Republic of the Philippines Department of Health WESTERN VISAYAS SANITARIUM Santa Barbara, Iloilo Title: Burnout and Quality Patient Care of Family and Community Medicine Resident Physicians in Iloilo Amidst the Pandemic WHAT IS THE BACKGROUND TO AND PURPOSE OF THE STUDY? You have been asked to take part of this study because you can contribute to the baseline data of burnout among FCM resident physicia ns in Iloilo through answering the questionnaire truthfully. With the increasing number of COVID - 19 cases worldwide, residents experience sudden and overwhelming demands in work, which may affect their well being and patient care. DO I HAVE TO TAKE PART I N THE STUDY? It is up to you to decide whether to take part or not. Even if you refuse to participate in the study, you will not be disadvantaged in any way. If you decide to take part you will be given this Written Consent Form to sign and are still fre e to withdraw at any time. WHAT WILL HAPPEN TO ME IF I TAKE PART IN THE STUDY? Once you decided to partake in the study, the researcher, thru a representative on your training institution will gather your email address. A direct link for the consent and questionnaire will be sent. WHAT DO I HAVE TO DO? First, it is important that you follow the instructions as directed. Just answer the questionnaire provided honestly, and logically. Please don’t be in a hurry. You can answer the questionnaire during yo ur free time. WHAT ARE THE POSSIBLE BENEFITS OF TAKING PART IN THE STUDY? By identifying the socio - demographic profile and the level of burnout as well as the quality of patient care, you can help the healthcare providers, training institutions formulate strategic plans on how to improve the well being of resident physicians esp ecially during this pandemic. Furthermore, this would also improve the quality of patient care provided by these health workers. WHAT ARE THE COSTS OF TAKING PART IN THE STUDY? You will not pay anything nor will receive any payment for taking for part in the study. We only ask of your time to participate so that future researches, as well as the national government and medical professionals, may benefit on the results of this study. If you suffer any side effect or other personal injury resulting from thi s study, the researchers will compensate it and will take full responsibility of such occurrences in accordance with the Law of the Philippines. HOW WILL MY PERSONAL DATA BE USED? By signing this form, you consent to the researchers collecting and process ing your personal data, including the following: Your age Your sex Your profession Your marital status Your religion Your income Level of burnout Quality of patient care The researchers will use your personal data for the purposes of administering and conducting the study, research, and statistical analysis. The researchers will share personal data collected during the study with the Research Office of West Visayas Sanitar ium. Your study data shared with the Research Office does not include your name (if there is any). The researchers will use your initials instead and will assign a code to the study data sent to the Research Office. Only the researchers have the access to the code to connect the study data to you. You have the right to request for any inaccuracies in your personal data to be corrected. You have also the right to request information about any personal data that the researchers may hold about you. If you wis h to make a request, then please contact the researchers in the first instance. The researcher, specifically the principal investigator’s contact information, is set out at the end of this form. Your consent to the use of your study data does not have a sp ecific expiration date but you may withdraw at any time by writing to the researchers at the address below. If you withdraw your consent, the researchers will no longer use your study data or share it with others and you cannot continue to take part in the study, unless the researchers need to do so to ensure the validity of the study data. Please note that the results of the study may be published in medical literature but your identity will not be revealed. The researcher is responsible for the processin g of the study data. WHOM SHOULD I CONTACT IF I NEED MORE INFORMATION OR HELP? In case of a study - related injury or whenever you have questions about the study, please contact: Principal Investigator: Twinkle Grace Germia Mobile Number: 09778220191 Address : c/o Western Visayas Sanitarium Sta. Barbara, Iloilo Philippines