22 Nov 2007 Joy R Rudland and John Dockerty

Policy regarding collection of Student Data for Research purposes

The Otago Medical School (OMS) has no concern in principle about requests to contact undergraduate medical students to participate in research into aspects of their education.

However, we do ask that researchers work through the OMS office in the first instance so we can ensure that students are not going to be overloaded or involved in research we consider inappropriate or of poor quality. We reserve the right to decline researchers the use of University channels to contact our students.

Otago Medical School Research Summary Form

Please complete this form (typed, not hand written) if you are conducting research that uses Medical Undergraduate Students in any of the four schools of the OMS (University of Otago, Wellington, University of Otago, Christchurch, Dunedin School of Medicine, School of Biomedical Sciences). Save it electronically as a MS Word document (please do not save it as a PDF) and please send to . Please complete all 18 questions, and send at least 4 weeks prior to data collection. It is anticipated that this form will be returned to you within 5 working days.

Official use only

Date received
Co-ordinating personnel

Basic information

1.  Title of Research
2.  Principal Investigator
Contact details
3.  Institution
4.  Other investigators and institutions involved

The research

4.  Aims of the research
5. Group studied (class, year and location)
6. Percentage of group to be approached?
7. Proposed dates (range) of data collection
8. Nature of data / analysis / Qualitative Quantitative Both
9. Type of research (e.g. case study, experimental, descriptive, cross sectional)
10. Method of data collection (e.g., observational, written survey (computer or paper based), interview telephone or face/face, focus or nominal group,)

Maori Consultation

11. If the research is conducted by a University of Otago member of staff, the following consultation process should be completed http://oupolicy.otago.ac.nz/maoriconsultation/index.html
Maori Consultation achieved yes no pending
If no consultation please explain:

Ethics approval and impact factors

12. Has ethics approval been secured and where. If not required, please explain. / Yes No Pending Not required
Approval Number:
13. The impact on students (e.g. potential for harm, intrusive)
14. How much time will students be required to input?
15. Any culturally sensitive issues?
16. What impact may this research have on the curriculum?

Support and feedback to students

17. Are you requesting any assistance with logistics? If yes by whom and what? (e.g. e-mail distribution list) / Staff member name:
(Staff member must have agreed to provide assistance)
Support required:
18. Is the option given for students to receive results and if yes how?

18. Any other details you would like to include

Dr. Kelby Smith-Han

Medical Education Research Academic Lead

Otago Medical School

University of Otago

NEW ZEALAND

Official Use

Permission status awarded / Pending yes No
Date of outcome
Date form returned to researcher
Other Comments

1

OMS November 2015