Here is the 6-point CBME evaluation for *2023 Batch - Roll No. 35* - Portfolio: *60F, Fever - 1 Week and Knee Pains (Both) - 2 Months*
Based on the anonymized text you pasted. Score 0-2 per level. Total /12.
### 1. Remember - Knowledge Recall
*Evidence in portfolio:*
- Chief complaints, HOPI, past history - HTN 2 yrs, Thyroid 10 yrs, medication history, personal history, vitals, systemic examination all recorded in structured format.
- Minor gap: SpO2 not recorded.
*Score: 2 / 2*
- Competency met: Complete, systematic documentation. Good recall of case facts.
### 2. Understand - Comprehension
*Evidence in portfolio:*
- Knee pain described as insidious onset, gradually progressive, associated with fever since 1 week.
- Fever is listed as complaint but vitals show Temp - Afebrile. No explanation of this discrepancy - was fever subsided? Was antipyretic taken?
- No explanation in own words of pathophysiology linking fever + knee pain + HTN + Thyroid.
*Score: 1 / 2*
- Partial comprehension.
- *Next target:* Explain fever pattern - intermittent / continuous, associated chills, and why knee pain is progressive. Explain how thyroid / HTN / age affect joint health.
### 3. Apply - Application to Patient Care
*Evidence in portfolio:*
- Provisional diagnosis given as Metabolic Syndrome.
- No investigation plan, no management plan, no BP management despite BP 170/100 mmHg - Stage 2 HTN.
- No knee examination - swelling, tenderness, range of movement not documented. No eye / thyroid examination.
*Score: 1 / 2*
- Partial application. Diagnosis stated but not applied to care plan.
- *Next target:* Add: CBC, ESR/CRP, Blood sugar / HbA1c, Lipid profile, Thyroid profile, X-ray both knees, Vitamin D, Urine routine. Add management - BP control, fever workup, analgesics, physiotherapy, diet advice.
### 4. Analyze - Differentiation & Interpretation
*Evidence in portfolio:*
- Differential Diagnosis is given - Osteoarthritis, Vit D deficiency, Rheumatic arthritis. This is an improvement over previous portfolios.
- But no for / against analysis for each differential. No analysis of why Metabolic Syndrome was chosen as provisional over the differentials.
- BP 170/100 not analyzed as risk / red flag.
*Score: 1 / 2*
- Partial analysis. Lists differentials, but no justification.
- *Next target:* Add table: Differential | Supports | Against. E.g. Osteoarthritis - supports age 60F, progressive pain; against - fever not typical. Rheumatic arthritis - supports fever + joint pain; against - need to check symmetry, morning stiffness. Also consider Septic arthritis / Reactive arthritis as urgent differentials to rule out.
### 5. Evaluate - Judgment & Reflection
*Evidence in portfolio:*
- No justification for Metabolic Syndrome as provisional diagnosis - no waist circumference, lipids, sugars recorded to support it.
- No reflection, no self-assessment, no patient safety discussion.
*Score: 0 / 2*
- Not met.
- *Next target:* Add: Why did I choose Metabolic Syndrome? Is it justified without investigations? What did I miss - uncontrolled HTN? What would I do differently - recheck BP, complete fever history, ask about joint swelling / redness?
### 6. Create - Synthesis & New Learning Product
*Evidence in portfolio:*
- No original product - no concept map, algorithm, patient education material, or follow-up plan.
*Score: 0 / 2*
- Not met.
- *Next target:* Create 1-page algorithm: Fever + Knee Pain in Elderly Female -> Red flags -> Investigations -> Referral, OR patient education sheet for HTN + knee care.
### Summary Sheet - Roll No. 35 - 2023 Batch
Bloom Level | Score /2 | Key Feedback
1. Remember | 2 | Excellent documentation
2. Understand | 1 | Fever vs Afebrile not explained, no pathophysiology
3. Apply | 1 | No investigations / management, BP 170/100 not addressed
4. Analyze | 1 | Differentials listed, but no for / against analysis
5. Evaluate | 0 | No justification for Metabolic Syndrome, no reflection
6. Create | 0 | No original product
**Total** | **5 / 12** | **Needs Support - Developing**
*Overall CBME Feedback for Roll 35 - Progression:*
- Previous portfolios: 45F back pain = 5/12, 60M knee + eye = 4/12, This portfolio = 5/12
- *Progress shown:* Now adding Differential Diagnosis - this is growth in Analyze.
- *Still to improve:* Must move from listing to justifying, and must address abnormal findings like high BP in Apply and Evaluate.
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