Exit Survey
2019

Multi-Year Tracking Study of  
NOSM Students and Graduates


CONSENT FORM


I agree to participate in the "Multi-Year Tracking Study of the Students and Graduates of the Northern Ontario School of Medicine" conducted jointly by the Centre for Rural and Northern Health Research (CRaNHR) and the Northern Ontario School of Medicine (NOSM). The questionnaire should take about 30 minutes to complete.

I understand that CRaNHR will take measures to safeguard my identity as described in the sheet “Commitment to Confidentiality” included in this package. Only CRaNHR research staff have access to the completed questionnaires and database of responses. No one from NOSM may see my complete questionnaire or my responses in the database. My name will not be included in the database with my responses. I understand that the information will only be used for scientific investigations and for the evaluation of the NOSM Program. Information will not be used to evaluate my performance as a learner.

The paper copy of the questionnaire will be kept by CRaNHR for seven (7) years and then it will be shredded. Electronic versions of responses will be kept indefinitely by CRaNHR in locked offices on password secured computers.

I understand the purpose of the study and my participation as described in the cover letter and instruction guide. I also understand that my participation in this study is strictly voluntary. I can choose not answer questions or withdraw at any time. My status as a student or graduate of the NOSM Program will not be affected in any way by my decision to participate or not to participate in this study.

Should you require further assistance during or after completion of this survey, please contact Margaret G. French (mfrench@laurentian.ca or 1-800-461-4030 ext. 4369)

          
Name:
Date:

I would like a summary of the findings.

       
         

6% Complete