PG Logbook Ayurved & Unani - Maharashtra University of Health ...

MAHARASHTRA UNIVERSITY OF HEALTH SCIENCES,
NASHIK
LOGBOOK
(FOR POST GRADUATE STUDENTS)
FACULTY :- AYURVED & UNANI
NAME OF COLLEGE:--------------------------------------
--------------------------------------
NAME OF P.G DEPARTMENT : KRIYA SHARIR
NAME OF STUDENT:- Dr. ----------------------------------
NAME OF GUIDE :- Dr. ----------------------------------
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Department of Kriya Sharir
PERSONAL BIO-DATA
PHOTOGRAPH
FULL NAME OF STUDENT:- Dr. ------------------------------------------------------------------------
DATE OF BIRTH :- ----------------------------------------------------------------------------
PERMANENT ADDRESS
:--------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------
LOCAL ADDRESS
:--------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------
TEL.NO.(With STD code) (OFFICE)---------------------------------(RES)--------------------------------------------
(HOSPITAL)--------------------------------------------
MOBILE No.----------------------------------- Email -----------------------------------------------------
CAMPUS ADDRESS : HOSTEL & ROOM
NO.----------------------------------------------------------------------------------------------------------------------------
BLOOD GROUP --------------------------------------------------------------------------------------------
M.C.I.M.REG.NO.:-----------------------------------------------------------------------------------------
DATE OF ADMISSION:------------------------------------------------------------------------------------
UNIV.ELIGIBILITY / ENROLLMENT NO. WITH
DATE:---------------------------------------------------------------------------------------------------------
DATE OF PASSING PRE-M.D / M.S. EXAM:----------------------------------------------------------
DATE OF SUBMISSION OF DISSERTATION TITLE :-------------------------------------------------
DATE OF SUBMISSION OF SYNOPSIS:----------------------------------------------------------------
DATE OF APPROVAL OF SYNOPSIS BY I.E.C.:--------------------------------------------------------
DATE OF APPROVAL OF SYNOPSIS BY UNIVERSITY:-----------------------------------------------
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DISSERTATION DETAILS:
NAME OF THE STUDY TOPIC
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
NAME OF THE PG GUIDE -------------------------------------------------------------------------------
DESIGNATION:---------------------------------------------------------------------------------------------
DEPARTMENT:---------------------------------------------------------------------------------------------
NAME OF CO-GUIDE :------------------------------------------------------------------------------------
DESIGNATION (IF ANY):----------------------------------------------------------------------------------
DATE OF SUBMISSION OF DISSERTATION TO
UNIVERSITY:------------------------------------------------------------------------------------------------
Educational Qualifications:
SR.
NO.
DEGREE
1 S.S.C
2 H.S.C
3 B.A.M.S
4
5
NAME OF
COLLEGE / SCHOOL
YEAR OF
PASSING
NO. OF
ATTEMTS
AWARDS/
DIST.IF
ANY
*Academic Achievements: Distinction / Prizes / Medals / Scholarships etc.):
---------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------------
*Marital Status:----------------------------------------------------------------------------------------------------
*Special Interest / Hobbies and Extra Curricular Activities:
---------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------------
*Expected Date of Completion of Course:------------------------------------------------------------------
PLACE:--------------------------
DATE:----------------------------
SIGNATURE OF STUDENT
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MAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK
CERTIFICATE
This is to certify that Dr.---------------------------------------------------
P.G. Student of ---------------------------------------------------------------------
College, under Department -----------------------------------------------------
has completed the tenure of M.D/ M.S, course along with all assignments
( practicals, clinics, clinical work, Teaching ) and research work as
prescribed by the University satisfactorily.
P.G. GUIDE
Date:
Head Of Department
Date:
I/C – P.G. Teacher
Date:
Principal / Dean
Date:
* In case of any dispute between the certifying authorities i.e The Guide and H.O.D,
the Dean / Principal should certify the certificates as per the assessment / facts and
positions to avoid academic loss of the student.
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PART – A
(COMMON ACTIVITIES RELATED
TO ALL P.G. SPECIALTIES)
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A- a) DETAILS OF HOUSE POST / REGISTER POST DUTIES (CLINICAL DUTIES)
SR
NO
1
NAME OF
POST
NAME OF
DEPT/ PLACE
PERIOD
SIGN.OF I/C
WITH REMARKS
2
3
4
5
6
7
8
9
10
11
* Additional Pages may be attached if required
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A- b) DETAILS OF PARTICIPATION IN UNDERGRADUATE TEACHING
SR
NO
1
DATE
TIME/
DURATION
U.G.
CLASS
NUMBER
OF PRESENT
STUDENT
NAME OF
TOPIC
TAUGHT
REMARKS OF
HOD /
TEACHER
2
3
4
5
6
7
8
9
10
11
* Additional Pages may be attached if required
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A- c) DETAILS OF PAPER / POSTER PRESENTATION AT REGIONAL /STATE / NATIONAL LEVEL
DURING MAIN COURSE
SR
NO
1
TITLE OF THE
PAPER / POSTER
DATE OF
PRESENTATION
PLACE OF
PRESENTATION
SIGN OF I/C
WITH REMARKS
2
3
4
5
6
7
8
9
10
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A- d) DETAILS OF ARTICLES PUBLISHED (IF ANY) DURING MAIN COURSE
SR
NO
1
TITLE OF THE
ARTICLE
NAME OF
PUBLICATION
EDITION WITH
MONTH &
YEAR
SIGN OF I/C
WITH
REMARKS
2
3
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A- e) DETAILS OF WORKSHOP /SEMINAR / SYMPOSIA/ GROUP DISCUSSIONS / C.M.E.
ATTENDED – DURING MAIN COURSE
SR
NO
1
DATE PLACE TOPIC SIGN OF I/C WITH
REMARKS
2
3
4
5
6
7
8
9
10
11
12
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A-f) DETAILS OF LEAVE RECORD
SR
NO
DATE OF
LEAVES
TOTAL DAYS REASON SIGNATURE
OF I/C
REMARK
1
2
3
4
5
6
7
8
9
10
11
* Additional Pages may be attached if required
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A- g) DETAILS OF E-LIBRARY / INTERNET WORK RECORD
SR
NO
1
DATE DURATION DETAILS SIGN OF I/C
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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A- h) PERIODICAL DEPARTMENTAL ASSESSMENT OF STUDENT
After every two semesters, guide and HOD will assess the work done by the student under
department. They will also assess monthly progress report of dissertation based on the record of the
work. The Head of Department will certify the satisfactory completion of that year. Satisfactory
completion shall be determined by 0 to 10 scales.
FIRST YEAR : FINAL M.D. ASSESSMENT
Attribute Score Should be Given 0 – 10 ( Minimum satisfactory score 50% of Total )
SR
HEAD OF ASSESSMENT
SCORE
NO
1 Sincerity
2 Regularity / Punctuality
3 Diligence & Performance
4 Interpersonal Skills
5 Initiative ness
6 Academic ability
7 Capacity to work in a team
8 Undergraduate / P.G. Teaching
9 Leadership Qualities
10 Research Aptitude
Total Score obtained (out of 100)
SIGNATURE OF GUIDE
DATE:-
SIGNATURE OF HOD
DATE:-
SECOND YEAR : FINAL M.D. ASSESSMENT
Attribute Score Should be Given 0 – 10 ( Minimum satisfactory score 50% of Total )
SR
HEAD OF ASSESSMENT
SCORE
NO
1 Sincerity
2 Regularity / Punctuality
3 Diligence & Performance
4 Interpersonal Skills
5 Initiative ness
6 Academic ability
7 Capacity to work in a team
8 Undergraduate / P.G. Teaching
9 Leadership Qualities
10 Research Aptitude
Total Score obtained (out of 100)
OVERALL ASSESSMENT OF FINAL M.D : EXCELLENT / SATISFACTORY / POOR
SIGNATURE OF GUIDE
DATE:-
SIGNATURE OF HOD
DATE:-
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PART – B
( ACTIVITIES RELATED
TO ENROLLED
P.G. SPECIALITY)
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B – a) DETAILS OF PRACTICALS PERFORMED IN DEPT.
( IN FIRST YEAR ) – 100 PRACTICALS PER YEAR
(MINIMUM 2 PRACTICALS PER WEEK)
SR.
NO.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
DATE OF
PRACTICAL
DESCRIPTION OF PRACTICAL
SIGN OF I / C
WITH REMARKS
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B – a) DETAILS OF PRACTICALS PERFORMED IN DEPT.
SR.
NO.
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
DATE OF
PRACTICAL
DESCRIPTION OF PRACTICAL
SIGN OF I / C
WITH REMARKS
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B – a) DETAILS OF PRACTICALS PERFORMED IN DEPT.
SR.
NO.
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
DATE OF
PRACTICAL
DESCRIPTION OF PRACTICAL
SIGN OF I / C
WITH REMARKS
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B – b) DETAILS OF PRACTICALS PERFORMED IN DEPT.
(IN SECOND YEAR ) – 100 PRACTICALS PER YEAR
(MINIMUM 2 PRACTICALS PER WEEK)
SR.
NO.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
DATE OF
PRACTICAL
DESCRIPTION OF PRACTICAL
SIGN OF I / C
WITH REMARKS
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B – b) DETAILS OF PRACTICALS PERFORMED IN DEPT.
SR.
NO.
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
DATE OF
PRACTICAL
DESCRIPTION OF PRACTICAL
SIGN OF I / C
WITH REMARKS
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B – b) DETAILS OF PRACTICAL PERFORMED IN DEPT.
SR.
NO.
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
DATE OF
PRACTICAL
DESCRIPTION OF PRACTICAL
SIGN OF I / C
WITH REMARKS
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B. DETAILS OF POSTING IN SUB DEPARTMENT
SR.NO. NAME OF SUB DEPT ACTUAL POSTING DATES SIGNATURE OF
I/C
1.
Experimental
Physiology
2.
3.
4.
5.
Clinical Physiology
Hematology
Biochemistry
Pulmonary Function
Test Unit
6.
7.
Prakruti Parikshan
Saar, Agni, Koshth,
Satva, etc. Parikshans
8.
Others
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Sr.
No.
B – d) Other Activities ( Museum work including museum Techniques )
reparation of minimum 5 specimens (i.e. slides etc) / Models/ Charts.
Nature of Work Period Remarks Sign. Of I / C
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B – e) Details of Departmental Project
( Each Student should complete at least 1 departmental project related to
Samhitas during the duration of the course the project will be decided by
Guide/ HOD. )
The work done should be certified by Guide and HOD in the following format in
duplicate.
CERTIFICATE
This is to certify that, Dr………………………………………………………………………………….
has completed departmental project in Sharir Kriya under our supervision.
The details of the project are as follows :-
Title of Project
Reference (If any)
Name of Guide
Date of Starting of Project
Date of Finishing Project
Total Cost of Project
He/ She has completed the departmental project satisfactorily/unsatisfactorily.
Signature of Guide
Signature of HOD
* The text of the project should be maintained separately by the student
along with one copy of the certificate and one copy of the project should be
submitted to the department.
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PART C
DAILY WORK RECORD
The P.G. Student should write in short all major activities / achievements / special work /
special cases / special procedures done by him / library work / total number of patients treated
by him at OPD / IPD on daily basis.
The concept behind maintaining daily record is to keep close supervision by the Guide on
work / activity of the student and to keep the Guide and the student both associated to each
other.
( Please add 200 pages in logbook as per the given format on next page i.e C-c)
Note :- 1) The daily work record should be certified by the Guide once in every month.
( Format of the certificate is given ) ( C - a, C – b )
2) The daily work record should be certified by the Head of department at the end
of each Month. ( Format of the certificate is given ) ( C - a, C – b )
* In case of any dispute between the certifying authorities i.e The Guide and H.O.D,
the Dean / Principal should certify the certificates as per assessment / facts and
positions to avoid academic loss of the student.
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C – a
COLLEGE NAME : - ………………………………………………………………………………………
CERTIFICATE
FINAL M.D. / M.S. – SECOND YEAR
This is to certify that Dr. ……………………………………………………………………….
P.G. Student of ……………………………………………………….. Department
has / has not completed the M.D. / M.S. tenure along with all the assignments,
practical / clinical / teaching and research work as prescribed by the University ,
satisfactorily and recorded the same in the daily work record book.
Sr.
No.
1
2
3
4
5
6
7
8
9
10
11
12
MONTH
REMARK – SATISFACTORY
/ NOT SATISFACTORY
SIGNATURE OF
THE GUIDE
REMARKS & Sign
OF HOD
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C – b
DAILY WORK RECORD
DATE :……………………………
DAY :…………………………..
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
…………………………………
SIGNATURE OF P.G. STUDENT
DATE :……………………………
DAY :…………………………..
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
SIGNATURE OF P.G. STUDENT
DATE :……………………………
DAY :…………………………..
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
SIGNATURE OF P.G. STUDENT
* Additional pages may be added as per requirement.
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