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PHYSICIAN ASSISTANTS IN RESEARCH QUESTIONNAIRE
Name: _________________________
Email: _________________________
Address: _____________________________________________________
1. Type of Practice (Outpatient/Inpatient/Surgical) ________________
2. Specialty/Family Practice ____________________________
3. Research Responsibilities (please Check)
_____Clinical Assessments
_____Adverse Event Monitoring
_____Informed Consent Process
_____Drug Accountability
_____Subject Recruitment
_____IRB Correspondence
_____Sponsor Correspondence
_____Contract Negotiation
_____Case Report Form Completion
_____Data Entry (eCRFs)
_____Research Team Management
_____Other, Please List _____________________________
4. Research Position(s) Held (Please Check)
_____Research Coordinator
_____Principal Investigator
_____Sub-Investigator
_____Other, Please List _____________________________
5. Percentage of Job Responsibility Spent Doing Research _________%
6. Were you hired to perform research or was this an acquired responsibility? ___________________________
7. Do you use a central or local IRB? __________________
8. Research Experience (Please Check)
_____Pharmaceutically Sponsored Multi-Center Trial
_____Investigator Initiated Research
_____Academic Research
_____Other, Please List ________________________________
9. How many trials do you have ongoing? ______________
10.Have you ever been the principal investigator (PI) for a research project? _________________________________
11.Do you think having a doctorate degree would increase the probability you would serve as PI? ___________________
12.Have you taken any Investigator/Coordinator Training Courses? ___________________________________________
13.How could PAR benefit your practice as a researcher?____________________________________________
Thank you!
Please fax completed questionnaire to:
Attention Christen Kutz
610-366-9160
Or mail completed questionnaire to:
Physician Assistants in Research (PAR)
1616 Millard Street
Bethlehem, PA 18017
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