Blood Vessel Game - Consent Form

Please read and understand the information sheet before filling in this form.

Title of Study: A serious game to study the effect of limited field of view in keyhole surgery.
Department: UCL Medical Physics and Biomedical Engineering
Researcher(s)
Connor Creasey - : rmaphcr@ucl.ac.uk
Stephen Thompson - : s.thompson@ucl.ac.uk
Principal Researcher
Matthew J. Clarkson : m.clarkson@ucl.ac.uk – contact with any issues.
UCL Data Protection Officer:
Spenser Crouch data-protection@ucl.ac.uk

This study has been approved by the UCL Research Ethics Committee: Project ID number: 24249/005

Thank you for considering taking part in this research. If you have any questions arising from the Information Sheet, please contact the Principal Researcher.

By ticking the box below, you are consenting to all elements of the study outlined in the following list. Without giving consent, you will be unable to play the game.

I confirm that I have read and understood the Information Sheet for the above study. I have had an opportunity to consider the information and understand what will be expected of me, and that if I had any questions they have been answered to my satisfaction.

I understand that data will be anonymised, and that it will not be possible to link my personal data (consent, contact details) with the study data. I understand that according to data protection legislation, ‘task in the public interest’ will be the lawful basis for processing.

I understand that all personal information will remain confidential, and that all efforts will be made to ensure I cannot be identified. Data gathered in this study will be stored anonymously. It will not be possible to identify me in any publications.

I understand that I will not be able to withdraw from the study after the point of data collection. This is due to the data being anonymous.

I understand that my information may be subject to review by responsible individuals from the University for monitoring and audit purposes.

I understand that I will not benefit financially from this study or from any possible outcome it may result in in the future.

I understand that I will not be compensated for the portion of time spent in the study if I choose to withdraw.

I agree that my anonymised research data may be used by others for future research. No one will be able to identify you when this data is shared.

I understand that the information I have submitted will be published as a report, which the researchers involved will make available upon request.

I am aware of who I should contact if I wish to lodge a complaint.

I confirm that I understand the above conditions and wish to participate: