MAHARASHTRA UNIVERSITY OF HEALTH SCIENCES, NASHIK (POST GRADUATE) FACULTY – MEDICAL DEPARTMENT: FORENSIC MEDICINE (MD/DFM) Name of the P.G. Student: ____________________________________ Name of the P.G. Guide: ____________________________________ Approved vide Resolution No. 141/2015 Academic Council dated 10/09/2015.
D:\Acad_51\Acad51\PG Main\51-2015\Log Book\2 MD-DFM FMT.docx 2 Postgraduate students registered for degree & Diploma in forensic medicine have to maintain the logbook. In other words this is a record of Academic & Technical /Professional activities done during their respective MD/DFM course tenure. It is mandatory for the P.G. students to make appropriate entries in the log book regularly & to submit the same to P.G. teacher and Head of the department whenever asked for. The concerned Postgraduate teacher is expected to verify the entries regularly & counter sign with appropriate remarks if any. Year wise provisional assessment/evaluation of log book reflecting candidate’s performance will be jointly done by PG Teacher & final assessment /evaluation of log book will be done by the PG Teacher & HOD jointly. 6 months prior to completion of MD & DFM course. The log book is a confidential document & is meant for observation of use of student & the information PG Teacher & HOD & is a department’s property.
D:\Acad_51\Acad51\PG Main\51-2015\Log Book\2 MD-DFM FMT.docx 3 DEPARTMENT OF FORENSIC MEDICINE PERSONAL BIO-DATA OF POST GRAUDATE STUDENTS Full Name : _____________________________________ _____________________________________ Date of Birth : __________________________ Blood Group : __________________________ M.M.C. Registration No. & Date : ____________________ Title & relevant details & Previous Qualification : Brief details & Previous Experience : Course Date of joining Expected date of exam Identification marks : 1) 2) Contact details : Mobile : Residence : Email id : Permanent Address : (Phone No.) Address for correspondence : (Phone No.) Name of PG teacher : Name of Co-Guide if any : Topic of dissertation : Date of Approval by Ethical Committee : Date of submission to the University : Remark if any :
D:\Acad_51\Acad51\PG Main\51-2015\Log Book\2 MD-DFM FMT.docx 4 RECORD OF ROTATORY POSTING SN Department Period Assignments Name & signature of faculty 1. Anatomy 2. Pathology 3. Biochemistry 4. Casualty 5. CL Toxicology 6. Emergency medicine 7. Imaging 8. F.S.L. 9. 10. Remark : Signature of PG Teacher
D:\Acad_51\Acad51\PG Main\51-2015\Log Book\2 MD-DFM FMT.docx 5 RECORD OF ATTENDENCE AT PG ACTIVITIES Month & Year No. of Session conducted No. of Session attended Remarks Sign of faculty January February March April May June July August September October November December Remarks : Signature of HOD (Please add 2 more pages)
D:\Acad_51\Acad51\PG Main\51-2015\Log Book\2 MD-DFM FMT.docx 6 JOURNAL CLUB SN Date Topic Journal Name & signature of faculty 1. 2. Remarks : Signature of PG Teacher SEMINARS SN Date Topic Name & signature of faculty 1. 2. Remarks : Signature of PG Teacher (Please add 1 more pages) GROUP DISCUSSIONS & CASE PRESENTATION SN Topic Case Name & signature of faculty 1. 2. Remarks : Signature of PG Teacher
D:\Acad_51\Acad51\PG Main\51-2015\Log Book\2 MD-DFM FMT.docx 7 DEPARTMENTAL/INTEGRATED LECTURES SN Topic Name of speaker Name & signature of faculty 1. 2. Remarks : Signature of PG Teacher (Please add 1 more pages) VISIT CRIME SCENCE & COURT SN Particular Name & signature of faculty 1. 2. Remarks : Signature of PG Teacher MEDICOLEGEL AUTOPSY ASSIGNMENTS SN Date Name of Deceased Police station Cause of Death Sign of faculty 1. 2. Remarks : Signature of PG Teacher (Please add 13 more pages)
D:\Acad_51\Acad51\PG Main\51-2015\Log Book\2 MD-DFM FMT.docx 8 CLINICAL FORENSIC MEDICINE ASSIGNMENT SN Date Particular Name & signature of faculty 1. 2. Remarks : Signature of PG Teacher (Please add 3 more pages) (A) SCIENCTIC CONTRIBUTIONS SN Name of CME/Workshop Details Name & signature of faculty 1. 2. Remarks : Signature of PG Teacher (B) SCIENCTIC CONTRIBUTIONS SN Name of Conference Details of paper presented Name & signature of faculty 1. 2. Remarks : Signature of PG Teacher
D:\Acad_51\Acad51\PG Main\51-2015\Log Book\2 MD-DFM FMT.docx 9 (C) SCIENCTIC CONTRIBUTIONS SN Topic Publication Journal details Name & signature of faculty 1. 2. Remarks : Signature of PG Teacher UNDER GRADUATE TEACHING ASSIGNMENT SN Date Batch Topic Type of activity Name & signature of faculty 1. 2. Remarks : Signature of PG Teacher DEPARTMENT/INTEGRATED LECTURERS SN Topic Name of speaker Name & signature of faculty 1. 2. Remarks : Signature of PG Teacher (Please add 1 more pages)
D:\Acad_51\Acad51\PG Main\51-2015\Log Book\2 MD-DFM FMT.docx 10 LABORATORY WORK ASSIGNMENT SN Date Particular of Assignment Name & signature of faculty 1. 2. Remarks : Signature of PG Teacher (Please add 3 more pages) SEMINARS SN Date Topic Name & signature of faculty 1. 2. Remarks : Signature of PG Teacher (Please add 1 more pages)
D:\Acad_51\Acad51\PG Main\51-2015\Log Book\2 MD-DFM FMT.docx 11 EVALUATION OF ACADEMIC PERFORMANCE OF PG STUDENTS (To be done 6 months earlier before commencement of University examination) SN Headings Comments 1 Sincerity & Discipline 2 Use of special method in doing Academic / Technical Assignment 3 General intelligence 4 Competence & Command 5 Supervisory / Controlling Capacity 6 Approach & Application General Remarks:- Excellent / Good / Fair / Poor This is to certify that Dr. ------------------------------------------------------------------- has /has not completed the MD / DFM tenure satisfactorily. PG Teacher I/C PG teaching Programme Professor & Head This report of final assessment has to be prepared 6 months prior to the expected for appearing at the University examination. One copy each to be sent to Dean office and University. (Please add 2 more pages)