Research Participant Information and Consent Form

MSU IRB Study ID: STUDY00003679

This study has been determined to be exempt under 45 CFR 46.104(d) 2ii.

You are being asked to participate in an educational research study. Researchers are required to provide a consent form to inform you about the research study, to convey that participation is voluntary, to explain risks and benefits of participation, and to empower you to make an informed decision. You should feel free to ask the researchers any questions you may have.

Department and Institution:

Obstetrics, Gynecology & Reproductive Biology
College of Human Medicine, Michigan State University

Address and Contact Information:

Cara Poland, MD
Michigan State University
College of Human Medicine
Department of OBGYN & Reproductive Biology
15 Michigan Street NE
Grand Rapids, MI 49503
Polandc2@msu.edu

1. PURPOSE OF RESEARCH
This research project is being conducted using anonymous online surveys of our MI CARES interactive learning modules to increase and improve knowledge of the MI CARES Addiction Medicine core curriculum and Practice Pathway processes for addiction medicine certification. From this study, we hope to learn the effectiveness of this mode of learning for physicians utilizing the MI CARES Practice Pathway services and tools as they prepare to take the addiction medicine board exam. We also seek to assess both knowledge and attitudes about the educational experience. Research data will be analyzed and utilized to assess and improve the educational experience for current and future participants of the program.

This project is being conducted by researchers from Michigan State University and Spectrum Health Medical Group. You must be at least 18 years old to participate in this research.

2. WHAT YOU WILL DO
For this study you will be asked to fill out a brief online anonymous survey at the end of each module you complete in the MI CARES program. Overall it is expected that each survey will require about 3 minutes.

3. POTENTIAL BENEFITS
A potential benefit to this research is to streamline and contribute to the generalizable knowledge about the process and preparation for addiction medicine certification.

4. POTENTIAL RISKS
There are no foreseeable risks associated with participating in this study. Participation will require time only.

5. PRIVACY AND CONFIDENTIALITY
The survey data collected will be kept confidential by using MSU’s Learning Management system in a password protected site.

Only the researchers and the Michigan State University Institutional Review Board will have access to the data. The results of this study may be published or presented at professional meetings, but the identities of all research participants will remain anonymous.

6. YOUR RIGHTS TO PARTICIPATE, SAY NO, OR WITHDRAW
Participation in this research project is completely voluntary. You may choose not to answer specific questions in the MI CARES program surveys. In addition, you may stop participating at any time by closing any of the survey links.

7. COSTS AND COMPENSATION FOR BEING IN THE STUDY
There is no financial cost for participation in this study. You will not receive money or any other form of financial compensation for participating in this study.

8. CONTACT INFORMATION
If you have concerns or questions about this study, such as scientific issues, how to do any part of it, or to report an injury, please contact the researchers:

Cara Poland, MD
Michigan State University
College of Human Medicine
Department of OBGYN & Reproductive Biology
15 Michigan Street NE
Grand Rapids, MI 49503
Polandc2@msu.edu

If you have questions or concerns about your role and rights as a research participant, would like to obtain information or offer input, or would like to register a complaint about this study, you may contact, anonymously if you wish, the Michigan State University’s Human Research Protection Program at 517-355-2180, Fax 517-432-4503, or e-mail irb@msu.edu or regular mail at 4000 Collins Rd, Suite 136, Lansing, MI 48910.

9. DOCUMENTATION OF INFORMED CONSENT
By continuing to the next section and completing the Baseline Survey, you indicate your voluntary agreement to participate in this research project.