Application for the

MD With Special Training In Research Program

FACULTY OF MEDICINE & DENTISTRY

Note: The student is to complete the following application form using the guidelines provided using a 10-12 font size.

A. / Contact Details /

Class of

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Student’s Name: ID#
Home Address:
Telephone (home): Telephone (work):
Fax:
E-mail:
Do you have a graduate degree?
If yes, please specify the degree and give the title of your thesis.
Supervisor’s Name:
Department:
Address:
Telephone (work):
Fax:
E-mail:
B. / Proposed Research: to be completed in consultation with supervisor (Items 1-7 in this section to be double spaced, paginated and include your name and id#) Your proposal must also include the following:
Title of Project:
1) Background/Introduction: (Maximum 2 paragraphs)
2) Hypothesis/Rationale: (Maximum 2 sentences)
3) Objectives: (Maximum 2 sentences)
4) Methods: (Maximum 2 pages)
For Clinical Science: include study design, inclusion/exclusion criteria, data collection, outcomes, statistical analysis
For Basic Sciences: include materials and methods
5) Integration into Supervisor’s research activities: (Maximum 2 paragraphs)
Describe how your project will link to that of the Supervisor and the research group/laboratory
6) Role of student: (Maximum 2 paragraphs) – be specific about what you will do during the summer
7) References (bibliographical citations)
Ethical issues, Indicate if the project involves:
(circle yes or no)
Human Subjects
Animal Experiments
Biohazards / Yes
Yes
Yes / No
No
No
If yes to any of the above, you must attach a copy of the ethics approval with your application. If pending, then proof must be provided prior to starting the project.
C /

Previous Research Experience (must include most recent summer)

(add extra rows if required)
Supervisor’s Name:
Year of Supervision:
Did the student work in a research project (Yes/No)
Title of the RESEARCH project:
Number of weeks the student worked in the research project
Address:
Telephone:
Fax: E-mail:
Supervisor’s Name:
Year of Supervision:
Did the student work in a research project (Yes/No)
Title of the RESEARCH project:
Number of weeks the student worked in the research project
Address:
Telephone:
Fax: E-mail:
D
/ INFORMATION FOR SUPERVISORS OF MD STUDENTS IN THE
SPECIAL TRAINING IN RESEARCH (STIR) PROGRAM
The main research requirement for students in the STIR Program is a minimum of 24 weeks of research experience (excluding vacation time). The student will complete the research requirement over two consecutive summers; s/he may work in a particular research environment for only one summer or for both summers.
At the outset, the student is expected to:
a)Become familiar with the salient literature in his/her area of interest; and
b)Take responsibility for writing the research proposal with minimal assistance from you.
After the research experience, the student is expected to understand
a)The basis and selection of methodologies used; and
b)The interpretation of results and an awareness of the significance of any findings; and
c)The dissemination of research findings.
DEMONSTRATE PRACTICAL UNDERSTANDING OF THE SCIENTIFIC RESEARCH PROCESS
To successfully complete the STIR program, the student must be able to demonstrate a good practical understanding of the entire scientific process, including development, formulation and testing of hypotheses, experimental design, and validation, presentation, analysis and interpretation of results (in the context of all other available scientific information).
As part of the evaluation process, the Committee requires that the supervisor submit a confidential evaluation on the student’s performance to be included in the student’s final report with a deadline in September after the summer of research. The evaluation form is available for download at the following website address:
Please note that the student is admitted based upon the proposed research submitted. If the project or role of the student changes, the Chair of the MD with Special Training in Research Program must be advised in writing by the end of May prior to starting the project or the student is automatically withdrawn from the program.
I have read the student requirements listed below and am confident that the submitted project will meet the unique training requirements of the Program.

Signature of STIR Supervisor

/ Date
E / REQUIREMENTS FOR MD STUDENTS IN THE SPECIAL TRAINING IN RESEARCH (STIR) PROGRAM
I understand that successful completion of the MD with Special Training in Research Program requires:
Maintenance of good academic standing by the end of each academic year in the MD Program, including the Practice of Medicine component.
Attendance at the Mandatory Research Ethics and Integrity Seminar.
Twenty-four (24) weeks of summer research over two consecutive summers commencing with either the summer of acceptance into the MD Program or the summer after Year 1 of the MD Program.
At least one oral presentation, after acceptance into the Program, during your summer of research.
Submission of a final report to the MD Research Committee. The report must be submitted by the last Monday in September, immediately following the completion of the 24-week research requirement. The report will focus on only your recently completed summer of research, which you were admitted into the program with (unless the same project was continued in the second year) and it will include:
a)A written abstract and report (with references) and a list of your contributions to the work. The guidelines for the final report are available at:
An oral presentation to be given to the MD Research Committee in October or November of the same year, as scheduled by the Office of Research in the Faculty of Medicine and Dentistry.
Research for the MD With Special Training In Research Program may be conducted outside the Province of Alberta. In such instances, I understand that the Chair of the MD Research Committee must approve the eligibility of the proposed supervisor, as part of the application process as indicated in the guidelines available at:

Proof of Ethics approval for any studies involving animal or human subjects (must accompany the application).
Advising the Chair of the MD with Special Training in Research Program in writing by the end of May prior to starting the project if the project or my role in the project changes.
Responsibility for writing the application and final report.
My Signature, given below, verifies that I have read and understand the requirements and expectation of the MD with Special Training in Research Program

Signature of STIR Applicant

/ Date

Submit your completed application package (original plus 3 copies) to the Office of Research, 2-13 HMRC before 4:00 p.m. on February 1, before your second/last year of eligible research.

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Approved by MD Research Committee October 27, 2003

Approved by DEC, January 30, 2004