Letter of Informed Consent*
Letter of informed Consent for the study: Professional burnout Among Oral and Maxillofacial Surgeons
Dr. Bruce Pynn, DDS, Principal Investigator, Thunder Bay, Ontario
Dr. William Montelpare, PhD., Co-Investigator, University of Prince Edward Island
You have been invited to participate in this research study, which is intending to measure characteristics of burnout in Oral and Maxillofacial Surgeons in Canada. Please read this consent form carefully before you decide whether you want to participate in this study.
You are free to ask questions at any time before, during or after you agree to participate in this study. You can contact William Montelpare by telephone at (902) 620-5186, or by e-mail at: firstname.lastname@example.org. He will do his best to respond to each of your questions.
Burnout is a syndrome defined by the work-related triad of high emotional exhaustion, high depersonalization and a low sense of personal accomplishment. Emotional exhaustion is the feeling of being emotionally overextended and exhausted by one’s work. Depersonalization is the adoption of a callous or dehumanized perception of others. Low personal accomplishment is the feeling of dissatisfaction with one’s job-related achievements.
Burnout in the physician population not only can lead to professional and personal dysfunction but can also lead to negative effects on their patient population.
One of the unfortunate paradoxes of professional burnout is that those most susceptible to burnout appear to be the most dedicated, conscientious, motivated and responsible.
Surgeons have a high risk of professional burnout as their commitment to patients, attention to detail, and recognizing the responsibility of endearing patients’ trust place them at greater risk for burnout.
What is the purpose of the research study?
The purpose of this study is to evaluate the characteristics of Burnout among Oral and Maxillo-facial Surgeons in Canada.
Why have I been asked to participate?
You have been asked to participate because you are among the specific target cohort identified within the scope of this research program.
Do I have to take part in this research process?
Your participation in any part of this research is voluntary. You may refuse to participate in this research without giving any reason. You have the option to withdraw from the research process at any point without giving any reasons. If you choose to withdraw from this research, any data you have already provided may be retained and used for the purposes of this research.
What will I have to do if I agree to participate?
If you choose to participate we will ask you to visit the website at: http://health.ahs.upei.ca/CAOMS/main.php to review the project overview, read the letter of informed consent, and complete the surveys. The surveys will consist of six parts assessing the following elements: 1) demographic information, 2) professional stressors, 3) personal and professional life satisfaction, 4) a self-efficacy survey, and 5) the MBI-HSS. The total time to complete the surveys may take approximately 10-15 minutes depending on your responses.
The items are standardized and will refer to specific constructs that have been thoroughly tested.
This information will enable the overall aim of the study to be achieved i.e. to understand the characteristics of Oral and Maxillofacial Surgeons related to burnout.
Are there any possible disadvantages from participating?
There are no foreseeable risks involved in participating as you could respond to the survey by completing the surveys online at any time and place. The website will be monitored and backed up by the technical support team at the University of Prince Edward Island. If there is any unexpected discomfort, disadvantage or risk to you during the course of this clinical assessment process please bring it to the attention of Dr. William Montelpare [(902) 620-5186; or e-mail email@example.com], to help you find support.
What if something goes wrong?
There are no known risks or harm with this research process. If you are harmed by taking part in this research process, there are no special compensation arrangements. If you have any problems with the ethical conduct of this study please send an e-mail to firstname.lastname@example.org or call (902) 620-5104.
What are the possible benefits from taking part?
The data will contribute to the knowledge base and inform the research support team about the characteristics related to burnout in the selected cohort.
Will my participation be kept confidential?
Yes, all information collected will be kept strictly confidential. During the study, Dr. William Montelpare and members of the research team will have access to data that you submit. Your response details that you submit will be stored in a password-protected computer. Your survey responses will not be held together with any personal details. Data will be stored on the University of Prince Edward Island firewall protected secure server that is only accessible via password for security and safety. After finishing this study the data will be stored in password protected computer of the supervisor (Dr. William Montelpare) for 5 years and then destroyed according to the University policy on data protection.
What will happen to the results of the research project?
A summary of the findings will be posted as part of the report to the Canadian Association of Oral and Maxillofacial Surgeons, and the selected members of the medical community where appropriate.
NEITHER YOU NOR YOUR SPECIFIC RESULTS WILL BE IDENTIFIABLE IN THIS REPORT. The results of the study will be submitted for publication in peer reviewed journals and presented at academic and professional conferences.
You may copy this information sheet for future reference.
Some basic guiding principles for the partnership between the researchers and the participants
I have read the information sheet for this study and have been given permission to print any information I wish. I have also been provided a contact number of the Principal Investigator and an invitation to ask questions about the study or my participation in the study.
I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason, without my legal rights being affected and I give consent for any data already given to be retained and used.
I understand that I will not benefit financially if this study leads to the development of education and training or future research/education/technological developmental outcomes.
I know how to contact the study team if necessary. I understand that I can contact the University Of Prince Edward Island Research Ethics Board at (902) 620-5104, or by email at email@example.com if I have any concerns about the ethical conduct of this study.
I understand that by responding to the survey, I am agreeing to participate in this study.
I understand that a written summary of the findings will be available to participants through reports produced by the study team and disseminated via professional and academic journals and conferences.
The research study will also help to reduce the stigma associated with a surgeon’s mental health issues and it is anticipated that with the data received, new activities related to mental health for physicians will be developed. It is anticipated that the outcomes of such a study will expand across the boundaries of all health professionals, not just the targeted surgeon population identified in this particular study.
It is expected that results of these investigations will provide essential information about the burnout phenomenon based an accurate and fundamental source of information for participants.
This information sheet is yours to keep. You can save or print a copy of this consent form for your records.