THE UNIVERSITY OF BRITISH COLUMBIA
#400 - 2194 Health Sciences Mall
Vancouver, B.C. Canada V6T 1Z3
Tel: 604.822.5571 | Fax: 604.822.2495
www.health-disciplines.ubc.ca
Date:
Informed Consent
Project Title:
Interprofessional Pain Management Pilot Course Evaluation
Principal Investigator:
Lesley Bainbridge
Location of Study:
University of British Columbia
Project Coordinator:
Victoria Wood
Telephone #:
604-822-1712
Organization:
College of Health Disciplines
University of British Columbia
400-2194 Health Sciences Mall
Vancouver, BC V6T 1Z3
Telephone #:
604-822-8693
* This consent form outlines your rights as a research subject if you choose to complete
the online evaluation survey. By completing the survey you will be providing your
consent.
Purpose: To evaluate a pilot Interprofessional Pain Management Module. This project will
expose health care students from various health care disciplines to a pilot module and will
evaluate the impact of this educational module on their interprofessional knowledge, skills
and attitudes. The aim of this project is to get feedback from students who participated in
the pilot module in order to improve the module in preparation for its delivery as a credit
course.
Study Procedures: If you choose to participate in this research, you will be asked to
participate in one module of two Interprofessional Pain Management Modules. The course
is comprised of two modules, each of which consists of:
• An online preparatory module that will ensure all participants have a
common understanding of the physiological aspects of pain
(approximately 1 hour)
• An introductory face-to-face session where you will have the opportunity
to meet you group (1.5 hours)
• An online component centred around a patient story and involving group
work (up to 3 hours)
•
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THE UNIVERSITY OF BRITISH COLUMBIA
#400 - 2194 Health Sciences Mall
Vancouver, B.C. Canada V6T 1Z3
Tel: 604.822.5571 | Fax: 604.822.2495
www.health-disciplines.ubc.ca
•
•
A face-to-face component bringing all participants together to share what
they have learned (2 hours)
An online evaluation of the course (approximately 15 minutes)
Participants will be asked to complete an online questionnaire after the completion of the
face-to-face component. The questionnaire will help the course developers measure the
effects of the module on students’ interprofessional skills, knowledge, and attitudes; the
effectiveness of the module as an interprofessional education experience; and the
effectiveness of the module’s delivery.
Potential Harm (Injury, Discomforts or Inconvenience): There are no anticipated risks to
participants. However, any participant will be able to refuse to answer any questions or to
participate in any discussion that, for any reason, is difficult for them.
Potential Benefits: Through participation in an IP learning experience, participants may
benefit from learning about a collaborative approach to the management of pain. Through
participation in this research project subjects will be assisting with the on-going
understanding of interprofessional health education and contribute to curriculum
development in this area.
Confidentiality and Privacy: All materials used in this study will be confidential.
Questionnaires will be numbered and stored on a computer with password protection.
Your name will not be associated with any of your responses and your participation in the
pilot course will not be linked to your online evaluation.
Publication of results: The study findings may be disseminated through presentations at
conferences and through publications in peer-reviewed journals. Participants in this study
will remain anonymous; you will not be identified in the study results in any way.
Reimbursement: Subject will receive a $20 gift certificate for their participation in this
research component of this project. Participants are asked to inform the Project
Coordinator (Victoria Wood viwood@interchange.ubc.ca) once they have completed the
online evaluation so they can be issued the $20 gift certificate in appreciation.
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THE UNIVERSITY OF BRITISH COLUMBIA
#400 - 2194 Health Sciences Mall
Vancouver, B.C. Canada V6T 1Z3
Tel: 604.822.5571 | Fax: 604.822.2495
www.health-disciplines.ubc.ca
Participation and Withdrawal: Participation is voluntary. If you choose to participate you
can withdraw from the study at any time without consequence by contacting the project
coordinator. Your role as a student will in no way be adversely affected and your decision
will remain confidential. The honorarium will only be provided to participants who
complete the module and the survey.
Contact for information about the study: If you have any questions or desire further
information with respect to this study, you may contact the Project Coordinator, Victoria
Wood at viwood@interchange.ubc.ca or 604-822-8693.
Contact for psychological concerns: If you develop any psychological distress from
participating in this study, you may contact Dr. Garry Grams, Director, Division of Behavioral
Medicine at (604) 822- 5704.
Contact for concerns about the rights of research subjects:
If you have any concerns about your treatment or rights as a research subject, you may
contact the Research Subject Information Line in the UBC Office of Research Services at
(604) 822-8598.
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