LATINA PHYSICIAN LEADERSHIP IDENTITY FORMATION EXPLORATION (LP-LIFE) (DEMOGRAPHIC QUESTIONNAIRE)

* 1. ADULT ELECTRONIC CONSENT TO PARTICIPATE IN A RESEARCH STUDY LATINA PHYISICIAN LEADERSHIP IDENTITY FORMATION EXPLORATION

SHORT TITLE: LP-LIFE


Hello, my name is Jaime M. Franco. You have been chosen at random to be in a research study about an examination of female physicians who self-identify as Latina or Hispanic and who hold senior leadership positions in U.S.-based health care organizations. The purpose of this study is to investigate the leadership formation of Latina executive physicians as they climb to positions of power. To this end, we seek to identify leadership related knowledge, skills, and dispositions associated with Latinas who have reached the pinnacle of personal and professional success. Due to the exploratory nature of this study the number of participants will be determined in the course of this study. Participation in this study will take approximately 2.5 hours of your time. If you agree to be in the study, I will ask you to do the following things:

1. Complete a questionnaire with twelve (12) questions. This questionnaire will be completed online.
2. Complete an interview where you will be asked to answer fifty-six (56) questions. The interview will be conducted in person, telephone, or telephony (e.g., FaceTime, Skype). The interview will be recorded on a digital tape recorder.

There are no foreseeable risks or benefits to you for participating in this study. It is expected that this study will benefit society by helping others to understand the barriers that Latina executive physicians face as they pursue a medical education and a career. Society will also benefit from this study by understanding how to develop educational or training programs for Latinas.

There is no cost or payment to you. If you have questions while taking part, please stop me and ask.

You will remain anonymous and your answers will be kept confidential. In any sort of report we might publish, we will not include any information that will make it possible to identify you as a subject. Research records will be stored securely and only the researcher team will have access to the records.

If you have questions for one of the researchers conducting this study, you may contact Jaime M. Franco at 305-934-7634.

If you would like to talk with someone about your rights of being a subject in this research study or about ethical issues with this research study, you may contact the FIU Office of Research Integrity by phone at 305-348-2494 or by email at ori@fiu.edu.

Your participation in this research is voluntary, and you will not be penalized or lose benefits if you refuse to participate or decide to stop.

ELECTRONIC CONSENT:
Please select your choice below.
Clicking on the "agree" button below indicated that: (1) you have read the above information, (2) you voluntarily agree to participate, and (3) you are at least 18 years of age. If you do not wish to participate in the research study, please decline participation by clicking on the "disagree" button.