23 - NIDA OMB B13 DUCOM cover letter for medical student survey 2-28-11 sh

Attachment B13:

DUCOM Cover Letter for Medical Student Survey

STUDY OF SUBSTANCE ABUSE DOC.COM MODULE PROJECT

March 2011

Attachment B13: DUCOM Cover Letter for Medical Student Survey

Dear rising MS3s:

I am giving you these surveys to assess the current standard education on substance use disorders during your 4-week Ambulatory Medicine clerkship, and to compare it to an online teaching module called "The Clinical Assessment of Substance Use Disorders." Half of the groups in this class will be receiving standard education; the half will receive the online teaching module.

DUCOM is one of two medical schools participating in this research study. We will be asking you to take 3 more surveys over the next 7 months:

1) At orientation of your Ambulatory Medicine clerkship

2) Friday at the end of the fourth week of the students Ambulatory Medicine clerkship rotation

3) End of year Clinical Skills Assessment (CSA) included as an 11^th station of our CSA, to be completed on a computer.

To track you longitudinally, please provide us with your name in the section provided below on this form. Do not place your name on any part of the survey. We will be generating a study ID number and labeling the survey with it for you, for data-entry. We can assure you that no individually identifiable data will be entered into the research database at the University of Pennsylvania. Thus, your responses will not be identifiable in any way or linked back to you.

Completion of the surveys is a requirement for DUCOM education assessment. If you decide to not allow your results to be used for research, there will be no adverse consequences.

Please ask me if you have any questions related to this research.

Once you have completed the survey you will receive a gift card.

Thank you for your cooperation.

Sincerely yours,

(Investigator)

Name: __________________

By checking the box below, I refuse to give permission to use my survey results for medical education research

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