Research Committee (RC) of IRB

Islamabad Medical & Dental College

RC FORM

Title: ____________________________________________________________________

____________________________________________________________________

Candidate/Author:

_________________________ _______________________ _____________________

NAME DESIGNATION DEPARTMENT

_________________________ _______________________
MOBILE EMAIL

Supervisor:

_________________________ _______________________ ____________________

NAME DESIGNATION DEPARTMENT

_________________________ ________________________
MOBILE EMAIL

Co Supervisor:

________________________ ________________________ ____________________

NAME DESIGNATION DEPARTMENT

________________________ __________________________
MOBILE EMAIL

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1. Research Domain

2. Introduction

3. Purpose of the Study

4. Objective(s) of the Study

5. Description of Method(s) used in Protocol

a) Study Design
b) Study setting
c) Study duration
d) Study population
• Brief explanation of subjects (e.g. age range, sex)
• Inclusion/Exclusion Criteria
e) Sample Size
f) Sampling technique
g) Data collection procedure
h) Statistical tools

6. Ethical Issues

• Human or animal subjects (reason for using as subjects)

• Confidentiality & privacy of the participants
• All known/potential risks to the subjects (Nature and degree of risk/adverse effects,
how these will be managed? who will bear the cost?)
• Written informed consent obtained
• State monetary benefit (if any) to the participant (for medication, test or investigation
done)

7. Significance of study in context of Pakistan

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8. Has this study been conducted elsewhere earlier?

If “Yes” why this research is being repeated in Pakistan?

9. The relevance and expected outcome/impact of proposed study?

10. Collaborating Labs (if any)

11. Funding Source (Institutional/HEC/Sponsored)

12. Estimated Budget and proposed project period

13. Total number of references. How many older than 5 years? (preferably >80%
should be within 5 years)

Signature of Supervisor: ____________________________________

Date:

Signature of Co- Supervisor: ____________________________________

Date:

Signature of Head of the Department: _____________________________

Date: