Responsible Conduct in Research Human Subjects Education Module Copyright©2002 Winona State University, P.O. Box 5838, Winona, Minnesota, 55987 Welcome to the WSU Human Subjects Education Module. Instructions • Documentation of successful completion of this program is required of all WSU students, faculty and staff who conduct research involving human participants on or off campus. It is also required of any individual not associated with WSU who conducts research involving WSU students or employees, or conducts research using records containing information on WSU students or employees. • Reviewing the module takes about 20 minutes. Successful completion is documented by scoring 80% on an online, 20-question multiple choice quiz. The quiz is available on Desire to Learn (D2L) https://winona.ims.mnscu.edu/. • See the next page for instructions on registering to complete the Human Subjects Education Module and the Quiz. Contents Instructions • You can self-register in the Human Subjects Education Module. Go to the Desire to Learn (D2L) Home Page at https://winona.ims.mnscu.edu/. Login and click Self-Registration on the toolbar. Select Human Subjects Education Module. Click on Register; click on Submit; Click Finish. A Registration Summary will appear. If you click on the Go to Human Subjects Module, you will go directly to the course. If you do not want to go to the course immediately after enrolling, click on Done and you will go back to your D2L Home Page. The next time you login to D2L, click on the + sign to the left of the words No Semester to see a list of courses and click on Human Subjects Education Module to go to the course. • Call TLT Services via ext. 2900 if you have any problems enrolling in or accessing the course. Contents Contents – Rationale for the Education Requirement – Definitions – History • The Nuremberg Code • The Belmont Report – The Belmont Principles and Applications » Respect for Persons - Informed Consent » Beneficence - Assessment of Risks & Benefits » Justice - Selection of Subjects Contents (Continued) – Federal Regulations – Principle Investigator (PI) • General Responsibilities • Request for Approval of Protocol • Informed Consent Form • Informed Consent Process Contents (Continued) – Institutional Review Board (IRB) • Members • General Responsibilities • Authority • Purpose of the Review • Content of the Review • Financial Conflict of Interest • Types of Review – Exempt Research – Expedited Review – Full Committee Review • Complaints and Investigations – Quiz Rationale for the Education Requirement – As of October 1, 2000, grant applicants to the U.S. Department of Health and Human Services (HHS) National Institutes of Health (NIH) must certify that all key personnel named in a research proposal have completed an education program in the protection of human subjects. – Other agencies are expected to adopt similar policies, just as, in 1991, sixteen agencies adopted the HHS human subjects protection regulations as their “common rule.” In addition, the U.S. Congress is considering extending all federal regulatory provisions to all research, regardless of the sources of funding. The state of Maryland has already passed such a statute with respect to the use of human subjects in research. Contents Rationale for the Education Requirement (Cont) – HHS strongly recommends institutions follow the federal regulations regarding protection of human subjects regardless of the source of research sponsorship. – WSU has filed a Federal wide Assurance with HHS affirming it will apply all federal research-related regulatory requirements to all research conducted under its auspices, regardless of source of financial support, if any. Hence, all persons submitting a Request for Approval of Protocol to the WSU IRB must include documentation that they have successfully completed this instruction module. Contents Definitions - What is “Human Subjects” Research? – Research is “a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge.” (45 CFR 46.102) – Research may involve direct interactions or interventions, such as obtaining data through surveys, interviews, observation, taking medical histories, obtaining blood samples, urine sampling, diagnostic procedures, or treating patients at least in part for the purpose of gaining generalizable information. Research may also be indirect, such as analysis of specimens or data. (Hint: The intent to publish or present the results of an activity usually, but not always, implies the activities involve research.) Contents Definitions - What is Human Subjects Research? (Continued) – Research (as defined previously) that involves human participants may be “human subjects research” if the subjects meet the following definition. – A human subject is a living individual about whom an investigator conducting research obtains either data through intervention or interaction with the individual; or identifiable private information from a confidential source. – Key to the human subjects definition are the phrases “about whom” and “identifiable.” Collecting information FROM individuals is not necessarily human subjects research, but collecting identifiable information ABOUT individuals usually is. Contents History: The Nuremberg Code – The U.S. government believes it has an ethical and legal responsibility to protect the rights of citizens who agree to participate in research studies. – The principles underlying the protection of human subjects have their seeds in events following World War II. In 1947, the Nuremberg Military Tribunal developed a code of standards to be used in judging physicians accused of conducting research atrocities in Nazi concentration camps. Contents History - The Nuremberg Code (Continued) – Key to the Nuremberg Code was the principle that the voluntary consent of individuals who were research subjects was absolutely essential. Such consent could be judged by three criteria: • Capacity to consent • Freedom from coercion • Comprehension of the risks and benefits involved Contents History - The Belmont Report – In 1979, the Department of Health, Education and Welfare issued the Belmont Report on the “Ethical Principles and Guidelines for the Protection of Human Subjects of Research,” developed by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (available at http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.htm) – The Belmont Report expanded upon the Nuremberg Code, establishing three ethical principles and accompanying applications for the protection of human subjects. Contents The Belmont Principles and Applications – Practical applications of the ethical principles set forth in the Belmont Report are: Ethical Principles Applications 1. Respect for Persons Informed Consent 2. Beneficence Assessment of risks and benefits 3. Justice Selection of subjects Contents Respect for Persons - Informed Consent – Respect for Persons - Researchers must respect individual participants’ autonomy and protect those with reduced autonomy. Persons must be given all the information and time they need to make an informed decision as to whether or not to participate in a study and must freely volunteer to do so. – There must be freedom from coercion, either directly or indirectly. Subjects should not feel any pressure to participate, including unintended pressure that may be created by the researcher and subjects’ non-research related relationships. – Extra care must be taken with individuals who may have a limited capacity to consent, such as children, the elderly and the mentally ill. Their legal guardians (for children) or legal representatives (if appointed) must participate in the decision-making process. Contents Respect for Persons - Informed Consent (Continued) – Informed Consent - Before agreeing to participate in a research project, human subjects must be given a clear description of the proposed research and must understand what the research will entail, including any risks associated with their participation. They must be assured participation is voluntary and that they may withdraw from a study, without prejudice, at any time. In short, subjects have a right to be “informed” and must freely “consent” to participate. – Securing subjects’ informed consent is generally confirmed through subjects (and/or their legal representatives) receiving and signing a copy of a form including the above information. Contents Respect for Persons - Informed Consent (Continued) – In the case of anonymous surveys, informed consent may be obtained by including a statement on the instrument indicating that by completing the survey the subject is giving his/her consent. The statement must include the elements required to obtain informed consent, but the human subjects’ signatures are not required. – Informed consent waivers may be only be requested in unusual circumstances, generally in cases where the only record linking the subject to the research would be the consent form and there is potential harm from a breach of confidentiality . Contents Beneficence - Assessment of Risks & Benefits – Beneficence - The Belmont Report stated research should “maximize possible benefits and minimize possible harms.” The researcher must balance the obligation to protect the well-being of the individual human subjects who agree to participate in her/his study with the possible benefits the research may offer society. – The ultimate benefits of any research must outweigh any and all of the risks to human subjects participating in the project. Contents Beneficence - Assessment of Risks & Benefits (Continued) – Assessment of Risks and Benefits - Risks must not only be disclosed in the informed consent process, they must be minimized in the research plan. Researchers must consider physical, psychological, social and economic risks in designing their research. – Researchers must also offer protections against invasion of privacy (access to information about a person’s body or behavior without her/his consent) and ensure the confidentiality of any data collected (safeguarding of information voluntarily given by one person to another). Personal information gathered about human subjects in the course of a study -- data that can be directly linked to a specific individual -- must not be accessible by any individual without the subject’s knowledge and consent. Contents Justice - Selection of Subjects – Justice - An “equitable distribution of research burdens and benefits” is required. This means selection of participants must not be based on the “favor” or “disfavor” of the researcher, nor the social status or “vulnerability” of the subjects. The past practice of recruiting subjects from “captive,” manipulatable populations (poor patients in public institutions, prisoners, soldiers, students) led to abuses, as well as faulty research results. – In recent years, National Institutes of Health have placed increasing restrictions on research that does not select sample populations reflecting the appropriate numbers of minorities, women and children. NIH has also established special provisions for reviewing protocols involving prisoners. Contents Justice - Selection of Subjects (Continued) – Selection of Subjects - Subjects should not be selected based on class, socioeconomic status or race unless the study objectives require such selectivity. Women in their child-bearing years must be included unless there is specific scientific evidence of risk. The use or non-use of children must be justifiable. If prisoners are involved, a prisoner representative must serve on the IRB. – Counselor-client, employer-employee and teacher-student relationships are potentially coercive, and extra precautions should be taken to guard against any such perception. For example, faculty awarding extra credit for students participating in a study should offer an alternative, comparable method of earning extra credit for those students who choose not to participate. Contents Federal Regulations • The following regulations and laws apply to human subjects research: – Code of Federal Regulations dealing with the Protection of Human Subjects (45CFR46) & Public Health Service (PHS) Policy http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm – Health Research Extension Act of 1985 (Public Law 99-158) as amended by the National Institutes of Health (NIH) Revitalization Act of 1993 (P.L. 103-43) http://www.hhs.gov/ohrp/humansubjects/guidance/statute.htm – (Note: The Food and Drug Administration (FDA) also has regulations that apply if the research involves a product regulated by the FDA. Protection of Human Subjects and informed consent requirements are prescribed in 21 CFR 50 and Standards for Institutional Review Boards appear in 21 CFR 56). Contents Federal Regulations (Continued) – The 1991 Federal Policy for the Protection of Human Subjects Institutions engaged in research supported by any of 16 agencies must file an assurance agreeing to protect the welfare of all human subjects involved in research, “whether or not the research is conducted or supported by a federal department or agency.” – Participating agencies include: The U.S. Departments of Agriculture, Energy, Commerce, Housing and Urban Development, Justice, Defense, Education, Transportation and Health and Human Services; and Veterans Affairs, the National Science Foundation, NASA, EPA, AID, Social Security Administration, CIA and Consumer Product Safety Commission. (Again, the Food and Drug Administration follows separate, but similar regulations.) Contents Principle Investigator (PI) - General Responsibilities – Researchers must adhere to the ethical guidelines and legal regulations covering human subjects research. They are responsible for: • Design of the study and preparation of the research plan • Submission of all required forms/information to the designated Institutional Review Board (IRB) • Conduct of the research, including reporting any unanticipated problems involving risks to subjects or others, or unexpected serious harm to subjects, to the IRB • Compliance with IRB decisions, stipulations and data requests • Submitting proposed amendments to previously approved research Contents PI General Responsibilities (Continued) – Three key documents must be submitted by the Investigator to secure IRB approval: • Protocol Request for WSU IRB Approval form • Informed consent form or statement or consent waiver request • Documentation of completion of this Human Subjects Education Module Contents PI - Request for Approval of Protocol The Request for Approval of Protocol Form includes descriptions of: • the proposed research activity • the scientific rationale for the proposed research activity • the risks to subjects • any procedures that are experimental • anticipated benefits to subjects, if any • subject selection, recruitment procedures and the anticipated number of subjects • the proposed consent document and process to be used • safeguards to be taken if vulnerable subjects are involved • steps to be taken to ensure confidentiality of data Contents PI - Informed Consent Form – The proposed informed consent form must be submitted with the Request for Approval of Protocol. Elements to be included in the form are specifically spelled out in federal regulations. – There are 12 basic elements and 6 possible additional elements. Contents PI - Informed Consent Form (Continued) 1. 2. 3. 4. 5. 6. A statement of the proposed research An explanation of the purposes of the research The expected duration of the subject’s participation A description of the procedures to be followed Identification of any procedures which are experimental A description of any reasonably foreseeable risks or discomforts to the subject 7. A description of any benefits to the subject or others which may reasonably be expected to result 8. A disclosure of appropriate alternative procedures or courses of treatment, if any, that might be advantageous to the subject 9. A statement describing the extent, if any, to which confidentiality of records identifying the subject will be maintained Contents PI - Informed Consent Form (Continued) 10. For research involving more than minimal risk, an explanation as to whether any compensation, and an explanation as to whether any medical treatments are available, if injury occurs and, if so, what they consist of, or where further information may be obtained 11. An explanation of whom to contact for answers to pertinent questions about the research and research subjects’ rights, and whom to contact in the event of a research-related injury to the subject 12. A statement that participation is voluntary, refusal to participate will involve no penalty or loss of benefits to which the subject is otherwise entitled, and the subject may discontinue participation at any time without penalty or loss of benefits, to which the subject is otherwise entitled Contents PI - Informed Consent Form (Continued) – The 6 additional elements that should be added, as appropriate, are: 1. A statement that the particular treatment or procedures may involve risks to the subject (or embryo or fetus, if the subject is or may become pregnant), which are currently unforeseen 2. Anticipated circumstances under which the subject’s participation may be terminated by the investigator without the subject’s consent 3. Any additional costs to the subject that may result from participation Contents PI - Informed Consent Form (Continued) 4. The consequences of a subject’s decision to withdraw from the research and procedures for orderly termination 5. A statement that significant new findings developed during the course of the research which may be related to the subject’s willingness to continue participation, will be provided to the subject 6. The approximate number of subjects in the study Contents PI - Informed Consent Process – Simply having a signed, acceptable form is not sufficient evidence that informed consent has been secured. Subjects must understand what the form says. They must have been given a reasonable amount of time to read the form and an opportunity to ask questions about the proposed research. In short, informed consent is actually an on-going process, which is documented through use of an informed consent form. – It is recommended consent forms be written at no more than an 8th grade reading level. In some cases, due to language barriers or other circumstances, the elements of informed consent may be presented orally. In those cases, the IRB must receive a written summary of what is to be communicated orally and a witness must be present at the oral presentation. The subject may then sign a “short” consent form. Contents PI - Informed Consent Process (Continued) – If the subject is potentially “vulnerable,” (elderly, cognitively impaired, or economically or educationally disadvantaged), extra care must be taken to be sure they are truly giving their informed consent. There are additional regulatory requirements if research involves women, human fetuses, neonates, prisoners or children. . – If the subjects have legal guardians or legal representatives, those representatives must participate in the informed consent process and their signatures also must be secured. Subjects (and their representatives) should be given a copy of the signed form. Contents Respect for Persons - Informed Consent (Continued) – In the case of anonymous surveys, informed consent may be obtained by including a statement on the instrument indicating that by completing the survey the subject is giving his/her consent. The statement must include the elements required to obtain informed consent, but the human subjects’ signatures are not required. – In some cases, the IRB may allow for alterations to the normal consent form elements or waive the the consent form requirements. However, the IRB can grant waivers only under special circumstances and it is not required to do so. Contents Institutional Review Board (IRB) - Members – Requests for Approval of Protocols and informed consent forms are reviewed by an institution’s Institutional Review Board (IRB). – The 1971 federal regulations required institutions to create IRBs with specific membership qualifications and representation. – Large research institutions may have multiple IRBs, each one of which reviews protocols involving specific types of research. At smaller institutions, an IRB may invite individuals with competence in special areas to assist them as needed. Contents IRB - Members (Continued) – IRBs must include: • at least five members representing a diversity of individuals • members with expertise in research and knowledge about regulations and professional conduct • both men and women • members of more than one profession • at least one member whose primary concerns are scientific and at least one member whose primary concerns are nonscientific • at least one member who is not affiliated with the institution Contents IRB - General Responsibilities – IRBs • review, approve, require modifications in, or disapprove all research activities involving human participants • review and require or waive documentation of informed consent • maintain written records of all correspondence, meetings, proposals reviewed, reviews, decisions concerning reviews, progress reports from investigators and reports of injuries • conduct continuing review of research at least once a year • investigate complaints that researchers have failed to obtain needed approval or mistreated, coerced or deceived subjects • suspend or terminate research that is not conducted in accord with requirements or has been associated with serious harm to subjects Contents IRB - Authority – The IRB has the authority to approve, require modifications in, or disapprove all research activities involving human subjects conducted by WSU students and/or employees or by individuals accessing records on WSU students and/or employees. – Research that has been reviewed and approved by an IRB may be reviewed and disapproved by officials of the institution. However, those officials may not approve research if it has been disapproved by the IRB. Contents IRB - Purpose of the Review – The IRB reviews protocols to insure the design of the study is consistent with sound scientific principles, ethical guidelines, and legal requirements. – The IRB’s paramount responsibility is to protect the rights and welfare of human research subjects. As such, it reviews requests in terms of the impact of proposed research activities on the human participants. The academic quality of proposed research is reviewed in that context. The research plan, design and methodology are reviewed as they are related to the protection of human subjects. – For example, a protocol would not be disapproved solely because the request for approval was poorly written, but it could be disapproved because a poorly written document might not provide the IRB the appropriate information needed to approve the request Contents IRB - Content of the Review – In reviewing requests to conduct research, the IRB determines: • risks to subjects are minimized • risks to subjects are reasonable in relation to anticipated benefits • selection of subjects is equitable • informed consent will be sought from each prospective subject and appropriately documented • the research plan makes adequate provision for monitoring the data collected to ensure – the safety of the subjects – the privacy of the subjects – the confidentiality of data Contents IRB - Financial Conflict of Interest – IRB’s may also consider a researcher’s possible financial conflict of interest as it may be related to the protection of human subjects. – A financial interest is anything of monetary value, including, but not limited to, salary or other payments for services, equity interests, and intellectual property rights. Conflict of financial interests involves situations in which the findings secured through research conducted by the principle investigator could result in personal gain or give improper advantage to themselves, coapplicants, or their spouses or dependents. – Questions on possible conflicts of interest are included on the Request for Approval of Protocol form. Contents IRB - Types of Review – Some activities are excluded from review by the IRB: For example: teaching/training, diagnostic evaluations, therapeutic procedures, clinical training (but not research training). – Assessment activities and randomly distributed, anonymous customer satisfaction surveys are examples of excluded activities. They do not fall under the definition for “research” on “human subjects.” – All other research proposals involving human participants fall under one of three types of review categories: • Eligible to be Exempt • Eligible for Expedited review • Full Committee review required Contents Types of Review - Exempt Research – The term “exempt” is something of a misnomer, because it does not mean a researcher is exempt from submitting a request to the IRB. Researchers cannot make self-determinations that their proposed research is exempt. – The Belmont principles of respect for persons, beneficence and justice still apply to “exempt” research. In addition, under PHS regulations, not all exemptions apply to all categories of human subjects. Many professional societies also encourage following informed consent procedures for exempt research. (The FDA does not allow for any waivers of informed consent.) – Hence, individuals conducting exempt research at WSU must request an exemption by submitting a Request for Approval of Protocol Form with an informed consent form to the IRB. . Contents Types of Review - Exempt Research (Continued) – The Chair or a designee reviews the request to confirm it does have exempt status and that appropriate documentation of the informed consent process is on file. – The Chair or designee is authorized to grant an exemption on behalf of the full IRB. A denial of an exempt proposal must be voted on by the full IRB. – The federal regulations identify 6 categories of exempt research. Periodically, these category descriptions are modified to reflect changes in certain fields of research. Abbreviated descriptions of the current categories follow: Contents Types of Review - Exempt Research (Continued) 1. research conducted in commonly accepted educational settings, involving normal educational practices, such as research on instructional strategies, techniques, curricula or classroom management 2. educational tests, surveys, interviews or observation of public behavior, unless information is recorded in such a manner that the human subjects could be identified and linked to the subjects and place them at risk 3. educational tests, surveys, interviews or observation of public behavior (not exempt above), if the subjects are public officials or candidates for public office or federal statutes require confidentiality Contents Types of Review - Exempt Research (Continued) 4. the collection or study of existing data, documents, records, pathological specimens, or diagnostic specimens, if the data is publicly available and recorded so subjects are unidentifiable 5. research conducted by official agency or department heads on public benefit programs, procedures for obtaining such benefits, or possible changes to such programs or benefits 6. taste and food quality evaluation and consumer acceptance studies of wholesome food or foods containing an ingredient that has been identified as safe by the Food and Drug Administration or the Environmental Protection Agency or the U.S. Department of Agriculture Contents Types of Review - Expedited Research – Two types of research are eligible for expedited review. 1. Projects involving “minimal risk” as identified by the federal government and published in the Federal Register. Minimal risk means the odds of harm are no more than one might expect to encounter in daily life or during routine medical or psychological examinations 2. Projects involving minor changes in previously approved research – The federal regulations identify 8 categories of “minimal risk” activities. Abbreviated descriptions of the current categories follow: Contents Types of Review - Expedited Research (Continued) 1. clinical studies of drugs (for which a new drug application is not required) and medical devices (for which an exemption is not required and/or the device is approved for marketing) 2. collection of blood samples in accord with specific federal criteria 3. collection of specific biological specimens by noninvasive means 4. collection of data through noninvasive procedures routinely employed in clinical practice (excluding x-rays or microwaves) 5. research on materials collected for non-research purposes 6. collection of data in audio or visual format 7. research on group characteristics or behavior employing survey, interview, oral history, focus groups, program evaluation, human factors evaluation or quality assurance methodologies 8. continuing review of research previously approved by the IRB Contents Types of Review - Full Committee Review – All other research involving human participants is subject to full IRB review. The Protocol and informed consent form must be approved by a majority of the IRB members. – During the course of any research approved by the IRB, any changes made in the research plan and/or any problems encountered must be reported to the IRB. At least a yearly review is conducted, however the IRB may request more frequent reviews. – Rejected protocols may be revised and resubmitted. However, research disproved by the IRB may not be conducted at or in association with WSU. An IRB decision to disapprove research cannot be appealed. Contents IRB - Complaints and Investigations – The IRB is authorized to investigate any complaints received from human subjects participating in a research study or from other interested persons who have concerns about the conduct of a research study. If warranted, the IRB may require previously approved research be discontinued. – Reports of research being conducted without IRB approval also warrant investigation by the IRB. The IRB will require any such unauthorized research to be stopped immediately until proper approval is secured. Contents Quiz – Successful completion (a score of 80%) of a 20-question multiple choice quiz is required of all WSU students, faculty and staff who intend to conduct research involving human participants on or off campus. – If you are already “enrolled” and are reviewing this material in D2L, click on the Module Quiz link to your left. Then click on Start Quiz. If you don’t see a Module Quiz link, simply return to the Contents page and access the quiz through that page. – If you have not yet enrolled, please see the Instructions at the beginning of this module. If you prefer to complete a hard copy version, contact the G&SP Office. – See the next page for instructions on completing the quiz. Contents Quiz (Continued) – Each question has an individual save button. At the bottom of the quiz, there's also a Save All Responses button. If you decide to change any responses, remember to re-save them. – SAVING YOUR RESPONSES DOES NOT SUBMIT THE QUIZ. – To submit the quiz, at the bottom of the quiz, go the far right side of the screen and click on the Go to Submit Quiz icon. You will be asked if you are sure you want to submit the quiz. Click Submit Quiz. A dialog box will ask if you are sure you want to submit the quiz. Click OK. Your results, along with the correct answers for any incorrect responses, will appear. Click on Submissions for a copy of just your grade, download the page and submit it with your IRB Protocol Request as documentation of successful completion of the course. Quiz (Continued) – If you need a copy of the quiz at a later date, Login to D2L. You will find a link to the course under Course list for No Semester. Click on the + sign to the left of the word No semester to see a list of courses and click on Human Subjects Education Module to go to the course. Click Grades. – To save an image of the screen to a file: • On a PC, click and hold the ctrl button and the print screen button. Open up a blank word document and click paste. Save the document to a file. on your computer. • On a MAC, click and hold the shift, command and 3 buttons. Open up a blank word document and hit paste. Save the document to a file on your computer. – Quiz (Continued) – If you want to save your grade as a pdf file instead, click print. Choose the option to save the file as a pdf file on your computer. Click print. The document will open. Save the file on your computer. (Note: If you do not have a pdf prompt when you click print, you may need to install Adobe Professional on your computer. This is available for installation on your computer. Go to Start, Control Panel, Add or Remove Programs. In Add New Program, select Adobe Acrobat Professional 9. Click Add.) – You may re-take the quiz at any time. Only your highest score will be recorded in the G&SP Office. The G&SP Office may certify the results upon the request of the IRB. – If you have any questions, contact the G&SP Office at ext. 5519 or npeterson@winona.edu. Contents