2/11/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 35* - Portfolio: *23F, Student, Swelling Both Lower Limbs - 5 Years, Increased Urine Output - 5 Days, Known Kidney Failure on Hemodialysis*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- Demographics with occupation, chief complaints, HOPI, past history - HTN since 5 years, medication history - currently on HTN medication, N/K/C/O DM, Epilepsy, TB, Thyroid, personal history, family history, general examination, PICCLE, vitals - with SpO2 included, systemic examination, investigations listed.
- Good details: Swelling initially mild & gradually progressed, consulted local hospital - kidney related problem, came for routine haemodialysis. No fever & weight loss. B & B - Increased urination - 5 days.
- Gaps: No weight, no dialysis frequency / duration, no drug name / dose for HTN medication, no urine volume. Increased urine output - 5 days in chief complaints vs 5 years swelling - timeline needs clarity.
*Score: 2 / 2*
- Competency met: Systematic documentation, investigations listed for first time in CKD cases.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Swelling + increased urine output + HTN + dialysis linked as CKD.
- But no explanation in own words of why CKD causes swelling, or why increased urine output for 5 days now in a dialysis patient - is this polyuria, residual urine, or new change?
- No explanation of CKD Stage V - what does Stage V mean, what is eGFR cutoff.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: CKD Stage V = eGFR <15, ESRD, needs dialysis / transplant. Explain: Early CKD - polyuria, late CKD - oliguria, dialysis patient - residual urine output matters. Explain why increased urine output for 5 days is new - infection? Medication? Need to interpret.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Provisional diagnosis given as CKD Stage V.
- Investigations listed: CBC, Blood urea, Serum Creatinine, Urine routine, Urine protein, Serum albumin.
- No investigation results, no management plan, no dialysis assessment - BP, weight, electrolytes, vascular access, dialysis adequacy.
- No application of increased urine output to care.
*Score: 1 / 2*
- Partial application. Investigations listed is progress, but results + management missing.
- *Next target:* Add: Results - Creatinine, Urea, eGFR, Hb, Urine protein / PCR, Albumin, Electrolytes, Calcium, Phosphate. Add management - for scheduled dialysis visit: Check BP, weight, SpO2, electrolytes, fluid status, AV fistula, counsel on salt / fluid, BP control, anemia, transplant counseling. Document dialysis frequency - e.g. twice weekly, duration.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- No formal differential diagnosis listed.
- But clues for analysis present: Young age 23F, HTN 5 years, swelling 5 years, increased urine output.
- No analysis of cause of CKD in young female - Glomerulonephritis vs Congenital anomaly vs Reflux nephropathy. No analysis of Stage V justification - no eGFR / creatinine result given despite listing investigation.
- No analysis of increased urine output - 5 days vs 5 years swelling - acute change vs chronic.
*Score: 1 / 2*
- Partial analysis - implicit, not explicit.
- *Next target:* Add differential table: CKD due to Chronic Glomerulonephritis - supports young onset, swelling, HTN, progression to Stage V. Congenital / Reflux nephropathy - supports kidney related problem at young age, increased urine output. Diabetic nephropathy - against - N/K/C/O DM. Nephrotic syndrome - supports swelling, urine protein, albumin - need results. Must use investigation results to justify Stage V - eGFR <15.
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- No justification for Stage V - investigations listed but results not given, so staging cannot be verified.
- No reflection, no self-assessment, no counseling for young student on dialysis, no discussion of HTN medication name / adherence.
*Score: 0 / 2*
- Not met.
- *Next target:* Add: Can I label Stage V without eGFR result? What is the risk of labeling Stage V on history alone? What would I do differently - attach investigation results, document dialysis details, ask why increased urine output for 5 days - is it a new symptom or ongoing? Reflection on 3rd CKD case in 23F - what is new learning compared to previous two?
### 6. Create - Synthesis & New Learning Product
*Evidence in portfolio:*
- No original product - no algorithm, concept map, patient education material.
*Score: 0 / 2*
- Not met.
- *Next target:* Create 1-page algorithm: Young Female with Swelling + Increased Urine + HTN -> CKD Stage V -> Dialysis Visit Checklist, OR patient education sheet for dialysis - diet, salt, fluid, medication adherence, transplant.
### Summary Sheet - Roll No. 35 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 2 | Good documentation, investigations listed
2. Understand | 1 | CKD Stage V not explained, increased urine 5 days not explained
3. Apply | 1 | Investigations listed, results + management missing
4. Analyze | 1 | No explicit differential, Stage V not justified with eGFR
5. Evaluate | 0 | No justification for Stage V, no reflection
6. Create | 0 | No original product
**Total** | **5 / 12** | **Needs Support - Developing**
*Overall CBME Feedback for Roll 35 - Progression:*
23F swelling + dialysis = 5/12, 23F swelling + ESRD = 5/12, *This portfolio = 5/12*
- *Progress shown:* First CKD case to list investigations. This is improvement in Apply.
- *Still to improve:* Listing investigations is not enough - need results to justify Stage V. This is the 3rd 23F CKD portfolio - all 5/12. To break to 7+, next portfolio must attach results, justify staging with eGFR, and add Analyze + Evaluate.
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