Appendix Format A (Protocol)

Format of the FCPS Dissertation Research Protocol
(Please use this format for typing your protocol on A4 size offset papers, but you may increase the space within any cell or attach
extra sheets if required). Please put ‘NA’ against any section that is not applicable
FCPS Dissertation/Thesis Protocol

Protocol No:
(To be provided by BCPS)
1. Date of submission of
2 0
protocol
2. Relevant Faculty- Discipline-
3. Name of the researcher

(in capitals) Keep a blank
cell between every two
parts of your name
4. Correspondence of the a. Address
examinee and contact b. Phone Number
phone numbers c. E-mail address
5. Title of the
dissertation/Thesis
6. Summary
(in around 300 words)
with key words
7. Place of study
8. Study Period
9. Study design
10. Introduction/context
(including a short review
of the relevant literature
and preliminary
observations)
11. Rationale of the research
(its scientific/medical/social
impact)
12. Research Question /
hypothesis
(as applicable)
13. Objectives a. General
b. Specific
14 Materials and Methods a) Main outcome variables to be

. (in sufficient details to studied
enable relevant authority b) Confounding variable
to assess:
c) Study population (mentioning
 how they would
species and strains, ethnic group,
achieve the stated
age, sex and other relevant
objectives
characteristics)
 whether they are
d) Sample size and the statistical
feasible)
basis of it
e) Screening methods, if
Give relevant references,
applicable
where applicable, in the
f) Sampling method (s)
‘References’ section.
g) Inclusion and exclusion criteria
h) Operational definitions
i) Flow chart showing the
sequence of tasks
j) Procedures of preparing and
organizing materials (e.g., into
groups)
k) Nature of controls, if applicable
l) Randomization and blinding
methods, if and as applicable
m) Equipment’s to be used
n) Procedures of collecting data
(including methods of
intervention, measurement,
estimation etc)
o) Professional assistance from
experts, if applicable
p) Procedure of data analysis of
interpretation (including methods
of statistical analysis – specific
methods and software used for
individual analysis)
q) Quality assurance strategy
r) Time table
15 Ethical implication
Think carefully about possible ethical implications and put
your views in short here.
Follow the guidelines from the appropriate Ethical Review

Committee (s) of the concerned institution (s) and/or
BCPS and attach necessary documents accordingly.
16 Total Budget
(dividing into main sectors of expenditure)
17 Source(s) of funding (if any)
18 Facilities available at the place of study
19 Other facilities needed
and the organization (s)/ institution(s) providing them
20 Dissemination and use of findings
21 References
(including the references for the “Materials & Methods”
section, if applicable
22 Any other relevant information
23 I solemnly pledge that this research protocol shall be implemented in accordance with the
relevant ordinance/ circulars of BCPS and funding agencies as when it is applicable. I hereby
declare that no part of the proposal research has been used in any thesis/ dissertation in partial
fulfillment of any degree/fellowship or any publication
I also understand that the BCPS reserves the right of accepting or rejecting this protocol.
Date Signature of the Researcher
24 Signature(s) of the Guide Signature of the Co-Guide
Name: -----------------------------------------------
Name: ----------------------------------------
Designation : ---------------------------------------
Designation : --------------------------------
Seal: --------------------------------------------------
Seal: ------------------------------------------
ATTACHMENTS:
The following papers have been attached to each of the two copies of the protocol submitted:
1. Data collection instruments:-
e.g., subject recruiting materials, questionnaire, interview guide, group discussion guide,
physical/clinical data collection sheet etc. if and as applicable
2. Documents regarding ethical clearance as prescribed by the relevant body of BCPS.

Appendix Format A (Protocol)

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Appendix Format A (Protocol)

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Format of the FCPS Dissertation Research Protocol

FCPS Dissertation/Thesis Protocol

3. Name of the researcher

14 Materials and Methods a) Main outcome variables to be

Follow the guidelines from the appropriate Ethical Review

Date Signature of the Researcher

24 Signature(s) of the Guide Signature of the Co-Guide

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