Today M-D-Y
Date Sr. Research Analyst completes initial review and sends to Asst. Dean of Assessment and Evaluation
Today M-D-Y
Date Assistant Dean for Assessment and Evaluation sends to review committee
Today M-D-Y
Date Assistant Dean for Assessment and Evaluation notifies requestor of committee decision
Today M-D-Y
Approved as is
Approved with caveats
Declined with request for more information
Declined
Today M-D-Y
Date data provided by Sr. Research Analyst
Today M-D-Y
Date log updated by Sr. Research Analyst
Today M-D-Y
Request Type (check all that apply)
Use of existing OME data
Use of Admissions data
Use of faculty evaluation data
Use of listservs for recruitment
New survey data collection
New qualitative data collection
New inter-institutional collaboration (extramural faculty or data)
What would you like to do?
Submit a new data use or collection request
Modify a previously submitted request
Please use the form below to note any changes since the initial request. A PDF copy of the initial request was sent as an email confirmation after submission.
any additional data being used or requested how the additional data relates to your research objectives/ hypotheses/ methods and types of analyses
I am a...
* must provide value
Faculty member
Staff member
Student
Please note that student investigators must have a faculty co-investigator listed
Department & Faculty Appointment or Staff Position Title
* must provide value
Email
* must provide value
Contact phone number
* must provide value
Are you the Principal Investigator?
* must provide value
Yes
No
If no, what is your role?
* must provide value
Name, affiliation, and email for any co-investigators
On what campus are you located?
* must provide value
Kansas City Salina Wichita
What type of study are you pursuing?
* must provide value
Research Study Quality Improvement Study I'm not sure yet Other administrative data request
What type of data will be used in your study?
Only data that is already collected by KU School of Medicine
Only the collection of new data
Both existing and new data
Unsure
OME data collection policies can be found on the OME website (https://www.kumc.edu/school-of-medicine/office-of-medical-education/scholarship-and-research-in-medical-education.html) under the heading "What approvals or support do I need to conduct educational research at the KU SOM?"
Do you intend to use surveys to request information from faculty, students, residents/fellows, or staff?
* must provide value
Yes
No
If yes, who would you like to survey:
Please identify any other individuals who will have access to the data used in your study. This may include members of the project team, such as faculty, postdocs, students and staff members. Please provide the following information for each individual:
Proposed start date for your study:
* must provide value
Today M-D-Y
Proposed end date for your study:
* must provide value
Today M-D-Y
Are there any important dates, such as presentation or submission deadlines, that OME should be aware of?
Please provide a project description highlighting objectives, hypotheses to be tested, and expected results (500 words maximum)
* must provide value
What are the potential benefits of this research (to the University/higher education in general/field of study/society)? (500 words maximum)
* must provide value
Please describe the research design and methods (100 words maximum)
* must provide value
What type(s) of analyses are planned? (250 words maximum)
What type of support will you need from the Office of Medical Education for your project?
* must provide value
Statistical analysis
Evaluation plan design
Research methodology
Data acquisition
Other
None
Please provide a description of the data being requested. Be as specific as possible.
A meeting with OME to discuss the proposal prior to submitting the data use or collection request is encouraged, but not required. Would you like to meet with OME staff to discuss the support being requested, above?
Yes
Not at this time
Only if OME would like to meet
Dissemination. Please provide a description of how the findings of your study will be reported/shared/presented. (500 words maximum)
* must provide value
IRB Approval. Research that involves human subjects must be reviewed by the KUMC Institutional Review Board (IRB) which oversees human subjects research. Research involving human subjects may not begin until the IRB has issued its determination/approval. Have you received IRB approval?
* must provide value
Yes
No
At this time, has the IRB requested a letter of support from the Dean for your submission?
Yes
No
Please provide your IRB project number or forward a copy of your determination letter to: sjohnst1@kumc.edu
I acknowledge that I must obtain IRB approval or determination prior to beginning my research. (please initial)
* must provide value
What is the funding status of this project?
* must provide value
Not funded
Funded - AME or MAITF
Funded - other grant or award
If funded by another grant or award, please specify:
I understand that all individuals who have access to the data being requested will be required to adhere to protocols surrounding the protection of that data.
Restriction of transfer of data to third parties:
I understand that the requested data may not be shared or transferred to any other researcher or any third-party without the prior written permission of the unit that is providing the data.
I agree to notify the Office of Medical Education of any publications, posters, presentations that are a result of the data provided.
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