Informed Consent Form

Study Title: An Education Module Designed to Address Bullying and Incivility in Occupational Therapy Fieldwork Environments

Principal Investigator: Edwin Myers, OTD, OTR/L, ATP

Co-Investigator(s): Caroline Aguiar, OTS, McKenna Beach, OTS, Angela Mae Elizalde, OTS, Grace Hamrick, OTS, Madison Imhoof, OTS, Carly McPhail, OTS, Alexandra Parrillo, OTS

You are invited to participate in a research study conducted through Florida Gulf Coast University. You must be age 18 or older to participate in the study. Your participation in this study is voluntary. The University requires that we obtain your signed consent to participate in this study.

Refusal to join the study will not affect any future services you may be eligible to receive from the University.

Study Summary:
 The purpose of this study is to determine the effectiveness of a newly created education module targeting occupational therapy fieldwork educators (FWE) by introducing and educating on topics related to incivility and bullying in the occupational therapy fieldwork environment. The information we learn from this study may help us complete the design of this module that we hope to deliver to the occupational therapy community.
 Participants in this study will complete a four-part educational module including pre- and post- module questions. Participants will participate in a post-module interview to give us feedback. The entire study is expected to take no more than two hours.
 There is a risk of exposure to sensitive topics that may evoke an emotional response. You have the option to discontinue participation at any time if the information causes discomfort for you. If you feel you require support, the PI will provide information on free resources through the National Alliance on Mental Illness (NAMI) to speak with you about your feelings. If you are interested in learning more about this study, please continue to read below and using the contact information at the end of this document ask me any questions you have to help you understand the study.

Purpose of the Study:
 The purpose of this study is to determine the effectiveness of an instructional module designed to educate FWE in identifying the factors of incivility and bullying in the FWE and student relationship (Myers, 2014). 
 Bullying and incivility during fieldwork of occupational therapy students has become increasingly prevalent. Forms of bullying can include microaggressions, exclusionary behavior, hostility, public humiliation, or any other act that makes the victim feel unsafe or unwelcome. This behavior occurs not only between healthcare professionals and coworkers, but also healthcare mentors and fieldwork students. According to the American Occupational Therapy Association (AOTA), the goal of “fieldwork is to develop competent, entry-level, generalist occupational therapists.” This experience is led by a FWE who serves as a mentor in the clinical environment for students as they immerse themselves into various healthcare settings. The FWE provides the student with a professional working alliance that serves as a guide, role model, and sponsor in their development (NASEM, 2019). This mentorship in occupational therapy between the FWE and occupational therapy student has been cited as the principal influence on the student learning process (Grenier, M.L., 2015). Bullying and incivility during fieldwork of occupational therapy students can have lasting negative effects throughout students’ career. Therefore, special emphasis should be placed on mentors creating a supportive environment that encourages growth and learning as part of the student experience.

Invitation to Participate in Study:
 We are asking you to take part in the study because you are an occupational therapist or occupational therapy assistant who has served as a fieldwork educator.

Description of your Involvement:
 If you join the study, you will be asked to complete the consent form, go through a short orientation for the module, complete pre-module questions, complete the four-part module, complete post-module questions, and participate in a post-module interview.

Benefits of Participation:
 Being in this study might benefit you by increasing your awareness of various aspects of incivility and bullying that may occur during fieldwork and, as a result, may influence your approach as a fieldwork educator.

Risks and Discomforts of Participation:
 Your participation will be kept anonymous. However, working with email or the internet has the risk of compromising privacy, confidentiality, and/or anonymity. Despite this possibility, the risks to your physical, emotional, social, professional, or financial well-being are considered to be 'minimal’ by completing the survey.

Compensation for Participation:
 You will not be paid to take part in this study.

Confidentiality:
 If you join the study, we will make every effort to keep your information confidential and secure by taking the following steps: storing all information on a password-protected computer in a secure location and destroying audio recordings after analysis. However, despite these safeguards, there is the possibility of hacking or other security breaches that could compromise the confidentiality of the information you provide. Thus, it is important to remember that you are free to decline to answer any question that makes you uncomfortable for any reason.
 We will not release information about you unless you authorize us to do so or unless we are required to do so by law. If results of this study are published or presented at a professional meeting, no information will be included that would make it possible to identify you as a study participant.
 It is possible that organizations responsible for making sure the research is done safely and properly such as the university, and government offices may need to see the information you provide.

Storage and Future Use of Data:
 Your information or biospecimens will not be used or distributed for future research studies even if your identifiers are removed from the information or biospecimens you provided for this study.

Voluntary Nature of Study:
 Participating in this study is completely voluntary. Refusal to join the study will not affect any future services you may be eligible to receive from the University. You can choose to not answer an individual question or you may skip any section of the survey by clicking “Next” at the bottom of the survey page to move to the next question.
 If you choose to join the study, you can leave it at any time with no penalty.

Contact Information for the Study Team:
 We do not foresee any medical problems from participating in this study. However, if you believe you experienced a research related injury, please contact Edwin Myers at 239-590-7551. If you have any questions about this study, please contact Edwin Myers at 239-590-7551.

Contact Information for Questions about Your Rights as a Research Participant:
 If you have any questions about your rights as a subject/participant in this research, or if you feel you have been placed at risk, you can contact the Human Subjects' Institutional Review Board through research@fgcu.edu or Sherry Alexander, Office of Research & Sponsored Programs, at sralexander@fgcu.edu.

Statement:
 I have read the preceding information describing this study. All of my questions have been answered to my satisfaction. I am 18 years of age or older and freely consent to participate in the study. My decision to participate or to decline participating in this study is completely voluntary. I understand that I am free to withdraw from the study at any time. I am aware of my option to not answer to any questions I choose.
 I understand that it is not possible to identify all potential risks I believe that reasonable steps have been taken to minimize both the known and potential but unknown risks. The submission of the completed survey is my informed consent to participate in the study. If you would like a copy of the consent form, print a copy before continuing.