BJC Innovations in Health Care Program

Clinical Scientist Training and Research (C-STAR) Program Division of Medical Education Washington University School of Medicine Application

Resident Applicant’s Name:

Faculty Primary Mentor Information

Name and title: Telephone number:

Department/Division: E-mail address:

If you have a secondary mentor, please complete this section:

Faculty Secondary Mentor Information

Name and title: Telephone number:

Department/Division: E-mail address:

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You may apply to MiM, MiM-I and/or C-STAR programs. Please refer to the website http://meded.dom.wustl.edu/education-programs.html for a detailed description of the programs and commitments. Please submit a separate application for Mentors in Medicine. This application is only for the C-STAR program. ______Using the instructions below complete the project outline in single-spaced type with one-inch margins and 12-point font. There is no page limit. Most applications are 3 pages of text excluding bibliography. The following headings should be used:

Project Title:

Research Question, Hypothesis or Goal: Give a one to two sentence description of the question to be addressed. Although there are exceptions, the hypothesis should be testable.

Background and Statement of Problem: In 1-2 paragraphs, state why the problem is important and outline the evidence that forms the basis for the hypothesis and/or goal stated above. Include appropriate references.

Intervention: Describe your experimental design. Include methodology for using controls. Provide details regarding your specific (the resident’s) role in implementing the proposal and any skill set that the project will allow you to learn.

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Outcome Measurement: Define the primary and (if applicable) secondary outcomes and describe how and when each will be measured.

Patients and Other Materials (if applicable): Describe the available population. To demonstrate feasibility, include the volume of patients, procedures per month/year, or availability of existing data.

Data Analysis: State the main statistical tests that you propose to use to evaluate the primary and secondary outcomes. You may wish to confer with a biostatistician or the Research Design & Biostatistics Group (RDBG).

Sample Size Estimation: State the clinically meaningful change in the primary variable that you want to detect with your study. Calculate how many units (patients, wards, hospitals, animals, etc.) you will need in the study to measure such a change. It is recommended that you use a two- sided alpha=0.05 and beta=0.20.

Project Role: Please state your specific role(s) on this project; be as specific and complete as possible. If a similar project has already been completed, state how the new project will differ.

Justification for block research time: Describe why you want to participate in the CSTAR program and how successful completion of your project will be enhanced by 12-weeks of time dedicated to research. Also, describe how participation in the “Designing Outcomes and Clinical (DOC) Research” course will facilitate your career goals.

References: List up to ten pertinent references to support the background and design of your proposal.

Mentor Letter: Provide a letter from your mentor(s) indicating that they have read and support your proposal. Include any additional support that the mentor(s) will provide--such as data, supplies, funding, and/or personnel (e.g. research assistant, laboratory technician, or biostatistical consultation). State how often the mentor and mentee will meet.

CV of applicant: Please attach a current copy of your CV.

Publications (if any): Rev Nov. 13, 2014 – SJ Page | 2 Clinical Scientist Training and Research (C-STAR) Program Division of Medical Education Washington University School of Medicine Please provide a list of publications you have submitted during your residency. You may attach them to the application, or you may upload them to MyEvaluations.com in the Scholarly Activities tab of the MyPortfolio module.

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If you have any questions or need assistance in preparation, contact the C-STAR Coordinator at [email protected] or 314-362-8065.

Please submit completed application by e-mail to [email protected]. You will receive a confirmation email that your application was received.

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