Appendix D: Consent Form for Classroom, Laboratory and Fieldwork Experiences
Department of Occupational Therapy
Entry-level Doctor of Occupational Therapy Program
Consent form for Classroom, Laboratory, Fieldwork, and Doctoral Capstone Experiences
As an occupational therapy student, you must learn to evaluate and treat a variety of conditions as well as participate in a variety of laboratory, fieldwork, research, and health care related experiences and activities at the institutional, educational, and community level.
Techniques involved in this endeavor are largely “hands-on” and may involve the use of physical activities, machinery, medical devices, lab materials, and thermal agents. To assure your competence, you will be asked to practice and/or implement various hands-on techniques and use these various pieces of equipment and other resources stated above safely under the direction of course faculty, lab instructors, graduate assistants, your fieldwork educator, clinical supervisor or doctoral capstone mentor. Within the classroom environment these skills will be practiced on you by other students in your class who have varying levels of competency, as well as by you on other students. In the clinical environment you may have the opportunity to demonstrate these skills on other students, fieldwork educators, patients or clients. As part of your doctoral capstone experience (ADE), you may also have a supervised clinical component that may require demonstration of these skills. In addition, your learning entails the dissection of a human cadaver and the use of materials to develop rehabilitation aids such as splints and casts as described below.
Types of activities students will be expected to perform: Treatment and examination techniques may involve palpation for anatomical structures, resistance to muscle contraction, stretching and compressing of anatomical structures, mobilization of joint and soft tissue structures, assistive exercises, positioning, mobility and transfer techniques, and other active body movements such as mobility training, stair climbing, cooking and adaptive equipment use and aerobic exercise. Use of machinery, mechanical devices, and thermal agents includes, but is not limited to, the use of mechanical traction, therapeutic electrical stimulation devices, hot packs, ice, and ultrasound. In the splinting course and other splinting experiences in fieldwork or the ADE, you will use boiling water and heat guns to mold thermoplastic orthotics. In human dissection, you will use sharp scalpels and bone saws.
Potential risks: While the laboratory environment will be controlled to minimize risks, the following potential risks are rare but possible: In having the above techniques practiced on you, or in performing the techniques on other students, you may experience muscle soreness, strain, sprains, tearing of connective tissue, syncope or falls, allergic reactions, burns, cuts, infections, and their sequelae. In having electrical and thermal agents applied to you, you may experience slight electrical shocks, burns, or frostbite. In the dissection labs, you may cut yourself with the scalpel or bone saw.
Potential benefits: In practicing the skills required of a licensed occupational therapist in a supportive and educational setting, you will be prepared to effectively, efficiently, and safely evaluate and treat patients. In having the skills practiced on you, you will gain an appreciation of the experiences of actual patients.
Methods used to reduce the potential risks: In all scheduled learning formats and environments you will have faculty members and lab instructors, who are licensed health professionals, as teachers and facilitators to instruct you and correct you in the required skills. Their instruction will include the precautions, contraindications, and safe application of the techniques they will teach you, which you in turn will practice on other students and have them practice on you. In all cases, the environment of any lab will be controlled to minimize risks, and faculty will indicate the appropriate use of any protective equipment, including PPE as needed in alignment with best practices in infection control. Faculty will be aware of and carry out any necessary emergency procedures. At times, students may choose to practice lab techniques outside of scheduled class times without faculty supervision. This situation may increase the chance of the risks outlined. You are not permitted to use electrical or deep thermal modalities without the direct supervision of a licensed occupational therapist. Portions of this instruction and practice can only occur in designated rooms which have been designed using specifications which accommodate the electrical requirements of specific equipment and provide adequate ventilation and air flow.
You will be asked to disclose in confidence any conditions which may increase the risks described above or prevent you from fully participating as a provider or receiver of the activities that are part of your student experience. During laboratory sessions, you are not permitted to practice techniques on a fellow student who has a known actual problem or condition for which occupational therapy may be a recommended treatment.
Fieldwork Education and Doctoral Capstone Experiences: Fieldwork education and doctoral capstone assignments are made with student input and are based on student learning needs, curriculum requirements, and availability of appropriate sites. The Academic Fieldwork Coordinator and Doctoral Capstone Coordinator will decide / approve final assignments for all fieldwork / capstone experiences.
Documentation of student understanding:
I will participate in the experiences to which I am assigned. I understand that I am responsible for reviewing materials from my assigned sites, and for complying with all regulations of that facility, including site-specific required immunizations, certifications such as CPR, and health history and certification, in a timely fashion.
The program will attempt to schedule assignments for part-time experiences to be within a reasonable traveling distance from the Institute but may not be accessible by public transportation. I understand that the Institute is not responsible for arranging my transportation to and from the Institute and to/from locations where my fieldwork education will be performed. I also understand and waive any liability for the Institute in connection with any such transportation and risks thereof. I shall be solely liable for any such risk and loses that arise from such transportation. Full-time experiences may require that I relocate for an extended period, 12-16 weeks for full-time level II experiences and 14-16 weeks for doctoral capstone experiences. I understand that I am responsible for my own health insurance, housing, transportation, and related costs (uniforms, lab coats, etc.) for all fieldwork / doctoral capstone education experiences.
Students’ rights: I understand that I have the right to refuse to participate in any situation in which I feel I am not safe, my health is jeopardized, or my religious or cultural beliefs are jeopardized. If I feel the environment is unsafe, I may request that the faculty member make reasonable modifications that will improve the safety of the environment. I also understand that course-grading requirements may include specific competencies in evaluation and treatment. Assuming that I have no condition that would prevent me from fully participating in the role of a patient or an occupational therapist, I understand that I will not be able to receive credit within the course for these experiences if I choose not to participate.
I understand that I may ask questions about the activities required within the curriculum at any time. As a student at the MGH Institute, I understand that I have full access to the resources provided by the Office of Accessibility and Wellness and the Student Assistance Program. These student services are available at any point in my studies to provide guidance and consultation regarding access, wellness, and accommodations, as well as personal short-term counseling, information, and referrals to support my performance in the program. If I have further questions about my participation in laboratory experiences, I can contact Emily Eddy, OTD, OT, OTR Program Director of the Entry Level Doctor of Occupational Therapy Program at (617) 643-4352 or my academic advisor. I have been given a copy of this consent form as part of my Program Manual in the Entry-Level Program in Occupational Therapy.
Injury Statement: I understand that in the event of an injury to me during any school activities, I will be assisted in finding appropriate medical care, which may be covered under the provisions of my health insurance policy. The MGH Institute of Health Professions is not responsible for the costs of health care associated with activities that are part of the educational program.
Disclosure: I understand my responsibilities and the potential risks and agree to participate in learning experiences as outlined above. I understand it is my responsibility to address any questions or concerns I have to my advisor or to the appropriate faculty / staff member. I understand that by signing this consent form I am not waiving any of my legal rights.
Signature Date
Name (Print)