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Required Forms Included in this Section:
History and Physicals:
Submit one H&P to mentor for review. The mentor must sign off that it is
acceptable.
- The physical examination may be deferred. Note on the H&P if this
is the case.
- The H&P must be submitted to Robin prior to Midterm.
- A well written H&P example and H&P evaluation forms are included
in your orientation binder.
- You will be completing other H&Ps during your rotation. If you have
completed more than 10 H&Ps by the end of week 5, please notify
Robin or Staci.
Please submit the H&P to Robin Zorn, the Clerkship Coordinator. Off-site
students can fax their documents to (217) 545-2275.
Papers
- Submission of 2 papers, 2 – 4 pages in length, double-spaced with a
minimum of 3 references. You may substitute one paper, 5 – 8 pages,
with a minimum of 6 references that will be counted as two papers.
- References need to be cited within the body of paper.
- Any topic related to psychiatry may be addressed in your paper.
- The first paper is due on the 3rd Friday of the clerkship.
- Final paper is due on the Thursday prior to the end of clerkship.
- An example of a well written paper and the Paper Evaluation Form is
included in your orientation binder.
Observed Interview
Student must have 1 patient interview observed by a MD faculty or resident.
Interview must be a minimum of 15 minutes. Students will be given a faculty
observation form in their orientation binders. This form is due by midterm.
E-Lectures
All students must review Psychiatric Emergencies and Medical Consequences of Alcohol Abuse E-lectures.
Mid-Term:
All students are required to take a mid-term that will consist of 2 parts:
- 75 Multiple Choice Questions
- 20 minute Empathic Interview (please see Midterm SP Exam Checklist, located in Tab 7)
Mid-term will cover mood, anxiety, psychotic disorders and substance abuse. Off-site students
will return to Springfield in order to take the mid-term. Mid-term will normally take place on the
third Friday of the clerkship, unless otherwise indicated. You will be dismissed from clerkship
responsibilities at 10:00 on the day of midterm. An e-mail with pertinent information will be
sent to students the week prior to the mid-term.
Required Patient Encounter (RPE) Cards:
Students must complete a required patient encounter card. This documentation is required to comply
with the LCME’s new ED-2 standard. Students should carry the card at all times in a clinic setting.
After a required encounter, students should date the card, circle the patient type and level of participation
and obtain a faculty or resident signature. The signature side of the card should be copied weekly and
placed in Robin Zorn’s mailbox. Progress on the card encounters will be discussed with the Clerkship
Director at mid-term feedback sessions.
AA Meeting
All students are required to attend one AA meeting during their psychiatry clerkship.
Please turn in a meeting brochure to Staci or Robin or have the coordinator sign off on your RPE card.
ECT Experience
All students are required to observe one ECT experience during their psychiatry clerkship.
This experience should be verified by a faculty or resident signature on the RPE card.
Patient Log Books:
Students are required by the YRIII Curriculum Committee to complete the patient logbook for
each patient seen. You are responsible for entering all patients seen in your daily patient encounters.
Feedback Form:
During the first 3 weeks of the clerkship rotation, students must elicit feedback from the faculty/resident
instructor of their primary assignment and ask them to complete and sign the Student Feedback Form.
Primary assignments include inpatient rotations at MMC 5A, MMC 3A, SJH IP, Consult Liaison and Substance
Abuse. Students assigned to Alton and Choate, may ask the attending they are rounding with at those
locations to complete the form. More than one form may be completed; however, a minimum of 1 form
must be turned in to Robin by the mid-term date. A feedback form is included in this section of your
orientation notebook.
ALL FORMS ARE POSTED ON THE CLERKSHIP WEBSITE AND MAY BE PRINTED DIRECTLY FROM THERE.
Revised August 2007
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