When applying, please check the following notes and submit the required documents. In addition, it is necessary to report to the Conflict of Interest Management Committee. For details, please refer to the website of the Conflict of Interest Management Committee in the General Affairs Division, Itabashi Campus Office.
Teikyo University Itabashi Campus Office General Affairs Division Site (accessible only on campus)
Please submit the following documents to the Institutional Review Board Secretariat (Itabashi Campus Secretariat). Also, please attach materials as necessary.
Please read the guidelines carefully before creating the documents.
Applications may not be accepted for documents that do not meet the requirements.
Information session materials on how to fill out the application form of the Ethics Committee
The briefing session video can be viewed from the following. (Accessable only on campus)
Teikyo University Itabashi Campus Office General Affairs Division Site
|Mandatory||Ethics Guidelines for Life Science and Medical Research for Humans Applicable Research Application Form (for prior confirmation) (Updated May 30, 2022)|
|Mandatory||Research Implementation Plan (Updated June 24, 2021) |
Research Implementation Plan Description Guidelines 20220401 (Updated April 26, 2022)
Checklist for research implementation plan preparation (updated June 20, 2022)
|By research||Explanatory document (updated March 25, 2022) |
Checklist for creating explanatory documents (updated March 25, 2022)
Consent Form / Consent Withdrawal Form (Updated June 24, 2021)
Information Disclosure Document (Updated June 24, 2021)
|Mandatory||人を対象とする生命科学・医学系研究に関する倫理指針該当研究外部倫理審査委員会への審査申請申告書（2023年4月19日更新）||[Before examination] Flow when requesting ethics examination to the External Ethics Examination Committee (Updated on May 30, 2022)|
On-campus procedures are also required when applying to other Accredited Clinical Research Review Boards (CRBs). Please refer to the page of the Clinical Research Review Board of the Faculty of School of Medicine for the required documents.
Teikyo University School of Medicine Clinical Research Review Board
Studies that fall under the following are subject to institutional review by the Institutional Review Board. The attendance of the applicant or a research organization member who understands the research content is required.
Please refer to the following for the dates and deadlines.
Scheduled date of the event / Scheduled deadline for submitting documents
Please refer to the following for the details of the examination. In the case of an institutional review board review, please attach the review application form.
About the institutional review of the ethics committee
Examination application form
Please attach the following required documents to all researchers belonging to the University listed in the research plan "5. Research Organization".
Members of the research organization on campus are required to examine conflicts of interest.
After completing the prior confirmation, please request the examination using the conflict of interest Web filing system after the guidance from the secretariat.
If you have not registered as a user, please contact the Research Compliance Office (email@example.com).
Please refer to the following for how to log in to the system. (Accessable only on campus).
Teikyo University Itabashi Campus Conflict of Interest Management Committee Page
If the university is the main research institution, it is necessary to confirm conflicts of interest even for collaborators of institutions that do not have an ethics committee. Please contact the secretariat (outside the university will not be examined).
Please check the site for ICRweb. Introduction to ICR Clinical Research
I have a facility contract. Please contact the secretariat before taking the course.
If you took the course before January 17, 2013 (old course), please take the basic knowledge course of clinical research of the current course again.
APRIN e-learning program
At Itabashi Campus (including Mizoguchi Hospital and Chiba General Medical Center), attendance is compulsory from 2015.
Please contact us if you have a certificate of completion of the CITI Program in the United States or a certificate of completion that you have taken at another institution in the past.
If you are taking this course for the first time, please contact us as we will register at the secretariat.
If you are a collaborative researcher outside the university and cannot take the course at your institution, please contact the secretariat.
In the case of multi-institutional joint research in which a member of the university is the principal investigator, the ethics committee of the university will conduct a batch review, so the principal investigator should apply collectively.
If you apply to the Institutional Review Board of the University for multi-institutional joint research with major research organizations other than the University, the Institutional Review Board of the University will conduct a batch review. Please apply by collecting the names.
For joint research with a major institution other than the University, please attach a copy of the plan and approval of the main institution.
When creating a research plan, be sure to refer to the written guidelines and various procedure manuals of the university.
To download the procedure manual, refer to the item "Various procedure manuals" at the bottom.
Please refer to the following for statistical consultation. It is not resident, so a reservation is required.
About statistical consultation in June
Submit the report to the Institutional Review Board at the time stated in the research plan.
Please download the form from the item "Documents required for reporting (University form)" at the bottom.
[Before examination by an external organization]
Please submit the University Declaration Form with the necessary documents to the Institutional Review Board Secretariat. For the documents that need to be submitted, please refer to the attached documents column at the end of the ethical review application report. For the format of the ethics examination application report, please refer to the item "Request for examination of documents (university format) required at the time of application to an external organization".
Flow chart (before examination)
[After approval by an external organization]
When the examination at the request destination is completed and approved, please submit the examination result report together with the necessary documents to the Institutional Review Board Secretariat.
For the format of the examination result report, please refer to the item "Documents required for reporting (University format)".
After submitting the report, the research can be started after the procedure for obtaining the approval of the director of the Faculty of School of Medicine is completed.
Flow chart (after examination)
Please attach materials as necessary.
|Every year after the start||Research Report (Updated June 24, 2021)||For research that falls under the "Standard Business Procedures for Keeping Records in Clinical Research", please submit the attached sheet and data below to the secretariat. (At the end of research)|
|At the end of the research|
|When the final result is announced|
|Serious adverse events||Serious Adverse Event Report (Updated June 24, 2021)||Refer to the relevant procedure manual|
|Sending and receiving samples and information||（様式①）他の研究機関への試料・情報の提供に関する記録（2022年7月26日更新）||-|
|Provision of existing samples and information (members of this university do not participate in research)||他の研究機関への既存試料・情報の提供に関する届出書（本学所属者が研究者として当該研究に参画しない研究用）（2022年9月14日更新）||Notification flow for providing samples and information for research that the University does not participate in (published on April 26, 2022)|
|Examination request to an external organization Examination result||人を対象とする生命科学・医学系研究に関する倫理指針該当研究外部倫理審査委員会審査結果報告書（2023年4月19日更新）||[After review] Flow when requesting an ethics review to the External Ethics Review Board (updated April 26, 2022)|
|Submit at the time of application||(Imperial Form 1) Ethics Examination Request Form_Batch (Representative) / Single Institution (Updated March 29, 2022)||Please attach a plan, etc. Please use the form for our university|
|(Imperial Form 2) Ethics Examination Request Form_Batch (Responsibility) (Updated March 29, 2022)|
|（帝倫様式3）共同研究機関一覧（2022年9月28日更新）||Only required for multi-institutional joint research|
|Submit after acceptance||（帝倫様式5）研究実施体制確認書（介入研究）（2022年10月25日更新）||The attached documents will include the examination results regarding conflicts of interest and the certificate of attendance for education and training.|
If you are a researcher (institution) who wishes to be examined by the Teikyo University Medical Research Ethics Committee, please check the following notes and contact the committee secretariat in advance.
Please make sure that you meet the requirements of our university. (Teikyo University Medical Research Ethics Committee Regulations Operation Detailed Regulations Article 7)
Teikyo University Medical Research Ethics Committee Regulations Operation Detailed Regulations
We will accept the examination request only if all of the following conditions are met.
Teikyo University School of Medicine Research Ethics Committee Secretariat
Office, 2F, Itabashi Itabashi Campus Kaga, Itabashi-ku, Tokyo