Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 36* - Portfolio: *23F, Student, Swelling Both Lower Limbs - 5 Years, Increased Urine Output, 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, treatment history - Sarad... tablet since 2 years, dialysis, personal history, family history, general physical examination, systemic examination recorded.
- Good details: Swelling initially mild & gradually progressed, consulted local hospital - kidney related anomaly, prescribed medication discontinued, kidney function progressively deteriorated to end stage, advised hemodialysis, came for scheduled dialysis.
- Gaps: No vitals - BP, PR, RR, Temp, SpO2 not recorded. No weight, no urine output volume, no dialysis frequency / duration - listed as headings but blank. No PICCLE in standard format, though Pallor etc. listed separately.
*Score: 2 / 2*
- Competency met: Good longitudinal history - 5-year progression from swelling to ESRD captured.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Progression described - swelling -> medication discontinued -> deterioration -> ESRD -> dialysis.
- But no explanation in own words of why CKD causes swelling, or why increased urine output is present in early CKD - polyuria.
- No explanation of why medication discontinuation worsened disease. Sarad... tablet not identified - what drug, what dose, why given?
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: Early CKD - polyuria due to loss of concentrating ability, late CKD - oliguria / anuria. Explain: Stopping antihypertensive / CKD medication -> uncontrolled BP -> faster progression. Explain what Sarad... tablet is - need to verify prescription.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Provisional diagnosis given as CKD.
- No investigation plan, no management plan, no dialysis plan - frequency / duration blank, no pre-dialysis assessment - BP, weight, electrolytes, anemia, vascular access.
- No application of increased urine output to care.
*Score: 1 / 2*
- Partial application. Diagnosis stated, but not applied to a dialysis visit.
- *Next target:* Add: For scheduled dialysis visit - Check BP, weight, SpO2, electrolytes, CBC, RFT, vascular access - AV fistula check, urine output. Add management - salt / fluid restriction, BP control, anemia correction, calcium / phosphate, transplant counseling, vaccination, avoid nephrotoxins. Fill dialysis frequency - e.g. twice / thrice weekly, duration - e.g. 4 hours.
### 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, progression to ESRD in 5 years.
- No analysis of cause of CKD in young female - Glomerulonephritis vs Congenital anomaly - "kidney related anomaly" mentioned but not analyzed. No analysis of increased urine output vs decreased urine output in previous CKD case - 70M had decreased urine, this case has increased urine.
*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 ESRD. Congenital anomaly / Reflux nephropathy - supports "kidney related anomaly" in history, increased urine output, young onset. Diabetic nephropathy - against - no DM mentioned. Polycystic kidney - supports increased urine, HTN, progression; against - need USG. Must compare increased urine output here vs decreased urine output in elderly CKD - stage matters.
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- No justification for CKD cause, no staging, no reflection.
- No discussion of medication discontinuation - why did patient stop? Cost, side effects, lack of counseling? No patient safety - incomplete drug name, incomplete dialysis details.
- No counseling for young student on dialysis - education, transplant, psychosocial impact.
*Score: 0 / 2*
- Not met.
- *Next target:* Add: Why did I accept CKD without eGFR / investigations? What is the risk of incomplete drug history - Sarad...? What would I do differently - ask why medication discontinued, counsel on adherence, check dialysis adequacy, discuss transplant? Reflection on adherence in chronic disease in young patients.
### 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 patient education sheet for CKD on dialysis - why not to stop medication, salt / fluid, dialysis schedule, transplant options, OR timeline concept map: Swelling -> CKD -> ESRD -> Dialysis -> Transplant.
### Summary Sheet - Roll No. 36 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 2 | Excellent 5-year timeline, progression captured
2. Understand | 1 | Progression described, polyuria + drug discontinuation not explained
3. Apply | 1 | CKD stated, no dialysis visit assessment, frequency / duration blank
4. Analyze | 1 | No explicit differential, congenital anomaly vs glomerulonephritis not analyzed
5. Evaluate | 0 | No justification, no adherence reflection, incomplete drug name
6. Create | 0 | No original product
**Total** | **5 / 12** | **Needs Support - Developing**
*Overall CBME Feedback for Roll 36 - Progression:*
- 45F back + knee = 5/12, 60M knee + eye = 4/12, 60F fever + knee = 5/12, 32M fever = 4/12, 36F thyroid nodule = 5/12, 32F SOB + edema = 4/12, 55M HTN + headache = 4/12, 55F back + knee + neck = 5/12, 45F back + knee = 4/12, 50F joints + back = 4/12, 70M swelling + SOB = 5/12, 38F neck + back = 4/12, 23F swelling + dialysis = 5/12, *This portfolio = 5/12*
- *Progress shown:* This is the best longitudinal history so far - 5-year journey from swelling to ESRD to dialysis is clear. Previous 23F case was cross-sectional, this one shows progression.
- *Critical learning from this case:* Two CKD cases in 23F students - compare them. One had facial puffiness + non-pitting edema + giddiness, this one has increased urine output + pitting edema + medication discontinuation. Same diagnosis, different presentation. Next portfolio must add Analyze table to show this comparison and must complete vitals + dialysis details - never leave frequency / duration blank.
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