Type of Assessment Repeated (nR)
No. Assessment {n- no. of times signature signature
repeated before
completion}
15
Attendance at the end of Elective Block I
No. of No. of No. of
Percentage of
sessions sessions sessions
attendance signature signature
conducted present present
16
ELECTIVE MODULE FOR BLOCK-2
Name of the elective
Competency for the
elective
Objectives
Department /
Location
Name of Internal
Preceptor
Name of external
Preceptor (if any)
17
BLOCK - 2 ACTIVITIES
18
Activities done during the Elective Posting
(Reflections/Feedback)
a. What Happened?
b. So What?
c. What Next?
19
Activities done during the Elective Posting
(Reflections/Feedback)
a. What Happened?
b. So What?
c. What Next?
20
Activities done during the Elective Posting
(Reflections/Feedback)
a. What Happened?
b. So What?
c. What Next?
21
Activities done during the Elective Posting
(Reflections/Feedback)
a. What Happened?
b. So What?
c. What Next?
22