Medical Student Research Program Proposal

Medical Student Research Program Proposal - Student

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Student Information

Class

Last Name

First Name

Cell Phone Number

Email Address

Location

Where your research will be conducted

Today's Date

Faculty Research Adviser Information

Last name, First Name, Degree (MD, PhD, etc.)

Email Address

Phone Number

Department

Adviser's Address (if non-Hershey)

Project Information

Project Title

Keywords (for data searches)

Is this research cancer-related?

YesNo

Are you working with other students on this research who may also use this as their proposal?

YesNo

Additional student name (Last, First) - click "Add another student" to add more names

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Proposal Document (.doc or .pdf)

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Research

The overall goal of the MSR is to promote, through a mentored research project, the development and application of critical thinking and problem solving skills that are fundamental to the integration of medical science and clinical care. Students gain an understanding of the research process, limitations and variability of data, and the translation of research and critical thinking skills to clinical practice. We expect our students to be able to articulate a relevant research question, decide on appropriate methods to address the question, collect and analyze the data, reach proper conclusions, and write a scientific report summarizing their work, including implications for further inquiry and/or clinical practice.

Does your research involve human subjects in any manner (including surveys, charts, etc.) ?

YesNo

IRB Approval

Your proposal can be submitted prior to final approval from the Institutional Research Board, but you must have IRB approval before beginning your research. If you are conducting your research somewhere other than the Hershey campus, you must have IRB approval from Hershey and the off-site location.

Hershey IRB Protocol Number

Pending

Non-Hershey Site IRB Protocol Number

Pending

Unit Approval

Does your human subjects research involve physicians or patients during regular clinic visits?

If yes, you must have permission from the relevant unit leader (Chair, Division Chief, Head, etc.) before beginning research

International Travel

Will this project involve international travel?

If yes, you must contact the Global Health Center administrative support person – Tamika Washington twashington4@pennstatehealth.psu.edu, and follow the procedures as defined in the PSU-COM Policy for Medical Student International Travel. All international experience must be approved by Dr. Ben Fredrick, Director of the PSU-COM Global Health Center or his designee, before research can be conducted.

Agreement

Enter your initials next to the following statements to indicate you have read, understood and agreed with their terms.

My MSR proposal was written entirely by me after consultation and revisions from my faculty advisor, and not copied from my advisor's materials or any other source.

I understand that all human subjects work (including surveys, charts, reviews, etc.) requires MSHMC/College of Medicine Institutional Review Board approval before any human subjects work is conducted.

I understand that all human subjects work conducted off campus for my MSR project must have both the MSHMC/College of Medicine Institutional Review Board approval as well as approval from the off campus site BEFORE any human subjects work is conducted.

Signature

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