ࡱ> {z $bjbj2\2\ :P6_P6_%%%8]L<%u11111111S3 611/1'''1'1''6.0/@1E10u1/7w78070,'11 u17 : AESC2/2008: APPLICATION for APPROVAL to undertake a SURGICAL TRAINING COURSE using ANIMALS. This form is also available on disk (Word Perfect or MSWord 97) 2008   Course Title:  Guidelines for the use of Animals in the training of surgical techniques Applications for the use of animals for surgical training courses will normally only be approved under the following conditions: there is clear and obvious benefit to the surgeon, in terms of developing his/her surgical skills. there is no equally effective or better alternative available (please include a supportive motivation , p5, question 3). the course should form part of a graded process involving a number of other approaches such as models and/or simulators. only dead or fully anaesthetised animals which do not recover from the anaesthesia will be used in the course. no course will be approved which is run primarily for commercial benefit (profit) either to the organizers of the course or to any commercial entity involved with the course (e.g. a company which provides equipment for the course). In addition to the above conditions, the AESC will expect that; - the course will be in keeping with the role of the University to provide training essential for Health Professionals. in general approved courses will focus on development of essential clinical expertise. no course will be organized prior to AESC approval and liaison with the Director of the CAS the financial aspects of training courses will be transparent and subject to full disclosure to the Faculty Business Manager. DECLARATION BY APPLICANT . 1. I am suitably qualified to perform or supervise the procedure(s) proposed. 2. There will be clear and obvious benefit to the surgeons, in terms of developing surgical skills. 3. The course does not to my knowledge unnecessarily repeat other courses. 4. The course has been designed so as not to be wasteful of animals. 5. The course will focus on the development of essential clinical expertise. 6. Having carefully considered all possible alternatives, I am satisfied that it is impossible to attain the objectives in any other way. 7. Organisation of the course (e.g. dates) will only be done after approval by the AESC and liaison with the Director of the Central Animal Service. 8. I shall comply with any restrictions or modifications required by the AESC. 9. I have read the Guidelines for the use of Animals in the training of surgical techniques . 10. I have made a full disclosure of all the relevant facts. 11. Indicate below the Clearance Numbers of previous applications related to this new one  Signature:  Name: (in capitals)  University Department  Date:  SECTION A 1. I hereby apply under the existing University regulations for approval for the course detailed below. Member of Staff Name:  Qualifications:  Univ. Dept:  Tel No:  Financial aspects: i) Source of Funding: MRC  NRF  University  Other  If University, please state the name of the fund: ..................................................................................... ii) Specify any financial involvement of outside corporate bodies (e.g. sponsorship/donations by biomedical or pharmaceutical companies) and indicate whether the corporate body could benefit financially (e.g. from the sale or promotion of equipment used in the course). iii) If an honorarium is being paid to the facilitators/demonstrators of the course , please specify the amount(s) and the name(s) of the recipient(s). Amount Recipient R.. .. R.. .. R.. .. Please give details of prior training , such as models or simulators, which the delegates to this course have received. Normally, a course using animals will form part of a graded approach to training Indicate whether or not delegates taking part in the course are eligible for CME/CPD accreditation. Accreditation: Yes/No 5. Indicate whether or not this course is also held at other venues in S. Africa Yes/No If yes, please give details. 6.. Indicate whether or not photography and/or audiovisual recording will be necessary at any stage of the course? Photography: Yes/No Audiovisual: Yes/No If yes, please give details and name/s, affiliation/s, contact number/s and registered postal address/es of the person/s involved. SECTION B: DETAILS OF THE COURSE 1. Statement of specific objective/s: (The major specific objective of the course is to be stated). 2. Trainees/Prevalence of clinical condition: (It should be made clear whether this course is targeting academic clinical practice and hence benefiting state hospitals and clinicians affiliated to the University. Also indicate the prevalence of the clinical condition that will require application of the specific surgical technique being taught , i.e. the extent to which surgeons are likely to encounter the need for the technique) 3. Background/Motivation. (The rationale for using the specific animals should be given i.e. it should be made clear that no better or equivalent alternative is available). 4. Details of procedures a) Training protocol: (Give details about the number of animals to be used and requirements to ensure appropriate anaesthesia and analgesia, including the premedication anaesthetics, together with precise surgical techniques. Indicate the duration of this part of the course and the expected numbers of trainees per animal.) b) Delegates (Please give the names and affiliations of known delegates. If this is currently not known the information must be supplied to the director of the CAS prior to the course taking place. When affiliations are known, but names are not yet available, please list the affiliations). 5. Animals required Species Strain Sex  Age/Body Mass Total number of animals required                6. Drug Administration: Please list in the table below the name/s and qualification/s of the person/s responsible for drug handling/administration (normally this will be CAS staff). Name Qualification Telephone No.       Co-workers: Please list in the table below the names, qualifications and duties of co-workers involved in the running of this course. If representatives of a commercial organisation are hinvolved this must also be indicated here. Name Qualification Specific Duties Tel. No.                             8. Role of CAS: Please indicate what equipment or services the Central Animal Services will be required to supply. 9. Declaration by Head of Department This application is submitted with my approval and I am satisfied that the course complies with the Guidelines for the use of animals in training courses. Signature (Head): .............................................. Date: ..................................... 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