Part 1: Research Strategy (2 Pages)

The goal of this program is to create meaningful research experiences for residents in the Department of Anesthesia, Critical Care and Pain Medicine at BIDMC. This program will allow residents to participate in a formal research program with a mentor during their residency and/or develop their already established skills. They will be guided toward an appropriate mentor, whether within or outside the Department, and assisted in the development of a proposal. The allocated time and resources will be periodically reviewed to identify barriers to success and facilitate the achievement of the final goal.

This is a 2-part application process (Part 1, Research Strategy and Part 2, Mentor letter). Please strictly adhere to the format below in order to be considered for this program.

Part 1: Research Strategy (2 pages)

Applicant Name:

Proposed Project Title:

Primary Mentor Name: Secondary MentorName (if applicable):

Please state if this is an original project proposed by the resident or if the resident is joining a previously established project.

Original Project Proposal Previously Established Project

Please indicate the number of research months requested: months

Do you have a preference for when you would receive this elective time? (ex. Spring 2017)

What is the current state of the project?

Conception and Design(Includes obtaining IRB approval)

No data has been collected

Ongoing data collection

Completed Data Collection / Data Analysis

Manuscript Preparations

Other:

Goals

Please state three goals to be achieved by the end of this project.

Project Plan

AimsClearly state the broad, long-term objective and then the 1-3 specific aims (immediate goals or questions to be answered) of this project

BackgroundConcisely state the relevant background and motivation for this project.

MethodsClearly state how you plan to achieve the stated specific aims. If relevant, include an estimate of sample size and/or availability of research subjects or data for the study.

Data AnalysisClearly state the proposed data analysis, including expected results.

ReferencesPlease cite any pertinent references.

Part 2: Mentor Letter

Please include a mentor letter including assessment of the candidate and their project. Please also describe your plan for supervision including research project environment and availability of key resources, as well as your commitment to guide the resident toward future clinical research.

Is it feasible for the candidate to achieve their proposed goals?YesNo

If no, please describe why:

Please indicate and describe any expected productivity:

AbstractsPresentationsPapers

Is the resident a candidate for the Department of Medicine Introduction to Clinical Research Program? Yes No

Submission

By signing the line below, the candidateand mentor agree to the submission of the candidate’s application to be considered for the Anesthesia Resident Research Program.

______

Applicant SignatureDate

______

MentorSignatureDate

Anesthesia Resident Research Program | Application version July 2015 / 1