AQI Registry Research Rotation

AQI Registry Research Rotation

Resident Application Form
Thank you for your interest in the AQI Registry Research Rotation. This rotation is only available to active anesthesiology residents.

Please complete all required fields (*) and contact EngageAQI@asahq.org with any questions.
Contact Information
Full Name*

First NameLast Name
Credentials*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Anesthesiology Residency Details
Institution/Affiliation:*
Year of Residency:*

PGY-1CA-1CA-2CA-3
Residency Program Director Name:*

First NameLast Name
Residency Program Director Email:*
example@example.com
Please share your intentions for pursuing this rotation including your personal goals, objectives, interests, and program expectations. Additionally, please share any additional thoughts regarding your unique experiences or challenges that the committee should consider when reviewing your application:*
Please provide a brief description of your statistical expertise including experience with R, SAS, STATA, or other statistical software available to you:*
Please share up to three anesthesia practice areas or specific topics for which you are most interested in researching:*
*AQI may recommend alternate topics for your rotation to ensure feasibility, impact, and data availability*
Which of the following rotation benefits are most interesting to you (Select up to 5):*

Peer-reviewed publicationASA/AQI clinician mentorshipImproving patient safety or quality of careProfessional or technical skills developmentCollaboration with ASA/AQI clinician leadersAnesthesiology conference presentation (e.g.ANES, Advance)Increased understanding of observational researchIncreased understanding of utilizing large clinical datasetsIncreased understanding of applying investigation to clinical practice

Please indicate your availability for participation in a research rotation during this calendar year:*

	Preferred	Available	Unavailable
June
August
September
October
November
December

Please upload a copy of your current resume/CV:*

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Please upload a formal letter of approval from your institutional residency program director to pursue the AQI Registry Research Rotation:*

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AQI Registry Research Rotation

Contact Information

Anesthesiology Residency Details