22 - NIDA OMB B12 Penn Med cover letter for medical student survey 2-28-11 sh

Attachment B12:

Penn Med Cover Letter for Medical Student Survey

STUDY OF SUBSTANCE ABUSE DOC.COM MODULE PROJECT

March 2011

Attachment 12: Penn Med Cover Letter for Medical Student Survey

Dear MS2s:

I am giving you these surveys to assess the current standard education on substance use disorders during your 4-week Family Medicine clerkship, and to compare it to an online teaching module called "The Clinical Assessment of Substance Use Disorders." Six of the 12 groups in this class will be receiving standard education; the other six will receive the online teaching module.

Penn Med 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 Family Medicine clerkship

2) After your Family Medicine examination

3) At the end of your Doctoring II class

To track you longitudinally, please provide us with your Penn card ID or name in the section, and the last 4 digits of your social security number and 2 digit month of birth in the sections provided below on this form. Do not place these details on any part of the survey. We can assure you that no individually identifiable data will be entered into the research database at Penn. Thus, your responses will not be identifiable in any way or linked back to you.

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

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

Thank you for your cooperation.

Sincerely yours,

Paul N. Lanken, MD

PENN ID: _ _ _ _ _ _ _ _ OR Name: ______________________

Study ID: _ _ _ _ - _ _

(6 digits – last 4 of your Social Security number and 2 digit month of your birth (e.g., 01 for January)

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

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