Confidentiality Agreement & Consent to Video Recording
Confidentiality Agreement & Consent to Video Recording
- During your participation in a Simulated Clinical Experience (SCE) at the Father Muller
Simulation & Skills Centre (FMSSC), you will be both an active participant in simulated
scenarios and an observer.
- The objective of the SCE program is to educate pre-licensed and licensed health care
practitioners to better assess and improve their performance in evolving health care
situations, ultimately leading to patient safety.
- By signing this agreement, you agree to maintain strict confidentiality regarding the
performance, whether seen in real time, on video, or otherwise communicated to you. Failure
to maintain confidentiality may result in unwarranted and unfair defamation of character of
the participants.
- Discussion of scenarios is encouraged during debriefing, but we emphasize that "All that
takes place in the Simulation environment - stays in the safe simulation environment!"
- Due to copyright considerations and to maintain optimal simulation experiences for future
learners, you must maintain strict confidentiality regarding the specific scenarios and
events during the simulation experience. A breach of confidentiality may result in loss of
privileges at FMSSC.
- I agree to maintain strict confidentiality about the details of the scenarios, participants,
and performance of any participant(s).
- I authorize the FMSSC staff to video record my performance during Clinical Simulation
Experience (CSE).
- I authorize the FMSSC staff to use the video recording(s) for purposes including, but not
limited to: Debriefing, Faculty Review, Educational, Research, Public Relations,
Advertisement, Promotional, and/or Fundraising activities.
- Every learner at FMSSC will read and sign this simulation confidentiality agreement and
consent for video/audio recording at the beginning of each course before utilizing the
simulation lab and equipment. This form will be kept on file in the simulation lab.
