Jeffrey Bennett, MD

Jeffrey Bennett, MD
Clerkship Director

Required Assignments

Required Forms – all required forms can be printed from the links below.

History and Physicals

  • Submit 3 H&Ps for review and sign off.  A blank H&P Evaluation form should be printed from the website and attached to the H&P prior to submitting to the assigned mentor or attending.  An example of a good H&P write-up can be found at the following link: H&P example.
  • The physical examination may be deferred.  Note on the H&P if this is the case.
  • One H&P must be submitted to Michelle Blanshan prior to midterm unless other arrangements have been made
  • You will be completing other H&Ps during your rotation.  If you have completed more than 10 H&Ps, please notify Michelle or Staci Becker.

Off-site students can fax their documents to Michelle at (217) 545-2275. 


  • Topic paper.  This paper will be 2 – 4 pages in length, double-spaced with a minimum of 3 references.  References need to be cited within the body of the paper.  Any topic related to psychiatry may be addressed.  The student should attach an Assigned Paper Checklist and forward the paper to a peer for review.  This form is available online.
  • Reflective paper.  This paper should explore your thoughts and feelings on your Alcoholics Anonymous experience.  1 – 2 pages in length are satisfactory.  Forward the paper to Michelle Blanshan for review.  It is not necessary to attach an Assigned Paper Checklist.
  • One required paper must be turned in to Michelle Blanshan by midterm.

Observed Interview
Student must have three patient interviews observed by a MD, one of which must be an attending.  Each interview must be a minimum of 15 minutes.  Students should ask the attending or resident to initial and date the appropriate section on the Required Patient Encounter and Requirements card.  One interview should occur by midterm unless approval to defer it to the second half of the clerkship has been given by a member of the clerkship staff. 

All students are required to take a midterm that consists of 2 parts:

Midterm will cover mood, anxiety, psychotic disorders and substance abuse.  Off-site students will return to Springfield in order to take the mid-term.  Midterm will normally take place on the third Friday of the clerkship, unless otherwise indicated.  An e-mail with pertinent information will be sent to students the week prior to the mid-term.

Outpatient EHR Documentation
While rotating in SIU outpatient clinics, students are required to document in SIU EHR (Centricity) on each patient personally assessed.  The note should be completed and sent electronically to the attending physician as an attachment to a flag within 24 hours of seeing the patient.  Within 48 hours, faculty will provide feedback to the student via a flag.  Each time the student makes changes to the electronic note, he/she will send the revised note to the attending via a flag.  After final approval has been given, students are required to go back into the EHR and sign the note.  The final note should be printed and turned in to Michelle Blanshan for the student file.  There will be no student documentation in EHR after the last Tuesday (week 6) of the clerkship. 

Required Patient Encounter (RPE) Card
Students must complete a Required Patient Encounter Card. This documentation is required to comply with the LCME's 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 card should be copied weekly and placed in Michelle Blanshan's mailbox.  Progress on the card encounters will be discussed at individual midterm meetings. 

Patient Log Books
Students are required by the YRIII Curriculum Committee to complete the patient logbook for each patient seen. 

On the last Thursday of the clerkship, all students will complete the NBME Subject Exam in Psychiatry.  A final clinical exam will take place on the final Friday.  A detailed email will be sent regarding these events.

Note:  These Assignments are in addition to your required experiences.  Refer to Required experiences for details.

All forms are posted on the clerkship website and may be printed directly from there.


About the Department of Psychiatry

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