• Y1 Mentor Logs
  • CRR
  • SSB
  • ERG
• Y1 Field/Elective Log
  • CRR
  • SSB
  • ERG
• Y1 Mentor  Evaluation
• Mentor Experience Signature
• Y1 Mentor  Log Printout
  • CRR
  • SSB
  • ERG
• Y1 Field/Elective Log Printout
  • CRR
  • SSB
  • ERG

 Student Activity Documentation

• Clinical Encounter Logbook
  • Logbook  Printout
  • Mentor Hours
• Mentor Experience Signature
• HII Clinical Experience Signature
• Resource Session Checklist -- ERG

 Student Evaluations

• Student Evaluation of Unit
• Student Evaluation of Facilitator
• Tutor Group Assessment Form (student)
• Tutor Group Assessment Form (tutor)

  Knowledge and Skills Assessments

• Faculty Evaluation of Student Oral Case Presentation
• Mentor Evaluation of Student Performance
• Patient  Evaluation of Student Performance
• Single Encounter Evaluation of Student Performance
• Standardized Patient Evaluation of Student Performance
• Student Progress Report & Remediation Plan

  Faculty Evaluations

• Doctoring Survey
• Facilitator Evaluation of Unit
• Faculty Evaluation of Unit

  Other Forms

• Approval for Elective Course Admission Prior to Year Three

FCM Clerkship

• LOGBOOK

  • Logbook  Printout

• END OF CLERKSHIP EVALUATION

Internal Medicine Clerkship

• LOGBOOK
  • Logbook  Printout
  • Quota  Printout
• END OF CLERKSHIP EVALUATION

OB/GYN Clerkship

• LOGBOOK
  • Logbook  Printout
• END OF CLERKSHIP EVALUATION

Pediatrics Clerkship

• LOGBOOK
  • Logbook  Printout
• END OF CLERKSHIP EVALUATION
• END OF CLERKSHIP FACULTY EVALUATION
• END OF CLERKSHIP EXAM EVALUATION

Psychiatry Clerkship

• LOGBOOK
  • Logbook  Printout
• STUDENT ASSESSMENT OF CLINICAL SUPERVISION
• STUDENT ASSESSMENT OF SEMINARS/ PRESENTATIONS
• STUDENT  EVALUATION OF PSYCHIATRY CLERKSHIP

Surgery Clerkship

• LOGBOOK (2007)
  • Logbook  Printout
• END OF CLERKSHIP EVALUATION

Electives

• Student Evaluation of Elective

• Approval Form for Individually Designed Electives for Year 3

Misc. Forms

• Pager Numbers

LOGBOOKS

• Year  4 Anesthesiology Logbook
  • Logbook  Printout
• Year  4 FCM Logbook
  • Logbook  Printout
• Year  4 Medicine Logbook
  • Logbook  Printout
• Year  4 Neuro Logbook
  • Logbook  Printout
• Year  4 Peds Logbook
  • Logbook  Printout
• Year  4 Psych Logbook
  • Logbook  Printout
• Year  4 OBGYN Logbook
  • Logbook  Printout
• Year  4 Surgery Logbook
  • Logbook  Printout
• Year  4 "Generic" Logbook
  • Logbook  Printout

EVALUATIONS

• Student Evaluation of Elective
  • Printout of Entries
• Report for Individually-Designed Elective
• Report for Extramural Elective

• Year 4 Neurology End of Clerkship Evaluation

• SIU Anesthesiology Clerkship

OTHER FORMS

• Elective Request form
• New Elective Course Application 2007
• Year Four Performance Evaluation
• Add-Drop Form
• Approval Request For Individually-Designed Or Extramural Elective