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The purpose of this structured elective request form is to explicitly define the roles and activities of both resident and supervisor(s) and the "deliverables" including presentation and publication of results. The idea is that this will serve as a "contract" so that everyone is clear about what to expect and so we can evaluate whether objectives have been met.

When you have completed the form, please send an email to the Director of Research and Scholarly Activity, Dr. Elton Ngan (elton.ngan@ubc.ca) to let him know.

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* 1. Resident's Name

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* 2. PGY Year

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* 3. Type of Elective Requested

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* 4. Dates of elective (note: all electives longer than 6 months will be re-assessed every 6 months):

Date
Date

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* 5. Project Supervisor's Name

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* Supervisor's email address

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* Co-supervisor (if applicable)

Note: Project supervisors are expected to be faculty members with some experience in research methods and publication (i.e., have published 2 or more papers in peer-reviewed journals in the past 10 years). If not, then a co-supervisor with such experience should be included. For any studies conducted in human or animal subjects, the project supervisor or co-supervisor must be registered in the RISe system (including an up-to-date Conflict of Interest/Commitment statement).

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* 6. Title of Project

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* 7. Description of Project (briefly describe, in 1-2 paragraphs, the objectives and methods)

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* 8. Resident's Role and Activities (check all that apply)

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* 9. Supervisor's roles and activities:
Dedicated and scheduled supervision time (in addition to "as needed")

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* 10. Other supervisor activities (check all that apply)

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* 11. When will results be presented at the UBC Dept. of Psychiatry Research Day?

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* 12. Are you expecting to present results at other meetings? (check all that apply)

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* 13. Are you expecting to publish your results? (check all that apply)

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* 14. Other information or comments:

Thanks for completing the form! Please send an email to the Director of Research and Scholarly Activity, Dr. Elton Ngan (elton.ngan@ubc.ca), to let him know that you've completed this.

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