30/10/2026
Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 9* - Portfolio: *CASE 1 - 61M, Farmer, Increase of Hunger (Polyphagia) - 6 Months, Increase in Urination - 3 Months, Generalized Weakness, Weakness + Polyuria + Polyphagia - 6 Months, On Metformin, K/C/O Diabetes, Appetite Increased, B&B Increased Urination, Provisional: Type 2 Diabetes Mellitus*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- 61 years / Male / Farmer, C/O: Increase of hunger (polyphagia) - 6 months, Increase in urination - 3 months, Generalized weakness, HOPI: Patient was asymptomatic 6 months ago, then developed weakness, polyuria and polyphagia. Duration 6 months. On treatment - Metformin, Past History: K/C/O - Diabetes, N/K/C/O - HTN, TB, Epilepsy, No surgeries or complications, Personal History: Diet - Mixed, Appetite - Increased, Sleep - Adequate, B&B - Increased urination, Addictions - Nil, Family History: No family history, Provisional: Type 2 Diabetes Mellitus.
- Good details: Age / Sex / Occupation - 61M, Farmer, C/C - Polyphagia 6 months, Polyuria 3 months, Generalized weakness - duration given, HOPI - Asymptomatic 6 months ago, then weakness + polyuria + polyphagia, Duration 6 months, On Metformin, Past - K/C/O Diabetes, N/K/C/O HTN, TB, Epilepsy, No surgeries / complications, Personal - Diet Mixed, Appetite Increased, Sleep Adequate, B&B Increased urination, Addictions Nil, Family - No family history, Provisional - Type 2 Diabetes Mellitus - given.
- Gaps: *No Polydipsia - classic triad is Polyuria + Polydipsia + Polyphagia - polydipsia missing - did you ask?* *No Weight loss - classic DM - weight loss present or absent? - missing.* *No General Examination - PICCLE missing - Pallor? Edema?* *No Vitals - BP, PR, RR, Temp, SpO2 missing - critical in DM - BP for HTN.* *No Systemic Examination - CVS, CNS, RS, P/A missing.* *No Investigations - FBS, PPBS, HbA1c, Urine - missing - no values to prove DM.* *No Metformin dose, duration, regularity - missing.* *No Complications - Retinopathy, Neuropathy, Nephropathy, Foot ulcer - missing.* *C/C contradiction - Polyuria 3 months vs HOPI Polyuria 6 months* - which one?
*Score: 1 / 2*
- Partial recall - classic symptoms + Metformin + provisional good, but polydipsia / weight loss / exam / vitals / investigations missing.
- *Next target:* Always ask classic DM triad + weight loss - Polyuria, Polydipsia, Polyphagia, Weight loss, Weakness, Blurred vision, Numbness / Tingling, Foot ulcer, Delayed wound healing. Always record General Examination - PICCLE, BMI, Weight, Systemic Examination - all 4 systems, especially CNS - sensation, reflexes, P/A, Foot exam. Always record Vitals - all 5 - BP, PR, RR, Temp, SpO2 - BP is critical in DM - HTN. Always record Investigations RESULTS - FBS - value, PPBS - value, HbA1c - value, Urine - sugar / protein / ketones. Always record Metformin - Dose, Duration, Regularity, Side effects. Always ask Complications - Eye, Kidney, Nerve, Foot, Heart. Clean contradiction - Polyuria 3 months vs 6 months.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Weakness + Polyuria + Polyphagia - 6 months, On Metformin, Provisional T2DM - listed.
- But no explanation in own words of why DM causes polyuria, polyphagia, weakness.
- No explanation of T2DM, Metformin - not explained.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain: T2DM = insulin resistance + relative insulin deficiency, blood sugar high, glucose spills in urine, water follows glucose -> polyuria, increased urination. Explain: Polyuria -> dehydration -> thirst -> polydipsia - you did not ask polydipsia. Explain: Cells cannot use glucose -> body thinks starving -> hunger -> polyphagia, appetite increased, but glucose lost in urine -> energy loss -> generalized weakness, weight loss. Explain: Farmer - physical work, weakness impacts work. Explain: Metformin = decreases liver glucose production, increases insulin sensitivity, does not cause hypoglycaemia alone.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- On treatment - Metformin - mentioned.
- Provisional - T2DM - given.
- But no student plan - no investigation plan, no management plan.
- No application of polyuria + polyphagia + weakness to care - no blood sugar monitoring, no diet.
*Score: 1 / 2*
- Partial application - Metformin mentioned, but no care plan.
- *Next target:* Add: FBS, PPBS, HbA1c, Urine - sugar / protein / ketones, RFT - urea, creatinine, Lipid profile, ECG, Eye - Fundoscopy, Foot exam. Add management - Continue Metformin - check dose, regularity, Diet - low sugar, low refined carbs, high fibre, regular meals, Exercise - walking 30 min/day, Blood sugar monitoring - FBS / PPBS, HbA1c every 3 months, Weight, BMI, BP monitoring, Foot care - wash, dry, no barefoot, Follow-up, Refer - Medicine / Ophthalmology. Add: If polyuria + polyphagia + weakness - urgent - check blood sugar, HbA1c, urine ketones, rule out DKA / HHS.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- Provisional: Type 2 Diabetes Mellitus - given.
- But no differential list.
- No analysis of alternative causes: T2DM vs T1DM vs Secondary DM vs Polyuria causes.
*Score: 1 / 2*
- Partial analysis - T2DM named, but not differentiated.
- *Next target:* Add differential table: Type 2 Diabetes Mellitus - supports 61M, Farmer, Polyphagia 6 months, Polyuria 3 months, Generalized weakness, Appetite Increased, K/C/O Diabetes, On Metformin, No family history; against - no HbA1c, FBS given, no polydipsia, weight loss given. Type 1 Diabetes Mellitus - supports Polyuria, Polyphagia, Weakness; against - 61M, no weight loss, no ketones given, On Metformin - T1 needs insulin. Secondary DM - Steroids, Pancreatitis - supports Polyuria, Polyphagia; against - No steroid history, No pancreatitis given. Polyuria causes - DM, CKD, Diuretics - supports Polyuria; against - No CKD, diuretic history given. Must analyze: Is polyuria due to DM - high sugar - or CKD - kidney damage - or diuretics? Is polyphagia due to DM or thyroid - hyperthyroidism - weight loss, tremor, palpitation - not asked.
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- Negatives - N/K/C/O HTN, TB, Epilepsy, No surgeries or complications, Addictions Nil - show judgment.
- "No family history" - shows judgment - you checked family risk.
- But no judgment on DM control - On Metformin, but polyphagia + polyuria + weakness still present - uncontrolled? - not flagged.
- No judgment on missing investigations - no HbA1c - not evaluated.
- No reflection.
*Score: 1 / 2*
- Partial evaluation - negatives show judgment, but DM control / missing data missed.
- *Next target:* Add: Can I label T2DM without FBS / PPBS / HbA1c? What is most urgent - 61M, polyuria + polyphagia + weakness 6 months, on Metformin - is DM uncontrolled? What is the risk if I miss DKA / HHS, retinopathy, nephropathy, neuropathy, foot ulcer? What would I do differently - ask polydipsia, weight loss, blurred vision, numbness, foot ulcer, check BMI, BP, foot exam, check HbA1c? Reflection on 61M Farmer - 6 months weakness + polyuria + polyphagia - impact on farming, work, family income, need for diet, exercise, regular medication?
### 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: Polyphagia + Polyuria + Weakness -> DM Triad -> Examination -> FBS + HbA1c -> T2DM vs T1DM -> Management, OR patient education sheet for T2DM - Diet, Exercise, Foot Care, Blood Sugar Monitoring, when to go to hospital - vomiting, breathlessness, confusion, foot ulcer.
### Summary Sheet - Roll No. 9 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 1 | Classic symptoms + Metformin good, exam / vitals / investigations missing
2. Understand | 1 | Symptoms listed, DM mechanism not explained
3. Apply | 1 | Metformin mentioned, no diet / monitoring plan
4. Analyze | 1 | T2DM named, no differential table
5. Evaluate | 1 | Negatives show judgment, DM control missed
6. Create | 0 | No original product
**Total** | **5 / 12** | **Developing - Competent**
*Overall CBME Feedback for Roll 9 - Progression:*
- *This portfolio = 5 / 12* - First case for Roll 9
- *Strength:* You captured the classic DM story in 3 lines - Polyphagia 6 months, Polyuria 3 months, Generalized Weakness, Appetite Increased, On Metformin - that is clean, and Provisional: Type 2 Diabetes Mellitus is correct. And Negatives - N/K/C/O HTN, TB, Epilepsy, No surgeries / complications, Addictions Nil - are complete.
- *Critical learning from this case:* You have a DM case with no DM proof - no FBS, PPBS, HbA1c values, no polydipsia, no weight loss, no exam, no vitals, no complications. In DM, HbA1c + Foot Exam + Eye Exam + BP are the case. Add PICCLE + Vitals + Systemic Exam + Foot Exam + FBS / PPBS / HbA1c RESULTS + Polydipsia / Weight Loss, and this case becomes 8-9/12.
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