Faculty of Health and Human Sciences

MSc Pre RegOccupational Therapy

Consent to participate in self development and group activities / act as a model
NAME
COHORT
DATE

Introduction for Students:

Skills are integral to your development as anoccupational therapist. Participation in interactive sessions, such as practical classes and creative self-development workshops, involving your participation in surface anatomy, active experience in activities, observation and feedback is essential to occupational therapy education.

Each academic year, module leaders will give you an overview of the theory and practice to be covered in the modules. You will be given time for discussion and clarification. In some practical sessions, the lecturer will demonstrate safe procedure of practical activities, explaining also all indications, contraindications, hazards and safety aspects. You will be given time to ask questions before commencing practice.

You are strongly encouraged to act as a model(e.g. for surface anatomy) or participantin self development activities for the teaching and learning processes involved in the acquisition of occupational therapy skills both in the School and on practice placements. However, you are under no obligation to agree to be a participant in such activities or a model (e.g. for anatomy), and your refusal is in no way a barrier to your continued eligibility to participate in skills learning exercises. Please discuss this with your personal tutor and/or session tutor, so that we may be aware of your situation and can offer further information and support if necessary.

You are responsible for your own health and safety and it is very important that you understand this. If you have any medical problem that might be made worse or otherwise prevent you from agreeing to participate in self development activities or as a model, it is your responsibility to inform the lecturer and/or practice educator.

As standard practice, people who are not able to participate in practical activities are encouraged to see the Occupational Health team who are always pleased to help.

By signing the declarations below you are consenting for the entire period of your study with the School of Health Professions. However you are able to withdraw your consent at any time by emailing your Programme Lead.

Statement of Consent

I understand the range of practical activities, and I agree to participate in creative self development activities or as a model in classes and on practice placements in a variety of settings.

I understand that the term “model” can be applied to practical skills sessions, role-play and other self development orpractical based sessions on placement.

I understand that unless health issues have been disclosed I am at present in good health.

I understand that should any information regarding my health status be discovered during a practical procedure, it is my responsibility to seek appropriate advice. This may include referral to my General Practitioner or other appropriate health professional. Wherever possible, such information will remain confidential.

I understand that it is my responsibility to inform my Department of any change in health status occurring since completion of this consent form and any subsequent change during the next academic session. (Failure to do so may have implications on you continuing the programme). The University nor the Department cannot be liable where there has been incomplete or non-declaration of any change in health status.

I understand that it is my responsibility to inform the Department of any disability/special needs. The University or the Department cannot be liable where there has been incomplete or non-declaration of any changes.

I understand that a practitioner holding a recognised qualification, which is deemed appropriate by the Department and the University, will introduce practical skills in a teaching environment.

I understand all lecturers will discuss indications, contraindications and hazards of any technique to be performed.

I understand all lecturers will demonstrate, using safe practice, all skills that may be performed on me.

I understand that information in respect of the known risks and limitations of the practical procedure(s) will be made available to me prior to experiencing the practical procedure for the first time.

I understand that I can ask questions and discuss all techniques with the appropriate lecturer at any time.

I understand that it is my responsibility to ensure that I have undertaken adequate self-study prior to undertaking the practical procedure.

I understand that it is my responsibility to be aware of the precautions and contraindications for each of the practical skills.

I understand it is my responsibility to inform either the Module Leader or a member of staff who is teaching that particular skill if I feel unable to undertake any of the skills for whatever reason.

I fully understand that it is my responsibility to inform the practitioner should I experience any untoward symptoms during the procedure. I acknowledge that it is the responsibility of the practitioner to stop the procedure immediately should I indicate such symptoms or request that it should be stopped.

I understand that I have the right, at any time, to withdraw from the procedure, or part thereof.

If consenting to take part in a practical procedure such as surface anatomy, I understand that I may be required to remove clothing, which may prevent observation and / or examination in order to undertake some practical skills effectively.

I understand that it is my responsibility to inform my Department of any change of my status with regard to criminal convictions since completion of my Criminal Records Bureau (enhanced disclosure) and any subsequent change during the next Academic Session. (Failure to do so may have implications on you continuing the programme).The University or the Department cannot be liable where there has been incomplete or non-declaration of any changes.

I understand that I am free to refuse to participate in acting as a model in practical classes.

I understand that if I give consent at this time, I may withdraw it at any later time. Should I choose to do so, I will ensure the matter is discussed with the appropriate member of staff.

I understand that should issues of concern arise I will discuss them with an appropriate member of staff (this may be the module lecturer and/or personal tutor).

I declare that I have read and fully understand that the aboveare important aspects of undertaking the Occupational Therapy programme.

Signature of Student:………………………………Date:…………………...

Student Name and Number:………………………………………………………

Year of Study:…………………….

Declaration of Confidence

I, hereby declare that I will hold in strict confidence any personal information concerning students, service users / clients/patients which may become known to me during my studies (for example divulged during the classroom, PBL groups or practical sessions) and duties in any of my practice placements and that I will not divulge such information to any unauthorised person nor discuss it with my colleagues in any public place.

I understand that such confidential or personal information includes students’/ service users’ / clients’/ patient’s diagnosis, treatment, personal experiences and other particulars relating to his or her condition, contact with services or life circumstances.

I understand also that the disclosure to unauthorised persons of confidential information concerning service users / clients / patients is classified within the disciplinary rules as conduct that may warrant the professional suitability procedures of the programme to be evoked, including dismissal from the programme.

Signed:………………………………………………..Date:…………………

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