Title of Project:
E-learning to improve Junior Doctor Paediatric Prescribing
Name of Researcher: Dr Morris Gordon
Version 1.2 (15/05/10)
1. I confirm that I have read and understand the information sheet dated on this website (version 1.3) for the above study. I have had the opportunity to consider the
Information, ask questions and have had these answered satisfactorily.
2. I understand that my participation is voluntary and that I am free to withdraw at any time, without giving any reason, without my education or legal rights being affected.
researchers. I give permission for these individuals to have access to my data
Name of Participant
A copy of this consent form will be emailed to you for your records.
Now, please answer the demographic questions below. This information will be used to ensure equal distribution of participant characteristics between the two study groups and will be treated as confidential.
Retype email address:
Undergraduate Medical School:
Year of graduation:
Special study options completed during undergraduate training:
Where you a graduate entrant to medicine? (Please delete as necessary)
If YES, what did you study in your previous degree?
Foundation training Year:
Please tell us the 6 job route for your Foundation Training, in order:-
If you answer YES to any of the following questions, please give further details in the free text box below:-
Have you ever worked as a pharmacist or in the pharmaceutical industry?
Have you ever worked as a graduate level doctor before taking up your foundation training post?
Have you received any specific prescribing training since graduating?