Interprofessional Education and

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Books in the Series
The Medical Library Association Guide to Providing Consumer and
Patient Health Information edited by Michele Spatz
Health Sciences Librarianship edited by M. Sandra Wood
Curriculum-Based Library Instruction: From Cultivating Faculty
Relationships to Assessment edited by Amy Blevins and Megan
Inman
Mobile Technologies for Every Library by Ann Whitney Gleason
Marketing for Special and Academic Libraries: A Planning and Best
Practices 6. Sourcebook Patricia Higginbottom and Valerie Gordon
Translating Expertise: The Librarian’s Role in Translational Research
edited by Marisa L. Conte
Expert Searching in the Google Age by Terry Ann Jankowski
Digital Rights Management: The Librarian’s Guide edited by
Catherine A. Lemmer and Carla P. Wale
Interprofessional Education and Medical Libraries: Partnering for
Success edited by Mary Edwards
Interprofessional Education and
Medical Libraries

Partnering for Success

Edited by Mary E. Edwards

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Names: Edwards, Mary (Mary Elizabeth), 1979- , editor. | Medical Library Association.
Title: Interprofessional education and medical libraries : partnering for success / edited by
Mary Edwards.
Other titles: Medical Library Association books.
Description: Lanham, Maryland : Rowman &Littlefield, [2016] | Series: Medical Library
Association books
Identifiers: LCCN 2016012312 (print) | LCCN 2016014793 (ebook) | ISBN 9781442263895
(cloth : alk. paper) | ISBN 9781442263901 (electronic)
Subjects: | MESH: Health Occupations–education | Education, Professional–methods |
Interdisciplinary Communication | Interprofessional Relations | Libraries, Medical
Classification: LCC R834 (print) | LCC R834 (ebook) | NLM W 18 | DDC 610.71–dc23
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Figures
Tables
 Preface

Mary E. Edwards, Nina Stoyan-Rosenzweig, and Paulette Hahn

Interprofessional education (IPE) is described as education
about teamwork provided to groups composed of practitioners or
students of diverse healthcare professions. IPE focuses on the roles
of various health professionals (physicians, nurses, pharmacists,
social workers, mental health practitioners, etc.) on patient care
teams, the importance of teamwork, strategies for creating effective
teams, the role of teamwork in patient safety, and other areas related
to an interprofessional approach to healthcare. To prepare future
healthcare professionals for work in a clinical setting that
increasingly features interprofessional care (IPC) and to fulfill
accreditation requirements, medical and health colleges across the
nation have created IPE programs. The purposes of this book are to
describe the variety of interprofessional education programs in both
didactic and clinical settings, discuss how libraries are partnering to
further the success of these programs, and expand the notion of
“interprofessional” beyond the typical health professions. It was
designed with a variety of audiences in mind: medical educators new
to interprofessional education, experienced IPE practitioners, and
medical librarians who want to learn more about IPE and the ways in
which libraries can support interprofessional initiatives on their
campuses. This book illustrates both a theoretical and practical
approach to interprofessional education. Chapter topics range from
foundational information such as the history of IPE, theoretical
underpinnings, and pedagogical perspectives to more practical
information regarding program implementation, accreditation, service
learning, interprofessional care and patient safety, best practices for
medical libraries, and assessing IPE programs. The book can be
read in its entirety, or each chapter can be consulted as needed, and
while there is some overlap, each chapter provides a unique
discussion of relevant IPE topics. The preface both introduces the
chapters contained within the book and expands upon the classical
definition of interprofessional education by discussing how medical
humanities and other disciplines are important considerations for a
truly holistic view of IPE.
 HOW THE BOOK IS ORGANIZED
Chapter 1, “The History of Interprofessional Education,” authored by
Robyn Dickie, of Mater Health Services in Australia, provides an
overview of the historical background of IPE and introduces the
current state of IPE programs across several countries including
Australia, the United Kingdom, Japan, and the United States. The
past informs the future; this knowledge helps illustrate how
interprofessional programs developed from early forays into
interdisciplinary teams to the robust educational programs of today in
order to see what the future may hold.
The foundation for interprofessional education draws from
various disciplines and professions including anthropology,
sociology, psychology, and education. Chapter 2, “Theories
Underlying Interprofessional Education: A Pragmatic Approach,” by
James Ballard at the University of Illinois (recently at the University
of Kentucky), thoroughly introduces the relevant theories and
describes how theoretical insights from these fields influence
interprofessional education.
With the recent trends in education including an emphasis on
active learning and teamwork, massively open online courses
(MOOCs), and flipped classrooms, it is important to have an
understanding of the underlying pedagogical principles involved with
successful interprofessional education programs in order to
efficaciously implement these methods. Andrea Pfeifle (University of
South Carolina) and Amy V. Blue (University of Florida) authored
chapter 3, “Pedagogical Perspectives on Interprofessional
Education,” which provides a discussion of the instructional theories
and practices associated with demonstrated student success and
satisfaction in interprofessional education programs.
As interprofessional education programs continue to expand,
the goals of such programs are linked to accreditation standards and
learning outcomes for a variety of healthcare professions. Chapter 4,
“Interprofessional Education as Organizational Change,” authored by
Alan Dow, Colleen Lynch, John Cyrus, and Tanya Huff introduces
theories of organizational change and describes their influence on
the planning and implementation of IPE programs. Case studies
embedded within the theoretical discussions illustrate how the
theories translate to practice. This chapter also includes a discussion
of how accreditation standards throughout the health sciences can
be used to leverage organizational change in support of
interprofessional education.
In chapter 5, “Designing an Interprofessional Education Program
from Planning to Implementation,” Jean Shipman (director of the
Spencer S. Eccles Health Sciences Library) and a team from the
University of Utah provide recommendations on how to design, plan,
and implement an IPE program. Included in this chapter are
descriptions of how other professions, that is medical librarians,
education specialists, and instructional designers, can add support
and value to the process. While many schools have rigorous
interprofessional education programs and seek to expand or revise
their programs, others are still in the nascent stages of development,
and this chapter has information relevant to anyone interested in
planning and implementation, including librarians and medical
educators.
Service learning is not new to medical education, but has not
routinely been a part of interprofessional education experiences in
the past. In chapter 6, “Engaging Service Learning in
Interprofessional Education: The University of Florida Experience,”
Erik Black, Nichole Stetten, and Amy V. Blue describe a unique IPE
course (Putting Families First [PFF], formerly known as
Interdisciplinary Family Health [IFH]) that focuses on
interprofessional groups of first-year students from all six of the
health science colleges working with families in the community.
Figures and tables are used to illustrate relationships and the
composition of the complex, but effective PFF course. This long-
standing, service-based IPE course can serve as a model for
institutions wanting to implement service components into their IPE
program or design a program from scratch.
Evidence has shown that communication failures in healthcare
can result in medical errors and negative patient outcomes. One of
the goals of interprofessional education is to break down
communication barriers among the various professions in the
healthcare team and improve patient safety. In chapter 7,
“Interprofessional Education and Patient Care: Supporting Patient
Safety,” Karen McDonough and Brenda Zierler of the University of
Washington review the literature on IPE and patient safety to
qualitatively describe various programs and evaluate the data
resulting from evaluation of those programs for the purpose of
connecting patient safety with interprofessional practice and
education.
Chapter 8, “Medical Libraries Supporting Interprofessional
Education,” authored by Lauren M. Young, a team of librarians from
the University of Mississippi Medical Center’s Rowland Medical
Library, and the Executive Director for Academic Effectiveness,
describes the ways in which librarians are supporting IPE and
includes vignettes as “sidebars” highlighting activities from several
institutions. From liaison programs to embedded librarians, medical
libraries have supported the educational activities of the healthcare
professions in their schools and programs through instruction,
outreach, and providing access to resources. As interprofessional
education programs become incorporated into the institutions in
which we work, there is a need to support them as well as we have
supported other disciplines and activities.
Chapter 9, “Clinical Medical Librarians and Interprofessional
Practice,” written by Lisa Travis (Emory University) and Skye Bickett
(Philadelphia College of Osteopathic Medicine–Georgia Campus),
provides an overview of clinical medical librarianship, introduces
results from their survey of Clinical Medical Librarians, and presents
examples where librarians are included as one of the professions in
IPE or are otherwise integrated into the interprofessional patient care
team in didactic or clinical instruction. Clinical librarians are
increasingly participating in rounds and clinical care as part of the
interdisciplinary patient team. The evidence suggests that this is a
valuable service and, as such, interprofessional education content
should expand to include the librarian’s role on the healthcare team.
As interprofessional education continues to develop and be
incorporated into the accreditation requirements for healthcare
professions, the need for rigorous assessment of these programs is
paramount. The final chapter, “Assessing Interprofessonal
Education,” authored by Erin Blakeney and Brenda Zierler at the
University of Washington, focuses on successful assessment
strategies and programs.
While the previously described chapters include various
components and aspects of interprofessional education, an
exploration of how other disciplines, including the humanities, can
contribute to the interprofessional experience, support
interprofessional care, and impact patient outcomes is a part of the
“big picture” of IPE. The following section is a departure from the
typical IPE content, with the hopes that more IPE work will include
the humanities and other disciplines in the future.

EXPANDING INTERPROFESSIONAL EDUCATION:

MEDICAL HUMANITIES AND BEYOND
Much of the book focuses on the traditional healthcare disciplines as
components of interprofessional education, but expanding beyond
those professions and disciplines provides a more complex, holistic
view of IPE and IPC. This section will first explore the emerging area
of medical humanities and then branch out into additional disciplines
of relevant interest.
Recently, the value of humanities—first in medical education
and then in the practice of all health professions—has come to be
more clearly recognized, studied, and appreciated. The term medical
humanities is commonly used; however the longer phrase
“humanities in health and illness” is more accurate and
encompasses other related subjects including social sciences,
humanities, and arts. Studying the health humanities, indeed
incorporating them into practice, offers a number of benefits for
healthcare practitioners, including the development of reflective
practice and broadening understanding of the experience of illness
and the role of healthcare systems in larger societies. These insights
can improve clinical skills and empathy, help avoid caregiver
burnout, and thus potentially reduce medical errors and lead to
greater patient satisfaction. In particular, the humanities offer great
opportunities in interprofessional education, providing models for
teamwork, as well as additional communication skills and greater
understanding of the role each profession plays in healthcare.
The humanities are a valuable tool because, first and foremost,
the humanities study humanity and the forms of expression that are
most basic to the function of human beings and their societies.
Research shows that material is most easily learned through telling,
interpreting, and understanding stories. Thus, when their work
includes the study and understanding of stories, learning formal
narrative analysis, and engaging in narrative study, student learning
and practice are inevitably enhanced (Cron 2012; de la Mothe and
Foray 2012; Haven 2007; Prusak 2001; Roche and Sandowsky
2003).
Additionally, and by their very nature, the humanities attempt to
understand and depict human experience. They are used to depict
suffering, triumph, fear, helplessness, and joy, among other
emotions. People try to explain the great questions through art and
thus to make sense of their experiences through music, dance,
writing, visual arts, and theater (Dewey 2005). The humanities
essentially explore those aspects of life that define the human
condition and thus are, at some level, universal. They help to
articulate emotional and intellectual responses to these experiences
and by so doing help to expand understanding and foster empathy
(Curtis 2009).
And, of course, humanities offer opportunities to foster creativity.
In fact, arts and humanities can arguably profoundly facilitate
communication, according to neuroscientist Daniel Levitin, who
argues that the universality of music shaped culture even as humans
created music that made possible intergenerational memory, work
synchronization, and the creation of civilizations (Levitin 2009). In
addition, participating in the humanities can offer profound
opportunities to reflect on self and others, and engagement in the
creative process can help to alter mood and reduce stress
(Pennebaker, Kiecolt-Glaser, and Glaser 1988; Davidson and
Goldberg 2004).
The value of the humanities for explicating human experience
and thus enhancing and fostering reflection, creativity, empathy, and
understanding has been well-recognized in the practice of medicine,
medical education, and in the practice of nursing and in nursing
education (Meites, Bein, and Shafer 2003). In general, medical
humanities have the capacity to enhance medical practice and
outcomes in a number of ways, but most can relate to the power of
storytelling and narrative and how the humanities impact creativity,
human emotion, and empathy. This same ability to provide a
universal message also makes humanities ideal for interprofessional
education. Teaching through the use of stories, or with a focus on the
narrative helps all students retain information and ultimately a
greater sense of empathy (Dellasega et al. 2007; Paliadelis et al.
2014; Paliadelis et al. 2015). The use of humanities also helps to
provide metaphors, means, and models for interprofessional
collaboration (Dellasega et al. 2007; Rogers and Chesters 2014).
The essence of interprofessional education and practice has the
patient at the center of the healthcare team. The humanities provide
a universal language in interprofessional education by strengthening
the collaborative approach to patient-centered care and linking the
professions together in a neutral educational experience. This allows
individuals from each profession to understand the expertise and
role of other professions in the care of patients. Through the
universal educational experience in the humanities, the professions
develop communication not only with patients, but also between
professions, enhancing leadership and the ability to resolve conflict
heightens collaborative practice.
Universal interprofessional education has been accomplished
through mutual educational experiences in ethics, narrative stories,
and art exposure, enhancing observation skills, reasoning, visual
thinking, and an understanding of the integration of the humanities in
the direct care of patients. Literature, music, art, dance, and writing
have become part of the patient experience as well as the
experience of healthcare professionals in healing and health
(Brajtman, Hall, and Barnes 2009; Charon 2001a; 2001b; Charon
2006; Klugman, Peel, and Beckmann-Mendez 2011; Reilly, Ring,
and Duke 2005).
The stressors of complex healthcare systems and emotions
related to the care of patients may erode the self-care of
professionals leading to burnout, ultimately compromising quality
and safe patient care. Reflection within each profession and also
between professions helps to restore an understanding of
experiences. When professionals reflect together they see the
“sameness” between their experiences, leading to less fragmentation
between professions, better teamwork, and respect and
understanding of the values and uniqueness of other professions.
This helps sustain compassion and humanism in the care of
patients, the care of each other, and the care of self. The humanities,
through “health humanities,” ultimately bring together science, art,
and humanism (Moyle, Barnard, and Turner 1995; Wershof Schwartz
et al. 2009).
Including medical humanities into the scope of interprofessional
education can help expand upon traditional definitions that focus on
the typical health professions, and there is growing evidence that
doing so can impact patient care and, potentially, health outcomes. It
is also important to consider social science disciplines and how they
can contribute to interprofessionality, both in terms of education and
clinical practice. Specifically, the fields of library and information
science, psychology, social work, and education can provide support
for and further insight into IPE and help develop health professionals
who are equipped to work in a dynamic interprofessional team
environment and think creatively when it comes to patient care and
research. In fact, many of the underlying theories that contribute to
interprofessional education are drawn from a wide variety of
disciplines in the social sciences and chapter 2 provides a thorough
examination of the theories and how they impact IPE.
As illustrated in several of the chapters in this book (chapters 5
and 8 specifically), libraries and librarians are providing support for
IPE activities in terms of space, infrastructure, services, and
personnel. Clinical librarians present another, potentially high impact,
type of library integration into interprofessional care. Chapter 9
provides a detailed examination of clinical librarians and the ways in
which they have been integrated into patient care teams. While it is
clear from the discussion in chapter 9 that librarians are functioning
as part of interdisciplinary patient care teams, this addition to the
team is not widely communicated to IPE faculty, who could
incorporate that knowledge into curricula and educate future
healthcare providers about the benefits of having librarians as active
members of interprofessional care teams. Integrating medical
humanities, various social science disciplines, and clinical librarians
into interprofessional education and care helps push the boundaries
of interprofessional education and practice to form a more inclusive,
expansive definition of what it means to be interprofessional.

CONCLUSIONS AND IMPLICATIONS

This book provides a unique perspective of interprofessional
education by first describing the foundations upon which it is built
and then transitioning to a more pragmatic discussion of significant
issues including accreditation, implementation, collaboration with
libraries and librarians, and practical recommendations and best
practice. The authors include health science educators and librarians
with years of experience working with interprofessional education. It
is clear from the chapters contained in this book and the discussion
of medical or “health humanities” that interprofessional education is a
significant and evolving area with opportunities for educational and
clinical research.

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Charon, R. 2001a. “Narrative Medicine: a Model for Empathy,
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———. 2008. Narrative Medicine: Honoring the Stories of
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 Acknowledgments

The editor gratefully acknowledges the contributions of all the

chapter authors, all experienced medical educators or librarians, who
provided their best work for this book. Additionally, the editor would
like to acknowledge the faculty in her department, especially Michele
Tennant, for their understanding and support during the process of
compiling this book.
 Chapter 1
The History of
Interprofessional Education
Robyn Dickie
Interprofessional education (IPE) and its subsequent learning
and practice are not new. Like most educational phenomena, it was
not constructed by an individual or a team overnight, but like Rome,
its foundations have been built over the last forty years due to a
number of political, academic, economic, and population-based
reasons.
The most commonly used definitions for interprofessional
education and learning arise from the Centre for the Advancement of
Interprofessional Education (CAIPE), a global collaborative
established in 1987 to support and promote interprofessional
education and practice. IPE “occurs when two or more professions
learn with, from, and about each other to improve collaboration and
the quality of care” (CAIPE 2002). Interprofessional Learning (IPL)
encompasses a larger sphere and may “arise [from] interaction
between members (or students) of two or more professions. This
may be a product of interprofessional education or happen
spontaneously in the workplace or in education settings” (Freeth et
al. 2005).
CAIPE’s contribution in encouraging and supporting academics
and clinicians in seeking to implement IPE initiatives, particularly in
the United Kingdom, has enabled a common language to promote
the interprofessional cause. CAIPE’s establishment in the United
Kingdom coincided with the publication of two World Health
Organization (WHO) reports in 1988, Continuing Education for
Physicians and Learning Together to Work Together for Health.
These reports highlighted the importance of training health
professionals together to enable patients to receive coordinated,
collaborative, and safer team-based care.
While these reports provided an impetus for change in the
1990s, from the published literature it appears that initiatives were
either implemented in local areas on a small scale or were not
reported or widely disseminated through conventional academic
channels. Early IPE has a somewhat unchartered history. By
undertaking a quick database search using the search term
“interprofessional education” and the publication date limiter to the
year 2000, a researcher is likely to find a less than one hundred
publications.
IPE’s early story is not illuminated from the pages of peer-
reviewed journals or carefully crafted texts. Its story was initially
disseminated through what one might describe as “urban legends.”
These legends belonged to small groups of highly motivated
individuals seeking global health professional education reform.
Baldwin in the United States, McCreary and Szasz in Canada,
Areskog in Sweden, and Pietroni in the United Kingdom pioneered
various IPE initiatives and are widely regarded as the early leaders
of global IPE with their seminal work still influencing IPE policy and
strategic direction today.
IPE together with IPL and interprofessional practice (IPP) has
gained global momentum, assisted with the introduction of
interprofessional-specific journals, such as the Journal of
Interprofessional Care and the Journal of Research in
Interprofessional Education. Such publications have improved the
quality of the published IPE studies, with greater emphasis placed on
rigorous methods and evaluation of initiatives in the past decade.
Fast forward to 2015 and the same rudimentary search yields over
three thousand publications. Numerous literature reviews and
synthesis of the published IPE literature have been conducted in the
last eight years offering universities and healthcare settings a
comprehensive overview of past and present IPE initiatives,
evaluation methods, and outcomes (Brandt 2014).
This exponential increase in IPE literature can be attributed to a
variety of factors. The number of IPE initiatives occurring globally
has increased, particularly since the release of the Institute of
Medicine (IOM) report To Err Is Human along with the Bristol Royal
Infirmary Report from 2001 and most recently the Mid-Staffordshire
Report. The reports highlighted specific deficiencies in the
healthcare system, particularly in relation to effective leadership,
teamwork, and communication. While these reports generally
attribute failure to implement interprofessional practice within a
health service, interprofessional education at both prelicensure and
post-licensure healthcare professionals levels appears to be the
“magic bullet” to address to shortcomings in our healthcare system.
Today’s healthcare consumer is not willing to accept failings in
our healthcare system as, perhaps, our forefathers did. The majority
of healthcare consumers are astute; and while during their episode
are vulnerable, have high expectations that they are being cared for
by a highly trained and integrative team. Brandt, Lutifyya, King, and
Chioreso (2014) describe the “Triple Aim”; a concept initially put
forward by Berwick, Nolan, and Whittington (2008) to improve the
quality of patient care, patient experiences within the healthcare
system, to reduce cost, and to improve overall population health.
Together with consumer demand for cohesive, team-based,
patient centered-care, there is an increased demand to include
interprofessional education within a health-professional student
curriculum. This is to ensure that professional competencies and
capabilities, together with regulatory requirements, are met. Globally,
four competency and capability frameworks have been developed
and published to improve interprofessional education outcomes for
students. These are: Interprofessional Capability Framework
(Sheffield Hallam University, Combined Universities Interprofessional
Learning Unit, United Kingdom, 2010); National Interprofessional
Competency Framework (Canadian Interprofessional Health
Collaborative Working Group, 2010); Core Competencies for
Interprofessional Collaborative Practice (Interprofessional Education
Collaborative Expert Panel, United States of America, 2011); and
Interprofessional Capability Framework (Curtin University, Australia,
2011).
The development of interprofessional competencies and
capability frameworks offers a guide to those educators seeking to
implement an IPE “endpoint” for their education. These endpoints
enable us to determine whether a student or participant undertaking
education has become “competent” or “achieved competency.”
Thistlethwaite and colleagues (2014), however, suggest that by
ensuring that students are “competent” in interprofessional education
and practice, the creation of meaningful learning objectives and
outcomes, the true interprofessional learning that may not be
inherent within the curriculum design, along with the formative
learning with, from, and about each other could be lost.
In reality, most healthcare education continues to occur in
discipline-specific silos, despite the best efforts of interprofessional
educators to dismantle them. When reviewing discipline-specific
accreditation and licensure requirements in Australia (Australian
Health Professional Regulatory Authority [AHPRA], 2015), twelve of
the fourteen registered health practitioners have multidisciplinary or
interprofessional teamwork standards as part of their core behavioral
and professional standards. While the need for interprofessional
capabilities is evident, further emphasis must be placed on individual
professional groups to enable health professionals to adequately
fulfil their mandatory licensure requirements. However, we should
not throw the “IPE baby out with the bath water”; on the contrary; we
need to be mindful when and to whom these capability frameworks
and competency standards are applied when designing,
implementing, and, particularly, evaluating interprofessional
education success.
Along with IPE competency and capability frameworks, the
WHO provides the following guidelines for Interprofessional
Education (as cited in Rodger et al. 2010).

1. IPE should be a mandatory component of every health

professional’s education.
2. IPE should be offered based on explicit learning outcomes
that are made clear to both staff and students.
3. IPE should be assessed with respect to what students were
intended to learn.
4. IPE should be offered by trained facilitators who have
received staff development in this area.
5. IPE should be evaluated for both process and outcomes.

A review of the collected WHO data undertaken by Rodger et al.

(2010) found that only 38 percent of higher education institutions
reported that IPE was mandatory for all their students, with some
differing requirements for specific health disciplines. Objectives and
outcomes were poorly understood with only 37 percent of
respondents stating that IPE learning objectives were assessed.
Faculty training was also limited; however, this is understandable
given the global current state of IPE. While IPE is evaluated, the
current plethora of tools or instruments are often specific to domains
of interprofessional learning such as teamwork, and are often
specific to the context of the activity, such as emergency care.
Brandt and colleagues (2014) share Rodgers’s and colleagues
(2010) concerns in relation to evaluation of IPE, stating that while
individual (student or staff) impacts and reactions following the
activity is common, very little literature focuses on population or
patient health outcomes or reduction of cost in healthcare by
implementing interprofessional education. When examining
longitudinal educational outcomes, there are often numerous
confounding factors, which cannot be controlled. Therefore, it is
difficult to know the true impact and effectiveness of IPE on patient
and population health outcomes; however, it is a question that needs
to be answered.

LOOKING BACK, LOOKING AROUND, AND

LOOKING FORWARD: A REVIEW OF KEY IPE
INITIATIVES
ACROSS THE GLOBE
There are many quality IPE activities occurring globally, many
remaining unpublished for a variety of reasons. IPE activities come
in different shapes and sizes; influenced by the type of health
professional students involved, faculty commitment, logistical and
geographical barriers, financial considerations, and involvement of
the local health delivery service. The snapshot of both historical and
current interprofessional activities below highlights a variety of IPE
activities across the globe.

United States of America: A New Beginning

Interprofessional education is not a new phenomenon for the

United States, where initiatives date back to the early 1960s. The
likes of Baldwin, Brandt, and Schmitt have lead IPE initiatives across
the country, with seminal works providing global IPE foundations.
Early IPE activities in the United States concentrated on primary
care, and were often unfunded, and relied heavily on the goodwill of
interprofessional faculty (Blue, Brandt, and Schmitt 2010). Like most
countries attempting to implement a coordinated, centralized IPE
curriculum across numerous health services without sustained
financial support, the United States has yet to achieve the WHO
guidelines for interprofessional education.
However, there are a number of notable projects across the
country particularly at a prelicensure level. Within the United States,
IPE has a number of “productive” pockets, each with their unique
approach to interprofessional education and practice.

University of Nevada

The University of Nevada, Reno implemented an

interprofessional curriculum in the late 1970s, which required
students to undertake a number of scaffolded IPE activities as part of
their health professional studies. A core “Introduction to Health
Sciences” course was used to promote the use of common
healthcare language, an understanding of the healthcare system that
students would be graduating into, and finally the introduction of
teamwork using group projects (Baldwin and Baldwin 2007). The
university used a facilitation model, using vignettes or role plays to
illustrate key learnings. This curriculum was finally cemented with a
clinical program “Team Approach to Healthcare,” a student-led
patient clinic supervised by university faculty.

Tucson, Arizona

There are many factors that influence the implementation of

IPE. Technology has increased its role over the past ten years, with
many universities implementing online or e-learning IPE
environments in which their students interact. These online forums
and activities offer opportunities for students early in their health
professional studies to learn about the roles and responsibilities of
other health professional students to take care of a “virtual patient.”
These activities are often supplemented using simulation-based IPE
training.

Simulation-Based IPE

Simulation-based IPE has offered new avenues for universities

to provide team-based training that minimizes harm to patients,
maximizes interprofessional learning opportunities to achieve
desired learning outcomes, and can be tailored to meet the needs of
the universities and healthcare facilities. Palaganas, Epps, and
Raemer (2012) state that simulation offers authentic experiential
learning opportunities within an environment that represents a real
clinical environment; allows participants to practice technical and
nontechnical skills (communication and teamwork) in an environment
that eliminates risks to patients; and provides opportunities for
faculty to observe teamwork in action in a controlled environment.
Simulation may hold the key to dismantling what Baldwin (2007)
describes as academic or professional “silos” that contribute to the
poor uptake to interprofessional education, along with the healthcare
settings, which promote hierarchical and authoritarian systems in
which students undertake their clinical practice. Simulation-based
healthcare training is strongly aligned with patient safety, which often
provides an impetus to implement interprofessional education and
practice changes within a healthcare facility. Simulation training
compliments IPE as both emphasize the patient being at the “center”
of the activity. See chapter 5 for more information about simulation in
IPE including a discussion of how the University of Utah uses
simulation in IPE training experiences.

Canada: The Pioneers of British Columbia

As previously mentioned, Szasz was one of the founders of IPE

in Canada, with a paper published in 1969 entitled “Interprofessional
Education in the Health Sciences: A Project Conducted at the
University of British Columbia.” Szasz (1969) highlighted issues that
still exist today: poor utilization of minimal human resources, poor
teamwork, and poor communication—all contributing to fragmented
patient care. Like many developed countries, it wasn’t until the early
2000s that this vision in Canada was realized. Following a review of
publically funded Canadian health services in 2001, a report entitled
Building on Values: The Future of Health Care in Canada (Romanow
2002) was released, highlighting the need to train healthcare
professionals together to improve and create an efficient and high-
reliability health system. This recommendation, together with other
key points, led to the creation and implementation of the
Interprofessional Education for Collaborative Patient-centred
Practice (IECPCP) across all areas of health. A National Expert
Committee (NEC) oversaw the implementation of the IECPCP
strategy, with IPE initiatives subsequently funded by Health Canada.
It must be noted that any funded initiative had to be linked to clinical
practice, rather than a stand-alone university IPE project. It is this
criterion that may be the key to Canada’s success; ensuring that IPE
leadership was not restricted to the university, but a collaborative
between health services, universities, and most importantly patients.
The University of British Colombia has implemented (and
continues to implement) an integrated IPE program, offering
students a number of IPE interactions throughout their studies. IPE
activities are underpinned by educational theory; appropriately timed
to ensure junior students are exposed to health professionals other
than their own in activities that promote active reflection. Activities
such as Health Care Team Challenge and immersion in
interprofessional placements such as the Interprofessional Rural
Program for British Columbia allows students to enhance
collaborative, communication, and care coordination skills, with
interprofessional mastery occurring as a qualified health professional
undertaking further study and collaborative clinical practice (Charles,
Bainbridge, and Gilbert 2010).
While Canada is seen as a global leader of IPE and
interprofessional care (IPC), Gilbert (2014) highlights that there are
numerous barriers that prevent the successful implementation of
IPE. Institutional structures both in academic and health delivery
sectors such as timetabling, lack of staff, and poorly trained faculty
are often barriers to the successful introduction of IPE and Gilbert
(2014) suggests that that evidence-informed leadership is the key for
success.

Sweden—Linkoping University: The Birthplace

of IPE Training Wards

In 1986, Linkoping University in Sweden established what the

world now refers to the “Linkoping IPE model.” While many
universities and healthcare facilities cite logistical and geographical
barriers to implement IPE initiatives, in the late 1980s Linkoping
University was able to embed IPE within programs as many
“hospital-trained” healthcare professionals transitioned to “academic
programs.” The influx of new health professionals offered the faculty
a unique opportunity to design a program that would meet Sweden’s
future healthcare and educational policy and address the changes in
public healthcare and new models of healthcare delivery. Curriculum
development was led by Professor Areskog, with a scaffolded,
experiential learning experience the result. Students undertake a
problem-based learning introductory module, followed by a clinical
team training experience within orthopaedic and geriatric wards and
Linkoping University Hospital. Evaluation of the program was initially
conducted for internal curriculum review with little evaluation data
published until the early 1990s (Bredange 1991). Program evaluation
results indicate that IPE prepares students for professions where
understanding each other’s roles and responsibilities to the patient
allows for improved delegation, differentiation, and discussion
(Fallsberg and Hammer 2000). Similar to the majority of IPE
literature, Wilhelmsson and colleagues (2009) report that
engagement, faculty ownership, and curriculum renewal are
important to the success of IPE initiatives. Wilhelmsson and
colleagues (2009) note the importance of student and alumni
involvement, not only as participants but as curriculum reviewers, for
it is these people who will potentially have the greatest ability to
improve student engagement and ultimately interprofessional
practice.
United Kingdom Experience: Sheffield

IPE in the United Kingdom has been integrated and prioritized

into prelicensure education since 1997, with partnerships between
education institutions and local health authorities enabling this to
occur. Creating an “authentic” learning environment was a key driver
when Sheffield Hallam and Sheffield Universities created the
Combined Universities Interprofessional Learning Unit (Gordon et al.
2006). Too often IPE activities force interaction between health
professional students that are not usually found within the healthcare
system, creating a “poorly simulated” environment. The Learning
Unit created a flexible interprofessional curriculum offering students
face-to-face, e-learning, problem-based learning, and mentoring to
achieve knowledge in practice, ethical practice, reflection in learning,
and interprofessional working capabilities according to the
Framework for Interprofessional Capability.

The Japanese Experience

Tamura and colleagues (2005) used metaphors to enable first-

year students to understand the key concepts related to
interprofessional education and practice. Students were asked to
create a visual “menu,” which included sushi rolls and curry to
illustrate how health professionals can work in harmony to achieve
success. Each ingredient, such as nori sheets or curry spices
represented how an individual profession could influence or create
cohesion within the team. This novel exercise engages students in
their first interprofessional education encounter. More recently, the
focus of Japanese IPE faculty has been to validate instruments to
the Japanese context to improve the rigour of their quantitative IPE
evaluations (Tamura et al. 2012).

Australia: The Resurgence of IPE

Following a hiatus, Australia is currently seeing a revival of IPE

activities following the Curriculum Renewal for Interprofessional
Education in Health commissioned by the Office of Learning and
Teaching (Dunston et al. 2014). The report highlights the pockets of
quality IPE activities occurring across both metropolitan and regional
areas. The Australian government has provided additional funding
through Health Workforce Australia, prioritizing interprofessional
education, particularly utilizing simulation as a key initiative to
improve patient safety and address workforce shortages.
Curtin University located in Perth, Western Australia, is one
pocket that continues to provide IPE leadership within both acute
and primary healthcare settings. Curtin University, along with
medical students from University of Western Australia, partnered
with Royal Perth Hospital to establish a student training ward, similar
to those found in Sweden. Students from medicine, nursing, social
work, physiotherapy, occupational therapy, and pharmacy undertook
a two- to three-week clinical placement in a medical ward, which
aimed to improve collaborative practice, provide client-centered care,
and improve safety outcomes for patients. Student capabilities were
measured against the Interprofessional Capability Assessment Tool
(Brewer and Jones 2013) and the Interprofessional Socialisation and
Valuing Scale (King et al. 2010). Overall, students reported an
increased awareness and respect of each other’s roles within the
interprofessional team, with the training ward providing them an
opportunity to practice autonomously, and improve their confidence
within their own professional role.
Like most countries, Australia’s healthcare delivery system is a
complex web, with funding arising from federal- and state-based
sources. Local health districts or areas liaise with universities and
other higher education intuitions across the country to enable
student clinical placements to occur. Student clinical placements, like
the ones utilized by Curtin University, are ideal to implement IPE
initiatives as health services can tailor a student’s clinical experience
in include IPE exposure. Of course, this relies on health services
utilizing an interprofessional practice model; a model that is desired,
but for the most part, not yet achieved.

CONCLUSION
Historically, interprofessional education has occurred in isolated
pockets across the globe, with little published literature available to
faculty wishing to implement similar activities. The increased
evaluation and subsequent reporting has resulted in an exponential
rise in the number of peer-reviewed articles and textbooks examining
interprofessional education, learning, and practice. As highlighted
above, many countries are implementing activities in attempt to meet
WHO guidelines for IPE. Rigorous evaluation of longitudinal
outcomes appear to be difficult to establish due to a number of
confounders. This, along with traditional barriers to IPE
implementation and evaluation are key priorities for our IPE leaders
globally.

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 Chapter 2
Theories Underlying
Interprofessional Education
James Ballard
This is not a definitive survey of all of the potential theories that
might impact development of interprofessional curricula. Work
toward this end has been done in earnest and can be reviewed
elsewhere (Adams et al. 2006; Colyer, Helme, and Jones 2012;
Hean, Craddock, and Hammick 2012; Reeves et al. 2007). Rather, it
is a selection of theories and related models, from a pragmatic
orientation, that educators who embark on the murky journey of
interprofessional education might consider as they design,
implement, and evaluate interprofessional curricula.
According to Clark (2006), one application of theory in
interprofessional education (IPE) is to guide instructional practice.
The other is to inform research and, although, this is important, this
chapter will focus on the implication of theory for instructional
practice and curricula design. This includes components such as, (a)
determining major concepts to guide the structures and process of
educational experiences, (b) determining appropriate learning
objectives and the strategies to achieve them, (c) understanding and
defining effective roles for faculty and students in the educational
process, and (d) measuring programmatic impacts and outcomes.
These components should not be surprising to educators; yet, the
early days of interprofessional curriculum design have been criticized
for a lack of theoretical grounding (Freeth et al. 2002). Recently,
however, this landscape has changed dramatically as more and
more educators are, indeed, designing and describing curricula that
is developed upon a sound theoretical footing. That is the good
news. The bad news is, as Hean, Craddock, and O’Halloran (2009)
well describe “this plethora of theories has become a confusing, and
un-navigable quagmire” (251). Further, there is no, and perhaps
cannot be, an overarching and consolidated theory that
encompasses interprofessional education. Nonetheless, as more
and more institutions and professions struggle to make sense of this
literature in order to develop sound curricula and evaluations of that
curricula, the need for a digestible account of relevant theory is
apparent. That is what has been attempted in this chapter. From this
perspective a selection of relevant theories from education, social
psychology, and organizational psychology will be put forth. All have
been selected because of their pragmatic utility in developing IPE
curricula within authentic, purposeful, and contextually appropriate
environments. Subsequently, a brief discussion of the developmental
nature of learning in tandem with its implications for interprofessional
education will be offered.

EDUCATIONAL THEORIES

Adult Learning

It seems reasonable that one cannot approach a discourse on

educational theories that are appropriate for learning among the
population of health professions students without a discussion of
adult learning. Yet, there is no single theory of learning that is
appropriately applicable to all adults. Nevertheless, the literature has
described a number of constructs that can be subsumed under the
heading of adult learning. All attempt to describe the distinctions
between learning as adults and as children. Three prominent
theories of adult learning include adult learning theory, self-directed
learning, and transformative learning theory.

Adult Learning Theory

Knowles (1980) proposed a set of assumptions about adult

learners that, perhaps, are unique to adults, and implications for
educational practice that follow from these assumptions. Accordingly,
he assumed that (a) as learners mature, they move from a
dependence on others toward a self-directed mode of learning; (b)
adult learners draw on past experiences gained through formal and
informal life experiences to aid learning; (c) adults are motivated to
learn when they assume new life or professional roles; (d) adults are
motivated to focus on problems and prefer immediate application of
learning toward solving problems; and (e) adults are internally, as
opposed to externally, motivated to learn.
Implications for educators follow from these assumptions and
suggest that learning should be situated within an appropriate
climate, and should focus on addressing the learner’s specific
interests and needs at the appropriate skill level. Additionally,
Knowles proposed that the adult learner needs to be actively
involved in planning the instruction and that learning based on
experiences, both positive and negative, is important. The notion of
experiential learning is also important within Knowles’s framework
and has been expanded by Kolb (1984), who describes learning as
an interactive process among members of a community of learners
who collectively explore the meaning of problems. This requires
learners to reflect on their experiences from multiple perspectives
and to create an integrated understanding that includes logical
theories that are used to make decisions and solve problems.
The construct of self-directed learning in adulthood is another
central theme of Knowles’s conception of adult learning. Specifically,
it is described as a process of taking the initiative for planning,
implementing, and evaluating one’s own learning experiences based
on one’s own perceived needs and goals (Knowles 1975). Knowles
argues that this leads to better learning in terms of both the quantity
of information learned and the quality, or effectiveness, of how it is
learned. Hiemstra (1994) cautions that self-directed learning is not,
in and of itself, a theory; yet, given its seeming persistence in
adulthood, and an acknowledgment of the socially constructed
nature of knowledge, it is worth mentioning in the context of
completing the paradigm of adult learning. It is important to note that
self-directed learning does not necessarily take place in the
academic environment; yet, it may, as is the case when learners
become empowered to take responsibility for their own learning
efforts.
From the perspective of interprofessional education, Barr (2013)
reminds that adult learning principles are relevant to, yet distinct
from, interprofessional learning. Whereas adult learning principles
place the responsibility of learning on the individual, in
interprofessional education this responsibility is shared among all
individuals within the group as they jointly attempt to learn with, from,
and about each other. Likewise Clark (2006) argues for the
relevance of adult learning principles in IPE in that they accentuate
cooperation and collaboration in addition to emphasizing the
importance of socially constructed knowledge. This emphasis on the
cognitive construction of knowledge is the focus of many educational
theories that have roots in the social cognitive perspective to be
described later.

Transformative Learning Theory

Transformative Learning Theory has been described by Mezirow

(1997) as a process of causing change within one’s frame of
reference. These frames develop as a result of life experiences and
include concepts, values, feelings, and associations that create
assumptions through which future experiences are understood. They
shape expectations, perceptions, thoughts, and feelings in
subsequent interactions with the environment. Once these frames
are established, there is a tendency to reject ideas that run counter
to these preconceived “habits of mind” described as “broad, abstract,
orienting, habitual ways of thinking, feeling, and acting, influenced by
assumptions that constitute a set of codes” (Mezirow 1997, 5).
Within the context of interprofessionalism, an example of a habit of
mind can be found in the construct described by Pecukonis, Doyle,
and Bliss (2008) as profession-centrism representing a
predisposition to potentially see others outside one’s own profession
as inferior. Clearly this is not an optimal perception to be held by
learners yet it is an understandable outcome of silo-based care that,
hopefully, can be transformed through experiences received within
IPE. Frames of reference can be transformed through critical
reflection on the assumptions that undergird interpretations of the
world. Educators can transform habits of mind by helping learners
uncover and critically reflect on their own frames of reference in
order to see things from different perspectives.
Educational Learning Theories from Cognitive
and Social Cognitive Perspectives

Educational learning theories are vast as are specific definitions

of learning. Together Illeris (2004) and Ormrod (1995) offer a view of
learning that seems especially pertinent to educators in
interprofessional education. Accordingly, they describe learning as a
confluence of cognitive, emotional, and environmental factors that
allow the learner to gain or enhance understanding in order to make
changes to one’s own skills, values, or worldview. The importance of
this definition is the recognition that learning must be viewed as a
continual process as opposed to the end-product of what has been
learned. From this perspective, learning can be described through a
number of theories, all focusing on particular components of the
process, be they the behaviors elicited among learners, their
cognitions, or the contextual environmental influences impacting the
learning process. Given the number of potential directions involved
with describing educational theories relevant to IPE, this section will
concentrate on what generally are described as cognitivist, social
cognitivist, and constructivist perspectives of learning as these have
significant relevance for affecting the learning processes of health
professions students who are learning with, about, and from each
other.
According to Merriam, Caffarella, and Baumgartner (2007) the
behaviorist perspective on learning, with its focus on stimulus and
response reinforces in the learning context, that became prominent
in the early to mid-1900s was challenged in 1929 by those within the
Gestalt psychology camp for being overly particularistic and
dependent upon overt behaviors to explain learning. This criticism
continued and blossomed throughout the mid-twentieth century in
concert with the cognitive revolution during which there was a
redefinition among the fields of psychology, anthropology, and
linguistics in addition to the genesis of fields such as computer
sciences and neurosciences. During this time scholars such as B. F.
Skinner, Noam Chomsky, and Jerome Bruner argued for the need to
include internal (not obviously observable) processes involved in
learning rather than adhering to the strict assumptions of the
behaviorists (Miller 2003).
The cognitivist perspective of learning is based on two primary
assumptions (Merriam, Caffarella, and Baumgartner 2007): (1) the
memory system is involved in storing and processing information to
be learned, and (2) new knowledge is built upon prior knowledge.
From this perspective memory is perceived through the sensory
system and is interpreted and given meaning. Here we see a shift in
locus from the environment (as in behaviorism) to the individual’s
mental processes. Emerging in the 1970s its proponents rejected the
idea that learners are passive recipients of information. Rather, they
argued that learners actively engage with their environment in a
developmental process of cognitive reorganization to construct
meaning. A leader within this perspective, John Piaget, was
instrumental in calling attention to the relationship between
maturation (development) and learning. In particular he proposed
that cognitive structures change as a result of both the maturation
process and the individual’s interaction with the environment. This in
turn affects what can be learned, how it is learned, and when it can
be learned (Duckworth 1964).
Building on the cognitivist perspective, the social cognitivists
shared the focus on internal processes and combined some of the
views of the behaviorists, namely reinforcement contingencies. The
social cognitive perspective of learning grew out of the work of
Bandura (1986). It focuses on learning that occurs in the social
context. Specifically, this perspective posits that learning occurs in a
social context and that people can learn by observing others
(Merriam, Caffarella, and Baumgartner 2007). From this perspective,
learning can be vicarious (learned through the observation of others)
and does not require imitation of behaviors as posited by the
behaviorists. Similar to the cognitivists, the learning process is based
loosely on the metaphor of the computer (sometimes referred to as
the information-processing model) and involves four processes
including: attention, retention (memory), rehearsal, and motivation
(Cowen 1988). For example, actions of others are observed and
attended to. This information is retained and processed in memory
until the individual is motivated to act on it.
 According to social cognitive theory, learning is predicated on a
number of assumptions about learning and behavior. This includes
that personal (cognitive), behavioral, and contextual (environmental)
factors interact in a reciprocal method to produce learning. As such
learning is affected by the reinforcements occurring in the learning
environment in addition to the learners own beliefs about themselves
and their interpretation of the learning environment. Additionally,
social cognitive theory assumes that learners influence their own
learning through purposeful, goal-directed methods. Finally, the
theory posits that a distinction be made between learning and
behavior. That is, that learning may occur, but may or may not be
demonstrated through behavior until the learner is motivated to do so
(Bandura 1986).

Constructivist and Social Constructivist Perspectives

of Learning

The central premise of constructivism is that learning involves

the process of meaning-making. However, constructivist
perspectives differ among several lines including, and importantly for
IPE, the distinction between whether this meaning-making is
fundamentally an individual or social function (Steffe and Gale 1995).
In regard to the former, Piaget described learning as an internal
cognitive activity of an individual’s adapting cognitive schema in
response to the changing physical environment. Learning operates
as an equilibration model. New knowledge encountered by the
learner is assimilated into existing knowledge structures. However,
when this new information does not fit within an existing schema,
cognitive disequilibrium occurs, and the learner is forced to reconcile
the fit of the new information to old by accommodating the existing
schema to master the new challenge. As the learner encounters
experiences that are counter to a current understanding, cognitive
conflict occurs. By working through this conflict the learner acquires
new schema that leads to new ways of understanding.
Alternatively, whereas the constructivist perspective of learning
posits that learning is constructed through interaction with one’s
environment (Merriam, Caffarella, and Baumgartner 2007), the social
constructivist perspective posits that learning is not constructed in
isolation from the social context. Rather, it is mediated by the social
environment with emphasis directed toward how social encounters
influence learners’ understanding and meaning-making within a
collaborative circumstance, especially with a facilitator or some other
external other (Davis 1994). The social constructivist view postulates
that meaning–making is a dialogic process through which knowledge
is constructed within a social context through communication or
shared problem solving. Driver, Asoko, Leach, Mortimer, and Scott
(1994), drawing from Vygotsky (1978) describe this process as one
in which learners build an understanding of the culturally shared
worldview of others. Recalling the learning with, from, and about
description of IPE (Barr 2002), this perspective is vital for
understanding interprofessional education (Hean, Craddock, and
O’Halloran 2009).
Although not a theory itself, a related construct that should be
considered, especially as it relates to social constructivism in
developing IPE, is the “hidden curriculum.” Philip Jackson (1968) first
introduced the concept of the hidden curriculum in the context of
general education. Specifically, he observed children in primary
education and identified values, dispositions, and behavioral
expectations that were rewarded in school. Although these
components were not tied explicitly to educational goals and
objectives, they were critical for success in school. In the 1960s
Fredric Hafferty first introduced the concept of the hidden curriculum
to educators in medical education (Hafferty 1998). Recently, this
construct was operationalized for the medical education community
by Gaufberg, Badalden, Sands, and Bell (2010) as learning that
occurs through informal interactions among students, faculty, and
others or learning through organizational, structural, and cultural
influences intrinsic to training institutions. Others, such as Gofton
and Regehr (2006), describe the hidden curriculum as a function of
implicit values held by the institution, the education, and the
professionals who work in the trainees learning environment who
impact students’ behaviors and attitudes. Likewise, Haidet and Stein
(2005) argue that the student–teacher relationship that emerges
within the medical education context is an important mediating factor
that influences how the culture of medicine, in its broadest sense, is
learned, both positively and negatively. Importantly, within the
discussion of social cognitive learning, the hidden curriculum is an
important feature of the learning context that must be considered if
educators are to be successful in developing and fomenting a
positive interprofessional worldview among learners. According to
Gaufberg, Badalden, Sands, and Bell (2010), medical educators
who, themselves, were socialized by the hidden curriculum during
training, may not recognize the messages they send to their own
trainees, thus proliferating the attitudes toward collaboration,
positively or negatively, that they hold themselves. As such it is
important for educators to remain mindful of their own values and
cognitions when interacting with learners.

THEORIES FROM SOCIAL PSYCHOLOGY

Thus far learning has been described as occurring at an internal
level, influenced by the environment. Within IPE, the context of
learning should be as authentic as possible. This often involves a
learning environment in which groups of learners from multiple
professions are interacting. Social psychology reminds us of the
potential dangers that may lurk below the surface of learning when
multiple groups of learners, or professionals, interact. Research from
this paradigm has provided a rich landscape of useful theories for
understanding how groups can coexist effectively and why bias
between and among groups can form. Much of this work has
focused generally on understanding and mitigating intergroup bias.
Intergroup bias is best understood as a tendency to systematically
view members of one’s own group (in-group) more positively that
nonmembers (out-group). This bias can be manifested in multiple
forms across behavioral (discrimination), attitudinal (prejudice), and
cognitive (stereotyping) domains (Mackie and Smith 1998; Wilder
and Simon 2001). As such, this literature is relevant to IPE in so
much as it both describes the circumstances in which bias between
and among professional groups can occur and strategies for
mitigating this bias. We begin first with some of the primary theories
that have been developed to understand how intergroup bias occurs.
In turn, a description of mitigating strategies is discussed.

Self-Categorization Theory

Self-Categorization Theory describes the circumstances under

which individuals from one group assimilate the self into an in-group
prototype, or category (Turner and Reynolds 2001). This is a
cognitive model whereby individuals reduce the organization of the
social world into social categories in an effort to reduce the
complexity of information occurring within a social context. This
abridged information is used to more efficiently, but not necessarily
more accurately, predict and guide behaviors. One example of the
outcome of relaying on these simplistic inferences is stereotyping, a
process in which individuals ignore individual characteristics of group
members and concentrate on a more generalized understanding that
may occur as a function of highly observable (i.e., gender, race,
profession) features, ascribing a limited set of attributes to most
members of that group. As a result, members of the out-group are
seen as more homogeneous while members of the in-group continue
to perceive themselves to be part of a more diverse group.
Members of the in-group tend to extend trust, positive regard,
mutual cooperation, and empathy toward fellow in-group members,
excluding those in the out-group (Brewer 1999). This in-group
favoritism has been demonstrated to arise automatically without the
individual’s awareness (Otten and Wentura 1999). It is generally
associated more strongly with an increased regard for one’s own
group as opposed to strongly negative attitudes toward the out-group
(Dovidio and Gaertner 2000), although out-group derogation can
occur in circumstances in which strong emotional reactions may lift
the normally occurring constraints that typically lead to in-group
favoritism (Brewer 2001).

Social Identity Theory

Social Identity Theory (Tajfel and Turner 1979) posits a self-

esteem hypothesis that leads to intergroup bias. Accordingly,
successful intergroup bias functions to enhance or create high in-
group status that offers a positive social identity for members of the
in-group, thus satisfying a need for positive self-esteem. In general,
the theory concludes that one’s identity as an individual is derived
from the social group to which one belongs. Groups provide a sense
of social identity or belonging. Given the tendency to prefer seeing
oneself in a positive light the in-group, of which one is a member, is
seen more positively than the out-group. In other words, individuals
tend to increase their own self-image by enhancing the status of the
group in which they belong. The corollary to this is that the image of
the in-group, and by extension, one’s own self-image can be
increased by denigrating members of the out-group.
According to Tajfel and Turner (1979) three variables contribute
to the tendency toward in-group favoritism. First, favoritism is
dependent upon the level of identification with an in-group. Greater
identification leads to an internalization of group membership as an
aspect of one’s self-concept. The second involves the extent to
which the context provides opportunity for comparison between
groups. Finally, the perception of relevance of the comparison group
to one’s own can influence in-group favoritism. Generally, individuals
are likely to display favoritism when self-definition is highly related to
identification with an in-group and when a comparison between
groups is meaningful (i.e., in the case of power differentiation).

Optimal Distinctiveness Theory

Optimal Distinctiveness Theory (Brewer 1991) is related to

Social Identity Theory and postulates that the opposing needs of
assimilation and differentiation must be cognitively reconciled. That
is, individuals are motivated to identify with groups that provide a
balance between these dichotomous needs. If, for example,
individuals feel too similar to others in their in-group they will seek
ways to be different. Likewise, if they perceive themselves to be too
different than others in the in-group, they are motivated to become
more similar.
According to this theory individuals are more likely to identify
with groups that can resolve the conflict between these two needs. A
good example of this is found in a study by Lau (1989) that
demonstrated the group identity of African Americans was strongest
when individuals lived in communities that were more integrated
rather than being predominantly black or white. It was hypothesized
that African Americans in this context were able to identify
themselves as somewhat similar to other African Americans, but
somewhat different as when they compared themselves to whites,
thus reconciling the balance between their assimilation and
differentiation needs.

Social Dominance Theory

Social Dominance Theory (Sidanius and Pratto 1999) posits that

intergroup hierarchies are either promoted or attenuated by
ideologies supported by society. Individuals in groups that have
greater access to power or privilege possess an amplified social
dominance orientation and, as such, have a stronger desire to
endorse intergroup hierarchies. Within these hierarchies their own in-
group maintains superiority over out-group members in terms of
status and power. Examples of groups that maintain a higher social
dominance orientation in our society traditionally have included men
in comparison to women. This also has been examined within the
context of whites and blacks in South Africa (Sidanius and Pratto
1999). One could hypothesize that within the current hierarchically
based healthcare system that power differentials may be important
to consider in the development of IPE experiences.
Given the implications of these various theories discussed
above that all describe nuances about why individuals tend to cluster
into and identify with subgroups, it is important to moderate the
effects of group identification when planning and implementing IPE
curricula. Two strategies in particular, decategorization and
recategorization, have been well-documented in the literature. Both
focus specifically on mitigating the tendency of individuals to isolate
people into discreet categories by designing contextual features of
experiences in order to decategorize or recategorize group
boundaries, thus reducing intergroup bias (Wilder 1986).
Decategorization

Decategorization is accomplished through a process of

individuation through which one is drawn to attend to individual
differences of individuals, as opposed to undifferentiated cognitive
representations of the group to which they belong, in essence
counteracting the cognitive efficiency of developing strict categorical
separations. Accordingly, as a result, repeated personal exposures
with members from other groups in which members of opposing
groups become acquainted, the strength of out-group categories
diminishes and intergroup bias is reduced (Miller, Brewer, and
Edwards 1985). Miller and Brewer (1984) describe this process as
occurring when members of groups attend to information that is
relevant to the self as an individual as opposed to the self as a
member of a group. That is, category identity as a source of
classification is replaced with individualized information. In practical
terms this suggests that interprofessional education groups should
be organized in such a way as to reduce categorical distinctions by
allowing for the development of personal connections between and
among group members. This might be done formally by devising
experiences in which learners are scaffolded to focus on the
personal and individual characteristics of each other; or, perhaps, it
can be accomplished informally by providing learners the opportunity
to socialize in a “neutral” or non-academic context.

Recategorization and the Common In-Group

Identity Model

Recategorization is similar to decategorization in that it functions

to reduce the salience of distinctions between in- and out-groups.
However, rather than focusing on reducing or eliminating
categorizations, the emphasis is on restructuring group
categorizations at a higher level of inclusiveness. This can be
accomplished by strategies designed to create a common in-group
identity whereby members’ perceptions of group boundaries change
from a perspective of us and them as individuals to we as members
of unique yet complementary groups consisting of members
functioning together at a superordinate level of identity (Gaertner et
al. 1993). This does not mean, however, that this process requires
an abandonment of one’s own group identity. Rather it is a process
more akin to members holding a dual identity in which they become
members of subgroups consumed within one cooperative larger
group (Brewer and Schneider 1990; Hewstone and Brown 1986).
Within the context of interprofessional education
recategorization suggests that the role of curricula is not to
circumvent students’ development of a professional identity, but
rather, to help learners develop a complementary interprofessional
identity as members of an interprofessional team. Here each
profession maintains its own group identity, yet by refocusing efforts
on a superordinate goal (i.e., patient care) they transform their
strictly individual identities into one as members of an
interprofessional team focusing of patients.

Intergroup Contact Theory

Intergroup Contact Theory is drawn from the work of Gordon

Allport (1954), and was developed to explain how tensions between
divergent groups, mostly based on racial and ethnic boundaries at
the time, could be reduced. Accordingly the theory proposes that
these tensions can be mitigated by bringing together members of
each group to interact under four necessary conditions. Group
members must have equal status, work toward a common goal,
cooperate with other, and must have the institutionalized support
(i.e., laws or customs). Expanding on this, Hewstone and Brown
(1986) added that groups must engage in positive contact, hold
positive expectations for the outcome of shared tasks, and have
success in achieving these tasks, and must intentionally focus on
understanding each other’s similarities and differences. It is
suggested that bias is reduced through intergroup contact through
the process of decategorization. As members of in-groups and out-
groups cooperate interdependently, individuated perceptions of each
other are formed and less attention to expectancy consistent
information is attended to (Miller and Brewer 1984; Erber and Fiske
1984; Neuberg and Fiske 1987).
 Intergroup Contact Theory has led to a significant amount of
research, expanding beyond its original focus on ethnic and racial
groups to include target groups such as the elderly, physically
disabled, and mentally ill (Pettigrew and Tropp 2006). Likewise it has
been applied to numerous social issues such as racial desegregation
(Pettigrew 1971), and mainstreaming of children with mental and
physical disabilities within the educational system (Harper and
Wacker 1985; Naor and Milgram 1980). Recently Pettigrew and
Trapp (2006) conducted a meta-analysis with samples from 515
studies and concluded that the theory holds up in reducing
intergroup conflict across a wide range of groups and contexts.
The importance of this work for informing IPE cannot be
understated. The four theories discussed above (social
categorization, social identity, optimal distinctiveness, and social
dominance) describe the tendency of humans to naturally refocus
the social world into smaller groups within which they identify as
individuals and how this can result in intergroup bias and reduced
cooperation. As described by Leape and Berwick (2005) entrenched
hierarchy and professional conflict result in faculty decision making
and reduced safety and quality of care. Social identity theory in
addition to the related constructs of decategorization and
recategorization processes provide guidance for how this
progression toward bias, and potential conflict, might be mitigated.
The salience of group distinction among health professionals is
enhanced by the current, but evolving, uniprofessional structure of
health professions training. It is hoped that by bringing students
together to learn cooperatively, using methods informed by social
identity theory and the processes of decategorization and
recategorization, that the potential bias existing among and between
professions can be reduced. This may pave the way toward
developing fully functional teams, unencumbered by intergroup or
interprofessions biases.

ORGANIZATIONAL PSYCHOLOGY
In this section, research from the field of organizational psychology
will be introduced as it relates to teams. This is included because it is
important not only to understand variables associated with group
functioning, typically the purview of the social psychological theories,
but also the effectiveness of interprofessional collaborative teams.
Too often, these components are approached in isolation, rather than
together. The ultimate goal of interprofessional collaborative practice
is to provide the best possible care for patients. This can only be
accomplished if the healthcare team is effective in its functioning.
Although the focus of this chapter is on theories that can inform
education, not practice, the field of organizational psychology is ripe
with models that may inform our understanding of team effectiveness
and, in turn, guide interprofessional curriculum development.
According to Jex and Britt (2008), research in organizational
psychology goes beyond the study of team dynamics, the foci of
social psychology, to concentrate on team effectiveness. Toward this
end, the literature informs that team effectiveness cannot be
assessed in isolation of the context in which it occurs. That is, before
one can determine the effectiveness of a team, one must understand
what kind of team is being observed, if a team at all, and in what
context the team is functioning. In relationship to IPE, this indicates
that context is important and the components of the team in which
students learn are dynamic and important considerations.
The construct of team is more complex than it appears at face
value. The literature is ripe with information about teams, but teams
are multifaceted and the structural dimensions of teams must be
considered as variables that affect their effectiveness. Hollenbeck,
Beersma, and Shouten (2012), offer a typology of team that can
inform educators about developing appropriate curricular
experiences that authentically represent the team environment.
According to their model, teams differ along three underlying
structural dimensions. The first of these, Skill Differentiation
describes the degree of differentiation among members’ skills and
knowledge. At its most basic level, uniprofessional teams are
composed of individuals from the same profession who hold a similar
professional identity in addition to similar skills and knowledge. As
the complexity of care, or the task demands of the interprofessional
learning team, increases the need for additional team members from
multiple professions, with additional skills and knowledge are
required. With this comes the additional complexity of how decisions
are made and who makes them within the team. This leads to the
second dimension, Authority Differentiation, described by
Hollenbeck, Beersma, and Shouten (2012), and refers to the extent
to which the entire team is involved in decision making. It can range
from some members, those of whom have higher levels of authority
based on professional role or status within the team, making all or
most of the decisions to a true collaborative team decision-making
process. The final dimension is Temporal Stability. This term refers
to the extent to which teams are composed of the same members
over time or are thrown together, ad hoc, to deal with a particular
problem. All of these three dimensions must be considered in an
evaluation of team effectiveness and in the development of
educational interventions.
In addition to the structural features of team, the team itself can
affect functioning. According to West and Lyubovnikova (2012), “real
teams” can be distinguished from “pseudo teams.” Accordingly,
these authors describe real teams as those characterized by (1)
working together with clear and shared objectives, (2) working
interdependently, and (3) purposely reflecting on team effectiveness.
Alternatively, although members of pseudo teams may believe they
are working together as a team, they tend to function independently
with little communication, unknown or disparate objectives, and with
little or no reflection on the team’s performance. According to West
and Lyubovnikova, most medical errors occur among groups
characterized as pseudo teams. As such, it is important to
distinguish the extent to which groups of individuals are functioning
as real teams if one attempts to study the effectiveness of healthcare
teams. Likewise if we wish to develop team skills among learners it
is important to situate learners within a context in which “real” teams
can develop.

Input-Process-Output Framework

West and Lyubovnikova (2014), propose the input-process-

output (IPO) framework developed by Cohen and Bailey (1997) as
the most widely accepted framework for understanding teams.
Beginning with the end in mind, the output of the model (hopefully)
results in high-quality care, high levels of patient satisfaction, and
high levels of team member well-being.
Within this framework, the inputs include the elements of the
teams’ task and composition in addition to organizational support.
Each affects the output of the team. Taken sequentially, the team’s
task determines whether the demands of the task warrant a team
approach. If the task is relatively simple, preferable outcomes may
be achieved without a team. However, within the context of
healthcare and interprofessional education, teams should be utilized
when dealing with complex tasks that require task interdependence
in which members of the team must rely on the knowledge and skills
of others to effectively complete the task. Salas, Dickinson,
Converse, and Tannenbaum (1992) consider interdependence in it
broadest sense (related to tasks, goals, feedback, and reward) as
the hallmark characteristic of teams. Of course, even given task
demands that optimally call for a collaborative team approach,
members within the team must cognitively decide that they should
work together as a team. As such, individual characteristics such as
preference for teamwork (Campion, Papper, and Medsker 1996) play
a critical role in groups coming together as teams.
A second input variable is team composition. According to this
framework, members within team must possess the appropriate
knowledge and skills to complete the complex task at hand.
Recalling the important role of attitudes for impacting behaviors
suggests that attitudes are as important as skills and knowledge.
The Theory of Planned Behavior demonstrates that behavioral
achievement is dependent on intention or motivation to engage in a
behavior in addition to having the individual control to perform a
behavior. That is, one’s behavioral performance is dependent upon
an intention to perform and the ability to perform (Ajzen 1985).
According to Ajzen (1991), this perceived behavioral control
combined with behavioral intention can predict behavioral
achievement.
Finally, the model recognizes the importance of organizational
support. The organization within which team function is important,
not just to provide required resources for the tasks (i.e., equipment,
tools), but also to ensure that contingencies are in place to recognize
and value collaboration over individual efforts. This should include
reward systems that encourage collaboration and recognize the task
interdependence of the work. Within the context of education, the
reward system is most akin to the evaluation methodologies utilized.
Therefore, it is important to avoid the assumption that evaluation is
impact neutral in IPE. One must consider the potential impact of
evaluating the individual rather than the team within IPE.
The second component of the IPO Frames work involves team
processes that affect team effectiveness. Within this sphere, three
subcomponents are important and include: (1) team objectives, (2)
leadership, and (3) reflexivity. Each will be discussed below,
beginning with the third component, reserving team objectives and
leadership for the end. Of the three, reflexivity is most basic. It simply
refers to the team’s ability to reflect on its performance and to build
team awareness that allows the team to critically evaluate its
performance and identify areas for improvement.
According to Poulton and West (1999), shared team objectives
are essential for motivating and guiding team behavior. However, the
construct of team objectives is more complex, especially when
considered within the context of teams with members who may differ
in terms of varying levels of hierarchical authority. Here it is important
to look additionally at the goals of the team. Social Categorization
Theory informs this process well. Recall that this theory describes
factors that help individuals within separate groups come together as
a unified group, and includes retaining one’s own identity as a
member of a profession, while all members of the team focus on the
superordinate goal of treating the patients (Haslam 1997). This
theory has been an important approach to issues of social influence,
group cohesion, group polarization, and collective action in addition
to topics of leadership development (Turner et al. 1987). Implied in
all of these are issues of in-group/out-group homogeneity, and power
(Turner 2001). Also, implicit in the issue of goal orientation and team
objectives is leadership. Teams cannot function effectively in a state
of anomie. Someone must provide leadership.
Leadership is the third process component included in the IPO
framework that impacts the output of team effectiveness. However,
leadership within an interprofessional healthcare team is more
complex when the team’s structure is composed of a diverse
combination of professions. Specifically, interprofessional practice
calls for answers to the questions: Who is the leader? Are multiple
leaders possible and appropriate? And, what new leadership skills
will become paramount under this new model of practice. Recently
Hall (2005) argued that if physicians are to provide effective
leadership to interprofessional teams they must have specific
leadership skills. These skills include: (a) identifying problems of
group dynamics, and (b) being able to blend the multiple
professional cultures within the clinical team. This seems clear
enough yet the underlying, and debatable, assumption is that the
physician must be, and is always, the leader of the team.
According to Dow, DiazGranados, Mazmanian, and Retchin
(2013), leadership in dynamic environments such as the healthcare
team is coproduced rather than fixed. It involves the cooperation of
leaders and followers to achieve patient outcomes. Depending on
the situation, all members of the team may be called on to lead or
follow at times, yet all must enhance and influence the collaborative
process. Leaders in this context must be able to involve team
members who may be separated by hierarchical barriers, yet
recognize instances when one member is better equipped to lead
the team. For this to occur, all members of the team must have
information about the range of professionals on the team, their scope
of practice, and the resources each needs to accomplish its work
(Carsten and Uhl-Bien 2013). In cases where leadership is
ineffective in pulling together the multiple professionals cultures,
obstacles can ensue in the form of conflict that negatively affects
team process and outcomes (West et al. 2003). This may occur for
many reasons, one of which is profession-centrism through which
status hierarchies and profession-specific values bias members of
the team to consider one’s own profession as most important and,
therefore, rightfully in control (Pecukonis, Doyle, and Bliss 2008).

COGNITIVE DEVELOPMENT AND PERSONAL

EPISTEMOLOGY
The connection between human development and learning is, at first
glance, obvious; yet, there is a rich history of varying conceptions of
the relationship between these separate yet interrelated constructs
(Hatch 2010). Notable exemplars of this controversy can be seen by
the discrepant notions of the learning-development relationship
characterized by Piaget and Vygotsky. Piaget argued that learning is
dependent upon development—that underlying cognitive structures
must be in place before learning can occur. In other words cognitive
development leads learning (Duckworth 1964). Alternatively,
Vygotsky argued that learning is a primary mechanism through which
development occurs (Harland 2003). From this perspective learning
leads development. Regardless of where one falls on this continuum
it is apparent that the two must be considered as they each frame
learning and development in a different light and influence how
learning is defined and how the process is described.
Learning as a function of development was initially envisioned
via the rise of behaviorism in the early twentieth century when
learning was seen as an observable change in behavior as a
function of one’s interaction with the environment (Merriam,
Caffarella, and Baumgartner 2007). Although the definition of the
term learning has changed as a result of varying perspectives of
learning, the idea of change remains a key feature of most
definitions. According to Merriam and colleagues, an appropriate
working definition that encompasses most theoretical frameworks is
that “learning is a process that brings together cognitive, emotional,
and environment influences and experiences for acquiring,
enhancing, or making changes in one’s knowledge, skills, values,
and world views” (2007, 277).
From the perspective of cognitive or intellectual development
the study of personal epistemology is an important concept.
According to Clark (2006) each profession defines and defends its
own type of complex knowledge and, often, does not see the whole
due to a concentration on the parts. Personal epistemology is
described by Hofer (2001) as the process through which one
develops a conception of knowledge and how an individual uses that
knowledge to understand the world. The seminal work of Perry in
1970 laid the foundation for this work. Perry developed a scheme of
epistemological development by analyzing how students described
their experiences and transformations with ways of thinking as they
journeyed from their first to last years as undergraduates at Harvard
University. Perry (1970) describes their “pilgrimage” as beginning
from a conception that the world consists of absolute truths toward a
recognition of the importance of context and finally toward
commitment, where one recognizes the need to make a stand
toward one way of thinking.
Perry (1970) describes movement through nine positions, or
stages, which can be grouped into four major categories that
describe one’s epistemological stance. Perry describes individuals at
the beginning of the spectrum as dualists (positions 1 and 2). At this
stage, truth is experienced as absolute and unquestioned. To the
dualist, the world is entirely black and white or right and wrong.
There is an unquestioned identification with authority figures (i.e.,
parents or teachers) from whom all knowledge is garnered. At the
next level, multiplicity, the individual begins to acknowledge
uncertainty. As such a third conceptualization of knowledge develops
and is included with the two opposing camps of right or wrong. Now
the category of the “not yet known” is added. However, even though
an individual recognizes that some things are not yet known, she or
he still believes that they are indeed knowable, given more or better
information. The transition to level three, contextual relativism, is
seen as the most significant. At this level, the individual views the
world as highly relativistic and context dependent. Most importantly,
at this stage the individual begins to understanding that people are
active meaning-makers. In both academic and personal contexts the
individual must actively construct their own meaning rather than
depend on authority figures to accomplish this for them. The final
stage of Perry’s scheme is commitment with relativism. At this point,
knowledge is understood as a clarification of one’s own
understanding of the world. This continual clarification and
refinement of one’s way of knowing is accomplished through a
continual process of reflection and reassessment.
Hofer (2004) argued that epistemic thought is theory-like and
within the metacognitive processing domain. That is, epistemic
beliefs are constructs, organized as theories that are activated
during learning situations by the individual. According to this view,
learning and knowledge building are influenced by “metacognitive
monitoring of epistemological beliefs, resources and theories” (Hofer
2004, 46) and this metacognitive process that can be altered by
context (e.g., teachers, task, learning environment). From this
perspective, like Perry’s conceptualization, epistemic cognition
includes beliefs about the nature of knowledge (what one believes
knowledge is). This includes beliefs about the certainty of knowledge
(the degree that knowledge is perceived as fixed or modifiable) and
simplicity of knowledge (the continuum of knowledge as discrete
facts or as an interrelated whole, the components of which are
relative, contingent, and contextual). Additionally, epistemic cognition
involves the nature of knowing (how one comes to know) and
includes beliefs about the source of knowledge (from outside,
transmitted by authority or actively constructed by the self) and
justification of knowing (knowledge claims are justified either through
a reliance on authority or self-evaluative methods). From this
perspective epistemic metacognition views epistemology as a set of
beliefs that are organized into theories that operate at the
metacognitive level that impact learning. These theories are
engaged when one encounters new knowledge, attempts to solve an
ill-structured problem or when one must construct knowledge in ill-
defined contexts (having contradictory interpretations or claims).
According to Clark (2006), this sequential development of
personal epistemology suggests that interprofessional education
may help students transcend the dualistic nature of thinking, with a
singular focus on their own profession’s worldview, toward a stance
of commitment with relativism with the acceptance that multiple
professions are needed to adequately promote patient care.
Likewise, when juxtaposed with social categorizations theory it may
be that interprofessional experiences that promote epistemic growth
will reduce intergroup bias. The construct of decentering, originally
posed by Piaget (Piaget and Inhelder 1969), is particularly relevant
here. Decentering occurs as a process of interacting with one’s
environment and results in an individual having the ability to attend
to multiple attributes of a situation rather than just one. This
foundational work was expanded to demonstrate its importance in
cognitively structuring the social environment in order to develop
successful interprofessional relationship (Feffer and Jahelka 1968;
Feffer and Suchotliff 1966). As one becomes better able to
understand the multiple perspectives of others, positive interpersonal
relationship are more likely to be forged and maintained.
However, one question that remains is how one designs
interprofessional curricula to propel students toward higher levels of
epistemic cognition and an increased recognition of the complexity
and multiplicity of care that can be achieved through
interprofessional collaboration. One useful strategy has been
proposed by Hofer (2001), who suggests that students must be
challenged, by faculty or the experience itself, to foster epistemic
doubt in order to lead to change. Clark (2006) posits that learning is
a developmental process that requires time and effort. He suggests
that the concept of scaffolded instruction (e.g., Vygotsky 1978) is
important for supporting emerging interprofessional skills. Multiple
and varied opportunities for practicing interprofessional skills can be
used beginning with highly structured activities moving toward less
structure as learners become more competent.

CONCLUSION
Clearly, theory is important for designing any educational
intervention, yet given the additional confounders that may transpire
when learning occurs within a social context among a diverse group
of learners, no single theory, or constellation of theories from a
specific paradigm can accommodate interprofessional learning.
Rather, a number of diverse yet complimentary theories must be
considered. Theories of learning provide a rich landscape describing
how individuals learn alone, and with others in the social context.
Theories from social psychology provide a view of how the context of
learning within diverse groups can impact one’s identity as a
professional and how the learning environment can be articulated to
reduce interprofessional bias and increase the likelihood of
interprofessional identity development. Likewise, theories from
organizational psychology further illuminate ways in which the
structure of the learning environment can be authentically fashioned
to promote a sense of team. Finally, as in all educational contexts,
designers of IPE must consider the implications of cognitive and
intellectual development for both learners and for curricular
development.

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 Chapter 3
Pedagogical Perspectives on
Interprofessional Education
Andrea Pfeifle and Amy V. Blue
Educational theory includes the purpose, application, and
interpretation of education and learning. As such, it can guide
educational practice (Craddock 2006). Interprofessional education
(IPE) is an educational practice wherein students from two or more
professions learn about, from, and with each other to enable
effective collaboration and improve health outcomes (World Health
Organization 2010). As the term implies, IPE is a specific
pedagogical approach that has an agreed-upon and overt purpose,
for example, education across professions expressly directed to
change health outcomes. This definition suggests that IPE includes
two components: Attention to process, or the interaction that occurs
between learners and attention to content that provides the context
wherein IPE occurs. For educators who have been traditionally
educated and trained in a particular area of expertise, such as
medicine, nursing, psychology, and such, this emphasis on content
and process presents a challenge, even for the most talented
teachers. IPE can be difficult for a number of reasons: perhaps,
because educators are unfamiliar with the term or the concept; or
are uncomfortable working with learners from multiple professions;
or because IPE superimposes nonconventional teaching of learners
from different professions in a conventional uniprofessional
environment; or because they are uncomfortable with learning
formats other than the traditional lecture.

ADULT LEARNING THEORY

Viewed simplistically, IPE is inherently a student-centric approach,
grounded in adult learning theory. The application of adult learning
theory, developed by Knowles (1984; 1990) is frequently associated
with IPE (Barr 2002, 23). Briefly, the assumptions of adult learning
theory are as follows:
 1. Adults need to know the relevance of what they are to
learn.
2. Adults are task- and problem-oriented and prefer to learn
when a task or problem is presented.
3. Adults bring life experience and existing knowledge to their
learning.
4. Adults are self-directed in their learning.
5. Adult learners want to be treated with respect.
6. Adults are ready to learn things when they need to know
them.

Other educational theories that can inform best practices in IPE

and that have been discussed in the literature are experiential
theory, social learning theory, constructivist theory, and
transformative learning theory.

EXPERIENTIAL AND SOCIAL LEARNING

THEORIES
The fundamental premise for IPE is the transference of knowledge
and skills that students learn “about, from, and with” each other into
intentional practice that ultimately benefits individual and population
health. Preparing students for interprofessional practice through IPE
requires a theoretical foundation that supports their evolution as
effective team members within the context of interprofessional
collaborative practice and research. This requires students to work
together in interdependent work groups periodically over the course
of their educational programs wherein they progressively apply
newly acquired competencies in real-world experiential settings (IPE
Collaborative 2011). Not surprisingly then, much of the literature
describing a conceptual framework to support IPE is grounded in
experiential and social learning theories.
Experiential learning theory (ELT) draws on the work of several
well-known twentieth-century scholars such as William James, John
Dewey, Kurt Lewin, Jean Piaget, Carl Jung, and others who made
experience central to their theories of human development and
learning (Kolb 1984). ELT defines learning as “the process whereby
knowledge is created through the transformation of experience.
Knowledge results from the combination of grasping and
transforming experience” (Kolb 1984, 41). Learning is thus
conceived as a continuous cycle (Kolb 1984), wherein immediate
concrete experience forms the basis for observation and reflection
on this experience is assimilated and generalized into the learner’s
“theory,” from which new implications or hypotheses for action can
be deduced. These hypotheses subsequently serve as guides from
which the learner creates additional, new experiences that can be
tested in other situations (Kolb 1984, 21–22). Accordingly,
experience plays a central part in the learning process that builds
upon the intimate relationships between learning, work, and other life
activities. The benefits of interprofessional learning within an
experiential context can facilitate students’ socialization into the
culture of interprofessional collaborative care (Kettenbach et al.
2011; Ker, Mole, and Bradley, 2014).
Social learning theory (SLT) recognizes learning as a cognitive
process that takes place within a social context (Bandura 1963). Ball
State University illustrated the overlapping constructs in ELT and
SLT by applying these concepts in a service-learning curriculum for
interdisciplinary student teams participating in “immersive learning”
experience and producing a tangible outcome or product at the end
of the experience (Gora 2007a; 2007b; Sanyal 2012).
Building on the integration of experiential and social learning
theories, Clark (2006) suggested three underpinnings for IPE:
epistemology and ontology of interdisciplinary inquiry, attention to
cognitive and ethical student development, and attention to the
development of learners as reflective practitioners.
Epistemology is the philosophical study of the origin, nature,
limits, methods, and justification of knowledge (Piaget 1972). Many
health professions education programs have evolved based on
students’ mastery of and the ability to generate and use specific
types of complex knowledge and skills. This set of knowledge and
skills in turn forms a cognitive framework or map for the profession’s
basic concepts, modes of inquiry, problem definitions, observational
categories, representational techniques, standards of proof, types of
explanation, and general ideas of what represents a discipline (Kuhn
1970). In addition to these cognitive maps, each profession has
normative maps that include basic values, modes of moral
reasoning, and methods of resolving ethical dilemmas (Drinka and
Clark 2000). According to Clark (2006, 582),

The acquisition of cognitive and normative maps is driven by the

process of professional socialization. Becoming a health care
professional means acquiring the particular traditions, customs,
and practices; knowledge, beliefs, morals, and rules of conduct;
and linguistic and symbolic forms of communication and the
meanings they share that are associated with the practice of
that particular profession. (citing Becher 1989)

The implications of these epistemological and ontological

concepts for the development of a theoretical framework to undergird
IPE have significant implications when teaching emerging members
of the health professions. Clark (2006) further suggests that
developmental theory is important when designing IPE. Blue and
colleagues (2010) have similarly described IPE as a transformative
process and integrated Mezirow’s (1978) ten-step process for
transformative learning into the Creating Collaborative Care (C3)
curriculum at Medical University of South Carolina; which includes
“genuine experience of dilemmas that require the development of
new roles and new ways of acting; clearly, developing the
interprofessional team skills necessary to succeed in a complex
health care system encompasses this type of learning” (Blue et al.
2010, 1291–92).

COMPETENCIES, COMPETENCY FRAMEWORKS,

AND LEARNING OBJECTIVES
Today, students enrolled in health professions education programs
must demonstrate proficiency working within their individual areas of
expertise as well as when working across disciplines to improve
individual and population health outcomes (Greiner and Knebel
2003; Institute of Medicine 2008; Lancet 2010; World Health
Organization 2006). Accordingly, many U.S. accreditation bodies
now require health professions education programs to provide
students with opportunities to learn about, from, and with one
another to varying degrees (Zorek and Raehl 2013).
Competencies describe measurable or observable knowledge,
skills, abilities, and behaviors deemed critical to successful job
performance. Competencies as applied to health professions
education programs describe what graduates have to be able to do
independently and consistently in practice; as compared to what they
know or are capable of doing under supervision, such as occurs
during training (Fernandez et al. 2012).
Thistlewaite and colleagues (2014) recently described the
relevance of competency frameworks across the collective group of
health professionals working together in the health system and
suggest they are useful for educators introducing IPE into their
courses or programs, “as a guide to inform curricula in combination
with appropriately aligned learning activities and assessments”
(2014, 869). A number of organizations have adopted competency
frameworks for interprofessional education, including the University
of British Columbia (University of British Colombia 2008), the
Canadian Interprofessional Health Collaborative (2010), and the
Interprofessional Education Collaborative in the United States (IPEC
2011). Increasingly, IPE activities are being aligned with these
competencies and assessment approaches are being developed to
verify that learners have attained stated competencies (Thistlewaite
et al. 2014).
The Core Competencies for Interprofessional Collaborative
Practice (IPEC 2011) were developed in the United States to
describe education and practice domains necessary to work
effectively across professions to advance accessible, high-quality
healthcare for individuals and communities. These include:

Values/Ethics for Interprofessional Practice: Work with

individuals of other professions to maintain a climate of mutual
respect and shared values.
Roles/responsibilities for Collaborative Practice: Use the
knowledge of one’s own role and those of other professions to
 appropriately assess and address the healthcare needs of the
patients and populations served.
Interprofessional Communication: Communicate with
patients, families, communities, and other health professionals
in a responsive and responsible manner that supports a team
approach to the maintenance of health and the treatment of
disease.
Team and Teamwork: Apply relationship-building values
and the principles of team dynamics to perform effectively in
different team roles to plan and delivery patient- and population-
centered care that is safe, timely efficient, effective, and
equitable.

Representatives of the American Association of Colleges of

Nursing, American Association of Colleges of Osteopathic Medicine,
American Association of Colleges of Pharmacy, American Dental
Education Association, Association of American Medical Colleges,
and Association of Schools of Public Health developed these
competencies as a basis for establishing learning objectives and
designing learning activities to teach interprofessional collaborative
practice at the prelicensure-certifying level, emphasizing the
importance of informing interprofessional learning experiences by a
theoretical framework.
While competencies describe standards that specify the
knowledge, skills, and abilities required for success in the work
place, objectives state intended outcomes for a specified learning
activity, course, or module of instruction. Anderson and Krathwohl’s
adaptation of Bloom’s Cognitive Taxonomy (2001, 67–78) classifies
learning objectives into three domains knowledge/cognitive;
psychomotor, and affective/attitudinal. Within these domains,
learning at higher levels can be predicated on fundamental concepts
and skills acquired and demonstrated at lower levels. Learning
objectives are best framed in terms of active verbs that clarify how
the learner is to demonstrate knowledge, skill, or affect. Well-written
objectives provide clarity to the learner (and educator) about what is
to be accomplished, how it is to be demonstrated and within what
time frame. These learning objectives should also guide the
assessment of learning outcomes. This taxonomy provides a useful
framework for learning objectives describing the intended outcomes
of IPE.

USING THEORY TO GUIDE PROGRAM

DEVELOPMENT
In consideration of theoretical underpinnings of IPE and how to apply
these to curriculum development, several authors (Benner et al.
2009; Blue et al. 2010; Charles, Bainbridge, and Gilbert 2010; Hean
et al. 2012) have referenced the value of scaffolding and use of a
developmental approach to IPE. With scaffolding, learners progress
along a continuum of learning and professional development is
explicitly recognized, with learning contexts (settings, objectives,
tasks, characteristics of colearners, etc.) paired with the learner’s
phase of development. Similar to the milestone approach in medical
resident education (Caverzagie et al. 2013), acknowledging a
developmental continuum assumes that a learner is prepared to
demonstrate acquisition of increasingly complex knowledge, skills,
and attitudes at certain points in time along a progression, and that
learning should follow in tandem. The work of Baxter-Magolda is
relevant to IPE scaffolding in consideration of how learners move
along a continuum from the most fixed to the most flexible ways of
knowing. Baxter-Magolda describe how learners’ early education
within any realm typically begins with absolute knowing, in which
knowledge is conceived as “fixed,” either right or wrong, more certain
than uncertain, and within the purview of instructors, not peers.
Through experience, learners progress to transitional knowing, in
which knowledge is uncertain in some areas, acquired by
understanding information, dependent on the instructor to direct its
application to different contexts, and explored with peers. Students
next move to independent knowing, in which knowledge is largely
uncertain, held by both instructors and peers, and comes from
thinking for oneself. This independent knowing requires open-
mindedness, allowing that others have their own beliefs that may be
different than one’s own. Ultimately, professionals’ learning is
characterized by contextual knowing, in which knowledge is
uncertain but can be formatively assessed and ultimately evaluated
and judged. Information is acquired by synthesizing expert opinion
and existing evidence, as well as the experiences of self and others.
Another perspective on scaffolding is based on the work of Vygotsky
(from Hean et al. 2010) and the concept of the “zone of proximal
development” (ZPD). In this theory, it is argued that learners are able
to learn concepts, with support, that they cannot comprehend in
isolation. Support systems, such as facilitators, more experienced
peers, and computer-based technology, serve as guides to learning
acquisition. Following this theory, scaffolding in IPE must be mindful
of the continuum of task complexity, with learning moving from
simple observation in realistic settings with two professions to
complex cases involving multiple professions in authentic settings.
Bainbridge and Wood (2012) describe sequencing considerations
when designing IPE; emphasizing the importance of learners having
the opportunity to learn about one another prior to learning with and
from one another.
IPE can include a variety of instructional methods, and some of
these methods are more suited to one particular theoretical
approach than to others. As examples, case-based learning,
problem-based learning, and team-based learning all have roots in
social constructivist theory in that learning occurs through social
interaction, applying and sharing one’s own knowledge, and
developing new knowledge through exchange. In these approaches,
cases and problems must be relevant for learners and when a
scaffolding approach is assumed, cases and problems for early
learners should not be as complex as those designed for more
advanced learners. Frequently, clinical cases presuming knowledge
of disease processes and specific treatment approaches are not
well-suited for early learners. However, when learners are more
advanced in training, clinical cases and problems that detail
symptoms and therapeutics may be more manageable to them and
therefore provide greater educational yield, because learners can
effectively apply knowledge and place new information in an existing
knowledge framework.
Simulation, whether low-fidelity with role play and the use of
standardized patients or high-fidelity with the use of computer-based
mannequins, provides another educational approach based upon
experiential learning theory (Kolb 1984). In simulation the learner is
given a scenario that mirrors real life by presenting a real-world
challenge to manage, and, through this, experienced learners
develop insight and acquire new skills. Using a scaffolding approach,
interprofessional simulation for early learners may focus on the
development of interpersonal and basic teamwork skills, such
asapproaching a patient regarding a potential medication error
(University of Washington 2015, for example), and for learners with
more advanced clinical training, a high-fidelity simulation may require
knowledge of diseases and medications to work through the
simulation but also focus on the development of more advanced
interpersonal and teamwork skills (Shrader et al. 2011).
Reflection in and on action have been recommended as best
practices for interprofessional education (Clark 2009). The reflective
practitioner is one who is well-trained in both the science and the art
of practice (Schön 1987). The scientific dimensions of practice
include the technical knowledge and skills of the profession. The
artistic dimensions of professional practice include integration of
understanding and applied reasoning across several dimensions of
practice, even where moral ambiguity, value conflicts, and ethical
dilemmas exist. Professional practice also includes reflection on and
in action; from both the procedural and interactive views (Jensen et
al. 2000). John Dewey defined reflection as “active, persistent and
careful consideration of any belief or supposed form of knowledge in
the light of the grounds that support it and the further conclusion to
which it tends” (Dewey 1933, 9). Reflection has been further
described as “that process of reconstruction and reorganization of
experience which adds to the meaning of experience” (Rodgers
2002, 848). Reflective practice requires a grasp of the cognitive and
normative elements of the profession as well as an understanding of
how other professions might approach a problem and incorporating
these perspectives into one’s own practice. Not surprisingly then,
several authors have endorsed the importance of reflection in IPE
(Blue et al. 2015; Barr et al. 2005; Clark 2009; D’Eon, 2005;
Oandasan and Reeves 2005; Parsell and Bligh 1998; Tsang 1998)
and some have described models and approaches for teaching and
learning reflective practice in this context that include attending to
the organizational context and the culture of patient-centeredness
(Zarezadeh 2009) and setting aside a time, place, and space for
reflection (Clark 2009). Reflection with learners, such as
assignments to reflect on learning during case discussions,
experiential learning, and service-learning activities provides
learners opportunity to develop skills pursuant to become effective
reflective practitioners.

LEARNING THEORY APPLIED TO

INTERPROFESSIONAL EDUCATION PROGRAM
DESIGN
Many interprofessional learning activities are single events for a
selected group of learners but others occur longitudinally over time
as part of an IPE program. Regardless, using learning theory to
undergird instructional design and curriculum decisions is imperative.
The Medical University of South Carolina provides an example of an
institution that has moved beyond using theory to guide an individual
learning activity to using educational theory to inform the
development and sequencing of activities at both the programmatic
and single-learning event levels (Blue et al. 2010). This program
combined several adult learning theories including Mezirow (1978;
1997); Kegan (1994); and Baxter-Magolda (1999; 2000) in order to
create a foundational context of transformative learning along a
developmental continuum. These theories provided the context for
multiple and varied learning activities within the IPE program so that
students could develop knowledge and skills at appropriate levels
and in various contexts to advance their learning. Additionally, based
on the work of Anderson and Krathwol in revising Bloom’s
Taxonomy, the conceptual framework guiding program development
was grounded on the argument that students should follow a
recursive learning process based on an intentional progression of
acquisition, application, and demonstration of their IPE knowledge
and skills. Learning activities were planned at the programmatic and
individual levels with this framework in mind: acquisition refers to
learning associated with remembering and understanding;
application refers to learning associated with applying and analyzing;
and demonstration refers to learning associated with evaluating and
creating. At the programmatic level, goals were designed based on
this framework (Blue et al. 2010), and at the individual learning
activity level, it was also applied (Blue et al. 2015). For example, in
Blue and colleagues (2015), the authors describe how the IPE
student fellowship was designed for students to complete learning
activities in the three phases of acquisition, application, and
demonstration.

SUMMARY
Using theory to guide program development provides educators a
framework on which to design IPE and to allocate the resources to
support these experiences. Reliance on theory can guide the
reasoned development of a learning event/program and inform
learning outcome assessment and program evaluation processes.
IPE by definition is based upon adult learning theory and the premise
of an active, self-directed learner who learns through engagement
with others in relevant learning contexts and has opportunity to apply
existing knowledge to new situations and problem-solving contexts.
Experiential and social learning theories are two educational theories
predominantly underpinning interprofessional learning. Health
professions education emphasizes a competency approach to
curriculum design to ensure that graduates have the knowledge and
skills for professional practice. The IPEC developed Core
Competencies for Interprofessional Collaborative Practice that
provide IPE educators with competency domains and
subcompetencies to guide curriculum development. Educational
theories can inform design of multiple types of learning activities to
address the competencies, including the value of scaffolding as a
developmental approach to a learner’s acquisition of
interprofessional collaborative skills.

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 Chapter 4
Interprofessional Education as
Organizational Change
Alan Dow, Colleen Lynch,
John Cyrus, and Tanya Huff
Although interprofessional education (IPE) is seen as essential
for expanding and enhancing teamwork in healthcare and improving
health outcomes (Institute of Medicine 2001; 2003), implementing
effective IPE faces many barriers (Jones et al. 2012; Lawlis, Anson,
and Greenfield 2014). These barriers exist at many levels, ranging
from systematic prioritization and resource allocation to individual
resistance at the level of faculty, practitioners, and students. In order
to overcome these barriers and implement successful IPE
experiences, educational leaders need to be adept at navigating the
process of organizational change.
To help navigate this organizational change, this chapter
outlines the barriers to IPE defined in the literature, describes two
frameworks of organizational change including presenting a model of
how their concepts overlap, and applies this model through two case
studies. The goal of this chapter is to provide educational leaders
with a roadmap for navigating the organizational change implicit in
implementing IPE.

BARRIERS TO INTERPROFESSIONAL EDUCATION

The factors that influence the success of IPE efforts, both positively
and negatively, have been conceptualized across three levels:
macro, meso, and micro (Oandasan and Reeves 2005). The macro
level includes interactions with senior institutional leaders as well
entities external to the institution. The meso level includes
interactions at the level of students, faculty, and staff involved in
interprofessional activities. Finally, the micro level includes
interactions within the individual. Although the three levels are
interconnected, defining them separately helps to describe the
challenges facing interprofessional educators. At each level, the
barriers involve different stakeholders for whom the value of IPE may
be calculated differently, and, hence, the approach to achieving buy-
in and implementing organizational change may vary.

The Macro Level

At the broadest level, a number of barriers face leaders of IPE.

As a newly emphasized curricular element, IPE competes with
existing curriculum for prioritization. This competition is driven by
external forces such as the accreditors, licensing examinations, and
professional certification as well as internal forces such as
institutional strategic planning and, perhaps most importantly,
resource allocation. For example, building on the call from the
Institute of Medicine (2003), accreditors have implemented
requirements for IPE in almost all health professions (Zorek and
Raehl 2013). In response, a number of institutions have created
centers for IPE to coordinate campus-wide efforts (Dow et al. 2014),
integrated IPE into institutional strategic plans, and added an
interprofessional emphasis to faculty advancement protocols. Many
of these institutional actions have been supported by an allocation of
resources to expand offerings in interprofessional education. Indeed,
many of the macro barriers to IPE have waned as IPE has become
accepted as a standard part of health professions education.
Yet, other areas in the macro level have been slower to adopt
an interprofessional emphasis. Licensure and certification processes
have not pivoted toward interprofessional models. As a result, while
educators seek to train interprofessionally collaborative graduates,
the models of care in which most learners train and most graduates
will practice remain decidedly uncollaborative (Josiah Macy Jr.
Foundation 2013). This conflict between the desired and current
state is a substantive barrier to effective health professions
education, especially to IPE.

The Meso Level

The meso level is where faculty, students, and staff interact in

IPE curriculum. Here, a number of additional barriers to IPE exist.
Curriculum can be seen as having several components: learning
goals, learning activities, assessment, and situational factors (Fink
2013). At each of these components, interprofessional educators can
face barriers, and delineating these barriers is essential for
curriculum planning and implementation.
Learning goals to guide interprofessional education can be
difficult to articulate. While interprofessional competencies such as
the Competencies for Interprofessional Collaborative Practice
(Interprofessional Education Collaborative Expert Panel 2011) have
sought to create overarching competencies, educators have noted
continued challenges with defining them to shape the instruction and
assessment of specific experiences (Reeves 2012; Thistlewaite et al.
2014). In addition, most educational research in interprofessional
education examines only short-term and superficial outcomes (Abu-
Rish et al. 2012). As such, the evidence base for effective
interprofessional education, from which educators can draw to
develop new programs, is limited (Institute of Medicine 2015).
Educators often struggle to link the clearly articulated problems with
communication in healthcare to curriculum and have to rely on
personal experience to develop the goals, activities, and
assessments of IPE programs.
In addition, IPE faces some unique situational factors. Because
IPE inherently involves bringing together students from different
programs, IPE often brings to light differences in scheduling or the
length of degree programs. Similarly, IPE may be emphasized
differently by various participating programs, such as whether
activities are compulsory or required or how individual performances
figures into grades. All of these factors can lead to IPE ironically
accentuating differences rather than the commonalities on the
healthcare team. Finally, IPE, by combining large numbers of
students, may present unique challenges in the size of educational
spaces and number of instructors needed for educational activities.

The Micro Level

At the micro or individual level, IPE faces barriers as well. All

professionals are socialized into their profession-specific culture.
This socialization inherently leads to biases, which in turn can lead to
real or perceived disrespect. In addition, conceptualization about
expertise—either clinical or educational—can be challenged by
similar expertise in other professions. As such, attitudes of students,
staff, and faculty toward IPE may be fraught with insecurity. When
added to the curricular constraints of already full curricula and a
debated theoretical basis, students, staff, and faculty may be
understandably reluctant to embrace IPE. Even for educators willing
to embrace IPE, the opportunities for faculty development are limited
and guiding principles have only been recently established (Hall and
Zierler 2015).
IPE can thus be seen as an endeavor of overcoming barriers.
Although some of the macro level barriers have begun to become
enablers, educators still face significant barriers at the meso level
that can reinforce resistance at the micro level. How then could an
educator faced with such barriers succeed at implementing effective
interprofessional education? Some frameworks for organizational
change can guide this work.

FRAMEWORKS FOR ORGANIZATIONAL CHANGE

During the 1940s, social scientist Kurt Lewin conducted research on
group interactions and attitude change at the University of Iowa and
the Massachusetts Institute of Technology’s Center for Group
Dynamics and described four broad themes: field theory, group
dynamics, action research, and planned change. While often treated
separately in discussions of his work, Lewin saw these four areas as
inextricably linked in understanding and implementing change. Each
area reinforced and supported each other (Bargal 2006; Lewin
1943).
Lewin’s field theory holds that the key to understanding group
behavior is the “quasi-stationary equilibrium,” a state of continuous
small-scale adaptation maintained by a complex system of
interacting forces or fields. These fields, such as social habit or
organizational culture, constitute the group environment in which an
individual or an institution functions (Burnes 2004). According to field
theory, understanding and potentially altering the way groups and
organizations act would require an analysis of the dynamic balance
of forces working in opposing directions.
Lewin’s work in group dynamics describes the influence of
groups over the individual. It acknowledges that many of these
forces from field theory are most visible at the group level, but deeply
influence actions and beliefs at the individual level (Lewin 1947).
Therefore, Lewin believed, the focus of any change effort must begin
at the group level. By creating new norms, removing obstacles to
individual change, and reinforcing individual change as group
culture, overall change in groups can occur.
Action research represents the process by which a group or
organization analyzes the forces that maintain the equilibrium. The
group identifies driving and restraining forces, and, through
identification of these forces, change can occur by upsetting the
equilibrium between these forces. Change can be accomplished
either by adding conditions favorable to the change or by reducing
the forces opposed to the sought after change (Bozak 2003).
Lewin’s research on planned change can be summarized by his
three-step change process of “unfreeze,” “change,” and “re-freeze”
(figure 4.1, outer ring). The “unfreeze” step is achieved by disrupting
the status quo by either strengthening the driving forces or by
weakening the opposing forces to change. In this step, it is often
necessary, as Lewin writes, to “break open the shell of complacency
and self-righteousness” by “bring[ing] about deliberately an
emotional stir up” (Lewin 1947). The “change” step identifies and
implements the most acceptable methods available to move a group
from the previous status quo to a new desired state. Achieving
desired change often requires several methods. Finally, the
“refreeze” step of Lewin’s model represents the attempt to ensure
that any gains made during the “change” step are secured and not
prone to backsliding. This final step in the process relies heavily on
Lewin’s previously stated belief that successful change must be
solidified at the group level for individuals to be affected (Burnes
2004). Lewin believed that change efforts often fail because they
achieve only short-term, individual results and are not cemented into
a new status quo in the group or organizational culture.
The Process of Group or Organizational Change as Described by Lewin (outer) and
Kotter (inner), Depicted as Concentric Processes and Showing Overlap between the
Models.
Photo by author.

Other researchers have built on Lewin’s work on group and

organizational change. In 1996, John Kotter added a major
contribution to the field of change management with a practical,
eight-step roadmap for organizational change (Kotter 1996) (inner
ring of figure 4.1). The first four steps challenge the status quo and
make the case for change (Lewin’s “unfreeze”). Steps five through
seven capture the process of actual change including its iterative
nature (Lewin’s “change”). Step eight institutionalizes the change
(Lewin’s “refreeze”). In Kotter’s words:

The first four steps in the transformation process help defrost a

hardened status quo. If change were easy, you wouldn’t need all
that effort. Phases five to seven then introduce many new
practices. The last stage grounds the changes in the corporate
culture and helps make them stick. (Kotter 1996, 22)

Aside from this quote that undoubtedly owes much to Lewin,

Kotter’s eight steps reflect additional application of Lewin’s theory.
Kotter stresses the importance of creating an environment where
change can be successful. He describes mentally preparing the
group to undertake the process by “establishing a sense of urgency.”
Framing the change as an organizational crisis similar to Lewin’s
“emotional stir up” disrupts group complacency and paves the way
for the following steps. Many organizations make the mistake of
failing to establish a sense of urgency regarding the need for change
(Borkowski 2011). This phase is critically important for successful
change efforts, as this initial phase of Kotter’s change process is
responsible for approximately 50 percent of failed change efforts
(Kotter 2007). According to Kotter, urgency becomes optimal for
successful change at the point when roughly 75 percent of the
management of an organization becomes convinced that business
as usual is completely unacceptable.
Building on the opportunity created by the crisis mentality, Kotter
stresses the significance of “gathering a guiding coalition” of key
players from across the organization that will minimize resistance
from internal groups and enable creation of change at the group
level so that it can be passed down to the individual. Though many
transformational change processes initially begin with only one or
two individuals, it is important for the leadership coalition to grow and
to strengthen over time. Kotter (2007) indicates failure is likely at this
step if a critical mass of supporters is not achieved early in the effort.
Additionally, Antoni (2007) found that outcomes of change processes
were positively influenced by stakeholder participation in change
processes. This coalition is essential for “creating a vision” or shared
mental model of the necessary change and “communicating the
vision” of the coalition more broadly. The importance of vision
transfer from the coalition to the larger group and specific individuals
is further demonstrated in Kotter’s fifth step, “empowering other to
act on the vision,” wherein structural, personnel, attitudinal, or other
obstacles are removed so that the desired change can be taken up
on a broader scale. Steps six and seven focus largely on maintaining
organizational momentum by using short-term wins to demonstrate
the value of the change, drive further change, and avoid a relapse
into complacency. Kotter (2007) states that until changes sink deeply
into organizational culture, new approaches are fragile and subject to
regression. This process can often take five to ten years. Instead of
prematurely celebrating the effects of change, leaders should use
the credibility gained by the initial victory to continue to implement
the change. The final step, “institutionalizing new approaches,”
emphasizes the necessity of anchoring changes in the culture of the
organization due to the ability of a culture to influence individual
behavior. This step relies on the idea that culture is exerted by the
group on the individual without conscious intent, influencing the
individual as they work in the organization (Kotter 1996).
These models are presented as overlapping frameworks for
organizational change that can be used to understand the process of
implementing innovations in interprofessional education and
practice. Breaking through the silos that define education and
practice in healthcare is a challenge, but these frameworks provide
an outline for how to approach this challenge. Using these two
complementary models that describe the change process as a
backdrop, this chapter provides two examples of how
interprofessional education was implemented using these models at
our institution, Virginia Commonwealth University.

CASE STUDY ONE: INTERPROFESSIONAL

CRITICAL CARE SIMULATIONS
In the fall of 2010, a medicine faculty member realized his critical
care simulation sessions with medical students lacked realism.
Though the students spent eight hours in the session, he did not feel
they left the session prepared to care for critically ill patients as
interns. He contacted two nursing faculty members who were also
clinical nurses at the academic medical center. The nursing faculty
had identified a similar need for their upper-level nursing course.
While their students had a good grasp of basic concepts, they had
trouble integrating the concepts in the care of actual patients. The
faculty shared a recognized need for better collaboration around the
acutely ill patient. In particular, this included the need for the
students to have a better understanding of how to escalate care to
each other and to rapid response teams, code teams, or more
experienced practitioners.
The faculty worked together to create a two-hour series of
simulations that built upon the content of the Fundamentals of
Critical Care course. They added triggers within the simulations to
teach competency in interprofessional collaboration in addition to
critical care skills and developed a feedback form to guide teaching
of the students after each simulation. They sought support from the
directors of simulation centers in each school allowing staff to
program the simulators and run the simulations. They also worked
with the leaders of the two degree programs to enroll students in a
pilot experience. The simulations were trialed with about twenty
students near graduation in the spring of 2011. Evaluation of the
simulations showed that the sessions were well-received by
students.
As course directors for specific sections of the undergraduate
curricula, the three faculty members were then able to develop and
implement a three-session, six-hour curriculum of interprofessional
simulation scenarios with all of the 350 fourth-year medical students
and senior undergraduate nursing students. The curriculum was
integrated into the nursing school as a requirement for the Senior
Clinical Practicum course and the medical school as a requirement
for the Critical Care experiences. Evaluation of these sessions
revealed an increase in students’ self-efficacy in both critical care
skills and interprofessional collaboration. These results led the
presentations in local and national forums. The simulations have
continued for four years, and faculty now have defined effort for
teaching the simulations.

Let’s examine this case study in the context of Lewin’s and

Kotter’s models.

Unfreezing

Establishing a Sense of Urgency

The faculty were spurred to develop the program by a

recognized need for better training of their graduates in
interprofessional collaboration. Although national and international
organizations had been advocating for increased interprofessional
education, the urgency in this case study came from the belief of
frontline faculty that abilities in interprofessional practice were
necessary for their students. These faculty can be thought of as local
champions, likely influenced by the national dialogue around the
need for increased interprofessional education. Often, IPE begins
because of the passion of a few faculty.

Form a Powerful Coalition

The faculty were united by a shared urgency of improving the

education of their students. In addition, they had responsibility for
course oversight in their respective programs. Previous success as
educators and practitioners granted them additional informal
authority to be able to lead and innovate.

Create a Vision

The faculty formalized their vision for the simulation experiences

by developing the curriculum. This curriculum began with desired
topics borrowed from the Fundamentals of Critical Care course with
interwoven interprofessional content. They created specific learning
objectives, scenarios, and feedback forms.

Communicate the Vision

Once the curriculum was developed, the faculty reached out to

several key organizational units necessary for the success of the
simulation experience. The main resources needed were access to
students and support from each school’s simulation center. Faculty
spoke with the leaders of the relevant degree programs in each
school to gain their approval and to provide access to students.
Likewise, the simulation leadership of each school agreed to support
the simulation experiences. Both groups saw the experience as an
opportunity to be innovative and enhance both the educational and
scholarly achievements of the institution.

Change

Empower Others

The leaders of the simulation centers directed their staff to

program the simulators and help refine the simulation-based
education. This engagement increased the quality of the course and
also engaged the simulation centers as co-developers of the learning
experience. In a similar way, the interprofessional simulations
provide the leaders of the degree programs an example of
educational innovation to trumpet.

Plan for and Create Short-Term Wins

The initial two-hour simulation session was implemented with

about twenty students. The faculty evaluated student responses to
the sessions while also noting their own impressions of the value of
the sessions.

Consolidate Improvements
 The data from the evaluations of the initial simulations proved
valuable. First, it allowed the faculty to refine the session for future
use. In addition, it provided the foundation to propose expansion of
the sessions. The faculty developed and proposed a three-session,
six-hour experience for all graduating medical and nursing students.

Freeze

Institutionalize Change

The new experience was proposed to and approved by the

program leadership for both professions. Each program implemented
it as part of a required experience for their students. For the past four
years, over a thousand students have participated in the program
and outcomes have been presented in several national forums.
Faculty now have supported faculty effort for teaching in the
simulation experiences.

CASE STUDY TWO: FOR-CREDIT

INTERPROFESSIONAL COURSES
Inspired by the successful interprofessional education innovations
like the interprofessional critical care simulations as well as
increasing accreditation requirements, university leadership
incorporated interprofessional education into the university’s
strategic plan and allocated resources to create a Center for
Interprofessional Education and Collaborative Care. The Center was
a convening entity for faculty and leaders in the health professions
from across the campus charged with expanding and improving
interprofessional initiatives. In order to meet educational and
accreditation goals, these individuals decided to develop two
campuswide, for-credit IPE courses embedded as curricular
requirements within the various health professions schools.
To negotiate the university and programmatic approval process,
the faculty under the Center took the following steps. First, an
interprofessional group of faculty developed the course offerings.
This faculty group included content experts as well curricular leaders
from each profession. Guided by the Core Competencies of
Interprofessional Collaborative Practice (Interprofessional Education
Collaborative Expert Panel 2011), this group crafted the learning
objectives, lesson plans, and assessments for the courses. The
course offerings were then submitted to and approved by the
university as elective courses under the Center.
Then, each individual health science program considered
whether to adopt the elective courses as curricular requirements
through their program-specific curriculum approval process. This
proved to be challenging. One challenge was that only a small
number of faculty had been exposed to earlier IPE efforts on the
health science campus, yet approval of curricular changes required
endorsement by the entire faculty. For many faculty, interprofessional
education was a new concept and it was difficult to conceptualize
how the new courses could be operationalized within the existing
curricular framework. In these instances, faculty champions
anticipated barriers and worked proactively to anticipate and respond
to concerns, such as making other curricular adjustments to keep the
entire program “credit neutral.” In addition, communication with
strategic faculty occurred before the faculty voting process in some
of the schools to support passage.
Once approved by the individual health sciences schools, the
course leadership identified learning spaces, found a common
educational time for participating programs, and recruited faculty.
The first course launched in the fall of 2015 with nearly five hundred
students representing five health science schools and seven degree
programs.

This case study represents a broader example of Lewin’s and

Kotter’s frameworks. For this discussion, we will focus on the central
efforts of the Center and the organizational change process within
the school of nursing. Notably though, each school had its own
specific and substantial challenges.

Unfreezing

Establishing a Sense of Urgency

 In contrast to the first case study, the urgency for large scale
curricular reform must be felt by a greater number of the faculty for
change to be endorsed. Urgency for large change usually comes
from external sources. In the specific case of interprofessional
education, a number of publications have cited the imperative for
more effective interprofessional practice over the past four decades
(Institute of Medicine 2003; World Health Organization 2010). For
programs that train health professionals, these reports have led to
the implementation of accrediting standards. For example, Essential
VI of the Essentials of Baccalaureate Education for Professional
Nursing Practice (American Association of Colleges of Nursing
[AACN] 2008), Interprofessional Communication and Collaboration
for Improving Patient Health Outcomes states:

Effective communication and collaboration among health

professionals is imperative to providing patient-centered care.
All health professions are challenged to educate future clinicians
to deliver patient-centered care as members of an
interprofessional team, emphasizing communication, evidence-
based practice, quality improvement approaches, and
informatics. Interprofessional education is defined as interactive
educational activities involving two or more professions that
foster collaboration to improve patient care. Teamwork among
healthcare professionals is associated with delivering high
quality and safe patient care. Collaboration is based on the
complementarities of roles and the understanding of these roles
by the members of the healthcare teams. Interprofessional
education enables the baccalaureate graduate to enter the
workplace with baseline competencies and confidence for
interactions and with communication skills that will improve
practice, thus yielding better patient outcomes. Interprofessional
education can occur in a variety of settings. An essential
component for the establishment of collegial relationships is
recognition of the unique discipline-specific practice spheres.
Fundamental to effective interprofessional and intra-professional
collaboration is a definition of shared goals; clear role
expectations of members; a flexible decision­making process;
 and the establishment of open communication patterns and
leadership. Thus, interprofessional education optimizes
opportunities for the development of respect and trust for other
members of the healthcare team.

Additional influences include the Future of Nursing Report

(Institute of Medicine 2011), which outlined the significant
transformation of the healthcare system over the past century—from
a healthcare system built on an acute model of care, to a system
much more focused on chronic conditions in the twenty-first century
—and further emphasized that training methods from the twentieth
century were inadequate to meet the challenges of the present day
healthcare environment. The Future of Nursing Report (Institute of
Medicine 2011, 13) called for a collaborative effort among health
professions schools to design and implement “early and continuous
interprofessional collaboration through joint classroom and clinical
training opportunities.” Amid health reform’s focus on cost, quality,
and access, the methods of educating health professionals to meet
the demand of twenty-first-century healthcare play a central role in
the national discussion and cannot be overlooked (Thibault 2013).
The national and global emphasis on interprofessional
education also stimulates formal institutional urgency. In our
example, interprofessional education was incorporated into the
university’s strategic plan and performance evaluations of leaders,
such as deans, included elements related to interprofessional
programming (Virginia Commonwealth University 2011).

Forming a Powerful Guiding Coalition

Implementing a successful interprofessional education program

that spans multiple health science schools and involves hundreds of
students requires skilled and respected change agents who can
span the different units of the organization. Although the Center had
been formed to coordinate interprofessional efforts, the proposed
courses were expected to include five hundred students from five
health science schools, and no one individual could single-handedly
lead such a critical change process across the campus (Appelbaum
et al. 2012). Developing interprofessional education courses as
curricular requirements requires involving those key stakeholders in
the curriculum design process to help craft the desired future state;
for example, faculty who currently teach potential interprofessional
course content uniprofessionally, or faculty in leadership roles within
their respective curriculum committees that can help navigate the
curriculum change process are both be very important stakeholders.
Interpersonal relationships within schools play an important role in
the ability to overcome resistance to change (Battilana and Casciaro
2012). As such, the coalition in our case study included content
experts from multiple professions as well as leaders within the
programs that could help shepherd the curriculum through the
programmatic approval process. All of this was coordinated centrally
through the Center, but the initiative was truly a collaboration
between the degree programs in each school and the Center.

Creating a Vision

A clear, consistent and well-articulated vision is critical for

directing change efforts (Kotter 2007). Here, the vision involved
developing courses that built upon the imperative articulated by the
Institute of Medicine, World Health Organization, and accreditors.
This vision was further supported by the overarching university
strategic plan and resources allocated by the university. Pulling from
the Core Competencies for Interprofessional Collaborative Practice,
the faculty coalition sought to develop the first course, a foundational
course about interprofessional practice. The faculty expanded
content and instructional methods piloted in a shorter experience to
develop a course focused on the individual and their professional
identity, how that identity overlaps and interacts with other
professions to form teams, and how those teams exist within the
complex systems of healthcare. Once the faculty had completed
outlining both courses and felt comfortable with their approaches, the
process of trying to implement change began.

Communicating a Vision
 Implementing the change needed to incorporate the courses
required communication on many fronts. First, the courses had to be
approved as electives under the Center by the university. Otherwise,
approval would be a piecemeal process with each curriculum
committee suggesting modifications, muddying ownership of the
courses. To accomplish approval of the two new courses under the
Center required working with university administrators to develop an
approval process for Center-based courses. Linking the courses with
the university’s strategic plan and winning the support of key
university leaders was essential.
In addition, members of the coalition began working with their
programmatic leadership to win approval and integration of the
course. In the School of Nursing example, adding the two one-credit
courses would require removing two credits elsewhere in the
curriculum. Coalition faculty approached this challenge by beginning
to describe the interprofessional activities that were already taking
place and how the curriculum could be revised to further integrate
this approach. Faculty members brought up IPE in department
meetings as a needed concept for future courses citing the Future of
Nursing (Institute of Medicine 2011) and other reports. They noted
how current course content could be taught via IPE, allowing for a
credit-neutral and content-neutral approach to integration. While
many of these faculty were supportive, some hesitations remained
as a key curriculum meeting approached to discuss the course.

Empowering Others to Act on the Vision

Worried about the level of support for, and difficulty involved

with, the curriculum change, the coalition faculty sought out some of
the informal leaders of the school of nursing. These leaders had long
tenures as faculty and were also engaged with the development and
training of more junior faculty. In conversations in hallways and their
offices with these key faculty, the coalition faculty worked to ensure
their buy-in. They listened to the concerns of these informal leaders
and sought to allay them or address them with the broader coalition.
In addition, the university approval of the courses as electives
demonstrated the university’s commitment to IPE and also raised the
possibility that the other programs might participate without nursing.
Having presented the situations and discussed the faculty members’
concerns, the coalition faculty asked them to speak in support of the
curricular change.

Change

Planning for and Creating Short-Term Wins

The initial step of the curriculum change process in the School

of Nursing was endorsement of the two new IPE courses by the
curriculum committee. During the designated curriculum meeting, the
faculty champions presented the vision for IPE across the campus.
They described how the experiences would shape the education of
nursing students and students from other health professions. The
supportive key faculty were scattered across the room and helped
field concerns from skeptics. The courses were endorsed by the
curriculum committee and recommended forward for approval by the
full faculty.
The next step was to bring the courses to the entire faculty for
approval. The IPE vision was presented at the meeting of the faculty.
Once again, faculty champions were present to answer all questions
and present information in a positive way. In addition, since the
curriculum meeting, the School of Pharmacy had adopted the course
as a curricular requirement. In the context of this urgency, vision, and
support, the courses were approved by School of Nursing faculty.

Consolidating Improvements and Producing Still

More Change

In this second case study, many barriers to a successful IPE

experience still remained after course approval. Center faculty
needed to identify the best learning space for the team-based
activities they had planned for the five hundred potential students.
They also needed to find a common time across academic calendars
for course meetings. And, they had to recruit additional faculty from
all the participating professions to teach the course. To accomplish
all of these goals, the faculty relied on the momentum from the initial
course approval to implement additional change.

Refreezing

Institutionalizing the Change

The goal of this step is to anchor the new approaches into

organizational culture (Appelbaum et al. 2012). Each faculty member
must be supported with knowledge, skills, and abilities to effectively
convey the content and teach with other health professions. Making
the connection between the new behaviors of the faculty, the
overarching success of interprofessional education on the health
science campus, and the urgent needs of our healthcare system was
an important final step in the complex, systematic undertaking of
improving health professions education across the campus.

SELF-REINFORCING CYCLES OF
INTERPROFESSIONAL CHANGE
Stepping back from these two descriptions of integrating
interprofessional change provides a broader view of the importance
of this type of approach. While the victories of change are won
through frontline work on critical issues such as buy-in and
overcoming logistical barriers, the most widespread impact of these
victories is felt in how the culture of an organization is changed by
increasing interprofessional education and practice. This culture
change is the dividend of the hard work of interprofessional leaders.
Organizational culture is the values, beliefs, and assumptions
that guide the behaviors of people in the organization (Schneider,
Ehrhart, and Macey 2013). Organizational culture is an aggregate
concept, derived from the experience of individuals, the stories they
hear about people within the organization, and their observation of
what succeeds within the organization. Organizations can have a
unifying culture or many separate subcultures, which may provide
substrate for conflict or inefficiency.
 The concept of organizational culture—or perhaps hoped for
organizational culture—has implications for leaders of
interprofessional education and practice. Individuals within our
organizations, whether they are students, faculty, practitioners, staff,
or even patients and their families, are active participants in defining
the culture of the organization. They are living the experiences,
hearing and telling the stories about components of the organization,
and being observed by others who are developing impressions about
the organization. For people within the organization, these
exposures to the culture of the organization are internalized and
recirculated through these people as further manifestations of the
organizational culture. As such, culture is a self-reinforcing concept
where cultural impressions beget other cultural impressions.
Interprofessional culture change then is about trying to
strategically influence the individuals in the organization to promote
interprofessional ideals. The “unfreezing” process—establishing
urgency, forming a coalition, creating and communicating a vision—
is about building the substrate upon which culture change can begin
to happen. The “change” process—empowering others, creating
short-term wins, and consolidating improvements—is about realizing
the culture change. And, the “refreezing” process—institutionalizing
change—is about ensuring that the culture change is sustained.
The interprofessional critical care simulations began as a
collaboration between a few passionate faculty with little institutional
support. They believed in the interprofessional mission and did not
expect traditional rewards, such as course credit or promotion,
based on this work. A well-articulated vision and curriculum won
them the capacity to pilot the simulations, and success of the pilot
brought them access to greater opportunities including conference
presentations and protected educational effort. But the real value to
the organization was that the program proved large-scale
interprofessional education could work. Through individual effort,
they created change in the larger culture and became an exemplar
of how interprofessional education could provide a well-regarded,
meaningful experience to students.
In the second example, development and adoption of the
university’s first credit-bearing IPE courses as curricular
requirements, the leaders built upon the foundation established by
the first program. The vision for large-scale interprofessional
education already existed, and some of the members of the coalition
that developed the courses were veterans of the first program. Yet,
the leaders in the second example took these ideas a step further.
Leveraging the evolving accreditation standards for interprofessional
education, the inclusion of interprofessional education in the
strategic plan for the university, and the curricular policies and
bodies of the individual academic programs, the leaders sought to
create broader learning experiences that would reinforce an
organizational culture supportive of interprofessional education.
Here, it was not just leading by example; rather it was negotiating
with numerous other leaders to collaborate on a sustainable
structure for interprofessional education as permanent curricular
experiences. In a sense, if the individuals involved in the first
program were trailblazers, the individuals involved in the second
program laid the asphalt for an avenue of interprofessional
education. This work—creating the procedures and structures
necessary for sustainable interprofessional education—can support
further innovation in interprofessional education, reinforcing
interprofessional innovation as part of the culture of the university.
What are the implications for organizational leaders who seek to
create a culture supportive of interprofessional education and
practice? Organizational change that increases interprofessional
education and practice must begin with individuals who believe in
this ideal. Often, they pursue it without a desire for traditional
academic reward. Leaders should recognize and seek to support
these individuals with a specific attention to removing the barriers
they face to accomplishing their goals. As these innovators succeed,
the success must be leveraged into broader organizational change
that is integrated more formally into the broader culture of the
organization. This integration occurs by weaving the new ideal into
existing policies, procedures, and processes of the organization, for
example emphasizing interprofessional work in tenure and promotion
guidelines. Leaders should support this integration by working with
organizational leaders from other professions to adapt organizational
structure so that they remain effective yet also incorporate
approaches supportive of the desired change. This
institutionalization of the ideal—in this case interprofessional
education and practice—will then serve to stimulate further
innovation in this area. In this way, the interprofessional spirit of
some initial advocates spreads to broader organizational change and
engenders a culture infused with the ideals of interprofessional
education and practice.

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 Chapter 5
Designing an Interprofessional
Education Program from
Planning to Implementation
Jean P. Shipman, Susan Chase-Cantarini,
Rebecca D. Wilson, and Alice I. Weber

UNIVERSITY OF UTAH IPE’S EXPERIENCE

Recognizing early on the importance of health sciences students
learning about each other’s practice domains and professional
boundaries, the University of Utah (UU) started exploring
interprofessional education (IPE). In 2002, the initial IPE course
consisted of four hybrid modules with in-person sessions
cofacilitated by faculty in health, medicine, nursing, and pharmacy.
This evolved into a more clinically focused, interactive learning
activity that incorporated interprofessional student teams interacting
individually with a standardized patient, followed by faculty-facilitated
team debriefing. New opportunities for IPE presented themselves
with the opening of a thirty-bed acute and ambulatory care high-
fidelity simulation center.
The UU is unique in that its development of IPE programs was,
for the first decade, led by health sciences library directors. The
reason for such leadership is that the health sciences administration
saw the health sciences library as a neutral entity that partnered with
every health sciences program. The Spencer S. Eccles Health
Sciences Library (EHSL) was also appointed to be the manager of a
five-story Health Sciences Education Building (HSEB) that was built
in 2006 to house a majority of the health sciences programs’ classes
and special events. The EHSL was placed in charge of
administrating this building, again as it was neutral and had the
ability to technologically support the classroom infrastructure.
Through planning the special events for the HSEB, the EHSL staff
learned how to apply scheduling software and provided the technical
support for HSEB’s simulated clinical patient exam suites. Librarians
from EHSL became schedulers of the initial ambulatory care
simulation IPE event, which used the HSEB suites; thus, EHSL
became even a more integral partner with the IPE program.
As the UU IPE program became more simulation-based, the
library director quickly realized that her expertise lacked special
knowledge with conducting simulated clinical experiences and an
understanding of how the academic student enterprise worked, due
to not directly instructing matriculated students. She also could not
dedicate the time that was required to run an IPE program that had
grown from one event to multiple events per year. It became clear
that a dedicated director for IPE needed to be hired. This new
director has added much to the UU program as she has a strong
background with simulation and also a PhD in education technology.
The current UU IPE program consists of six simulation-based
courses set in acute care, ambulatory care and telehealth/rural care
across dentistry, health, medicine, nursing, pharmacy, and social
work programs. The IPE program trains over 1,200 students per
year, involving a cadre of sixty faculty facilitators and twelve faculty
governance committee members. It is from this collective experience
and recent literature that the authors provide the following tips for
initiating an effective and productive IPE program.

TIPS FOR INITIATING AN INTERPROFESSIONAL

EDUCATION PROGRAM
Designing, planning, and implementing an IPE program is highly
context-dependent; however, there are some common approaches
to consider and pitfalls to avoid. In general, the goal is to assist
healthcare students to learn from, with, and about each other in
order to promote collaboration and improve patient care (World
Health Organization 2010). For the purposes of this chapter, we
define design as creating the infrastructure and curricular elements,
planning as determining the logistics of bringing students together,
and implementation as activities needed to prepare faculty to work
with students within the interprofessional curriculum. Although
addressed separately, the elements of designing, planning, and
implementing are highly interconnected and iterative. Oftentimes,
what you can accomplish logistically will inform the types of program
outcomes that can be achieved by students and how those
outcomes will be assessed.
The following lessons were learned the hard way. We quickly
developed a simulation pilot soon after a new simulation center was
opened in the College of Nursing at our higher education
administration’s request. We piloted the course in record time without
going through any formal curricular committee review of any school
or college due to the strong encouragement of one dean. We applied
the course credit from a previous interprofessional course in order to
be able to assess a student fee. This fee is used to financially
support the program. As many schools and colleges were unaware
of the course’s offering until the final hour, several decided to cover
the fee for the first semester to be able to have their students
participate. Programs that have set student fees and not credit hour
courses had to compensate for their equivalent student credit hour
contributions. Schedulers of the various scenario student groups had
to hustle to obtain student names and assign them to the correct
group configuration. Faculty had to be quickly trained in debriefing
techniques, and a course management site (Canvas) had to be
rapidly created to disseminate basic information about the course,
course requirements and assignments, and expectations for
professional conduct. Students also had to be informed about how
they would be assessed and graded, and a process for assigning
grades, accepting incompletes, and waiving student fees in some
cases had to be outlined. Despite learning the hard way, we realize
that we gained a lot of knowledge about how to better create an IPE
program that we are sharing tips to others.
Offering new and innovative changes, such as an IPE program,
across a health science center can seem overwhelming at first;
starting small with strategic planning will lead to great rewards in the
end. Having the “big picture” or goal in mind will help ease some
potential challenges. Synergy will develop as you gain support,
develop your team, and design your program.

Tip #1 Gain Support (Design)

 Program design includes creating the infrastructure: gaining
support and creating the leadership and governance structures
required to move forward. This includes generating both grassroots
and administrative champions at each participating school. Including
clinical partners early in the process may also be beneficial.
Consider sustainability and impact while designing: How will the
program be funded and sustained with long-term support? Is there
an internal grant funding process you could apply to for initial seed
support? Can you identify local foundations that might be interested
in funding an IPE program? Work with your development office to
identify and approach potential donors who are interested in
supporting IPE training. Collect patient and provider stories that
touch donors’ hearts and that indicate the impact IPE can make on
offering improved and safer patient care. Is there a source of funding
available from higher administration for at least initial support of an
IPE program? Are there other unique funding opportunities available
within your community?
It is important that deans of the health sciences schools support
IPE, and recognize it as a service to their students. Currently, there
is movement toward including competence in interprofessional
collaboration as part of accreditation standards in order to promote
and advance IPE (Zorek and Raehl 2013). Initiatives across the
country are underway offering new approaches, models, and
frameworks for implementation (Barr 2013; Pardue 2015;
Thistlethwaite et al. 2014). Deans are instrumental in providing
financial support and allocating faculty time (Bridges et al. 2011).
Deans can also stress the importance of being involved to their
faculty and assist with incorporating involvement in IPE programs as
part of faculty contracts and integrating IPE program participation
into criteria for promotion and tenure. In addition, deans can request
financial support from their institutions for IPE programs and for
staffing. They can build costs within their school budgets and help
with identifying donors who may want to sponsor an IPE program.
Another key ingredient to success is to identify early on who can
be champions of such programs and to harness the energy of these
individuals to encourage others to engage with planning the
program, to assist with teaching, and with endorsing it to others
(Bridges et al. 2011). Champions are found in unexpected places
and will be the early adopters that help others to see the value of
interprofessional learning. There may be faculty close by that are
easily influenced to participate as they believe in the philosophy of
IPE to improve the future of healthcare.

Tip #2: Develop Your IPE Team (Design)

Bring your champions together to develop your program’s

model. Establish a governance structure once you have outlined the
program with the needed committees and advisors. For example, the
program at the UU has an IPE Advisory Committee, which sets
overall direction, and three subcommittees that coordinate efforts
through the Advisory Committee: Curriculum, Faculty Development,
and Research/Scholarship. Be willing to adjust your governance
structure as the program grows. Look for participants from all the
health sciences programs, including the health sciences library, as
this entity can help to reach out to known individuals and to
coordinate committee activities and document their progress with
technological support and organization skills.
Librarians have experience with organizing and prioritizing
information and knowledge and can offer an overarching perspective
on IPE program goals. Providing foundational evidence from the
literature is important for establishing and maintaining a rigorous IPE
program that addresses both academic and clinical aspects. Health
literacy is an important component of providing excellent patient
care. Health sciences librarians have training on this important topic
and are in an excellent position to share their knowledge with
students, faculty, and clinicians. Librarians are also neutral parties
within an IPE team, which can become politically polarized. They are
in a unique position to facilitate connections between people in a
variety of associated fields and can call upon their established
relationships to encourage initial and continued participation in IPE
programs.
Balanced representation from all participating programs is
essential to ensure that all voices are heard, and that decisions
incorporate the visions, needs, and concerns of these areas. Decide
how many individuals are needed, what skills are required, and who
can contribute effectively to the efforts, and who can influence and
create needed impact. Appoint members that fit best with your
institution and try to get such appointments recognized by your
promotion and tenure process. Consider including a student member
on key committees, as they bring a unique perspective as to what is
desired by health sciences students and can provide insight into
scheduling and other curricular demands. Promote the committees
and their composition publicly to encourage others to learn more
about IPE and for them to give consideration to joining in the future,
as it is important to keep committee membership fresh and engaged.
Once the teams or committees are formed and members are
appointed, create guidelines for these committees or teams. Begin
developing common understanding about working definitions, goals,
and program frameworks. Members will come from a diversity of
perspectives and organizational cultures, and will bring their own
professional language, culture, and expectations, which adds to the
beauty of an IPE program. Such variations, however, can lead to
early confusion or conflict if it isn’t clearly articulated early in the
proceedings what is meant by IPE and its related competencies.
Take time to articulate what key terms mean and carefully review the
verbiage of the team charters to reach agreement early in the
process. As you create guidelines, common understanding,
terminology, and team charters, you will notice that you are leveling
the playing field of members, recognizing each one’s contributions,
and thus, living the experience of forming an interprofessional team.
Your team is a microcosm of future team development.
Knowledge management can be a challenge when bringing
participants together across schools and campuses. Establishing a
common document sharing site is an essential part of the
communication plan. Listing committees, their charges, membership,
and associated terms of appointment, is also critical for informing
others of the IPE program and how it functions. In addition, consider
conducting update meetings for all interested faculty to share
experiences and knowledge. This is a great area for health sciences
librarians to take a lead, as they can apply their organizational and
communication skills as well as their technical expertise. Course
management software can be used, as well as content management
systems (e.g., Drupal), or websites can also be a common way of
sharing information about IPE programs.

Tip #3 Use a Conceptual Framework (Design)

It is important when developing an IPE program to take the time

to create or adopt a conceptual model for the program from the
beginning. Over the years, there have been many efforts to provide
team-based education; most formal models and frameworks have
evolved during the last decade. Many reflect on the interdependence
between health professionals’ education, practice, and competence
domains. The Interprofessional Education Collaborative (IPEC)
Expert Panel reported three frameworks that captured the
interdependence between health professionals’ education and
practice to improve patient and community-based care. These
included: (1) D’Amour and Oandasan’s “The Interprofessionality as
the Field of Interprofessional Practice and Interprofessional
Education: An Emerging Concept,” (2) the World Health
Organization Study Group’s “Framework for Action on
Interprofessional Education and Collaborative Practice” (2010), and
(3) the Commission on Education of Health Professional’s “Health
Professionals for a New Century: Transforming Education to
Strengthen Health Systems in an Interdependent World” (2011).
Meanwhile, several organizations around the world began
publishing competency frameworks, statements, and domains
capturing the essence of interprofessional practice. These
frameworks offer attributes required of healthcare students and
professionals to practice effectively in interprofessional teams. Some
common attributes or competence domains consist of the following:
ethical practice, conflict resolution, teamwork, communication,
collaboration, and role clarification (Thistlethwaite et al. 2014). IPE
models and frameworks can serve as a basis for your program
outcomes and develop into system-wide activities in education and
practice settings. The development of assessment and evaluation
tools should also complement these frameworks and competencies.
Tip #4 Frame Curricular Parameters (Design)

Prior to developing curricular elements, it is helpful to determine

what givens or constraints will be placed on your program based
upon your education or practice setting. Larger questions to address
include whether your curriculum will be embedded in current courses
or if will it be offered as separate credit-bearing courses (e.g.,
didactic, simulation, or clinical), or separate noncredit bearing
seminars/workshops that each health sciences program may require
its students to attend.
Building interprofessional experiences into service-learning
opportunities is another potential venue that gives students a chance
to connect within their communities The University of California, San
Diego (UCSD) has a well-established program called the UCSD
Student-Run Free Clinic Project (Beck 2005). New York University
uses online courses as one way to deliver IPE instruction along with
simulation and virtual patients (Djukic et al. 2012). University of
Florida offers an interdisciplinary family health course that is featured
in chapter 6 of this book and at http://education.health.ufl.edu/pff/.
Whatever you offer, you will want to consider overlap in shared
content across curricula and provide opportunities for students to
gather, despite their complex and varied schedules.

Tip #5 Plan Early for Program Evaluation

(Design)

Early in your planning, explore methods for evaluating your IPE

program. More health sciences accrediting bodies require IPE in
curricula (Zorek and Raehl 2013); incorporating accreditation criteria
can guide the development of program outcomes, which drive your
evaluation plan. Once your program outcomes are determined,
consider using a logic model to guide a comprehensive evaluation
plan (McCawley, n.d.). These models include diagraming how both
input and processes will lead to the desired program outcomes. As
with any large-scale program it is important to consider the
stakeholders. In particular, determine what documentation the
participating programs need to demonstrate inclusion of IPE
competencies for accreditation purposes.
Evaluation data should be gathered from a variety of
stakeholders to provide a more comprehensive view. Chapter 10 of
this book offers information about assessing IPE programs. Consider
using both quantitative and qualitative data, as either alone often
does not provide sufficient information. Data can be solicited via pre-
post surveys, open-ended questions during interviews, focus groups,
incorporated as part of formal course evaluations, and other
methods. Depending on the questions to be answered, there are
several assessment tools available that can contribute to program
evaluation. These include: (1) the Interdisciplinary Education
Perception Scale—IEPS (Zanotti, Sartor, and Canova 2015), (2)
Team Objective Structured Clinical Exam—TOSCE (Emmert and Cai
2015), (3) Kirkpatrick’s evaluation outcome mode (Anderson, Smith,
and Hammick 2015), and (4) Readiness for Interprofessional
Learning Scale—RIPLS (Murphy and Nimmagadda 2015).
Recognize students and faculty as lead contributors to the
evaluation process; engage them in both formative and summative
feedback. Formative feedback includes information gathered during
planning and implementation as a basis for continuous improvement.
Summative feedback is a holistic approach that gathers information
about the entire program, often for the purposes of determining if the
program should be continued.

Tip #6 Curriculum (Design)

There is no one right way to approach IPE curriculum design;

current available models are as individual as the institutions
themselves. However, one place to start is exploring content that is
similar across participating programs. Consider shared content, such
as patient-centered care planning or systems-based care; and high-
risk care elements that require coordination, such as discharge
planning or resolution of conflict or ethical dilemmas. Involving
clinically savvy educators from each participating discipline will help
ensure the relevance of the education for the various student types.
Be sure to look for places where IPE may already be happening.
Determine where students from different professions are currently
gathering and interactivity already occurs. Opportunities may be
closer than you think; follow the energy. For instance, at the UU, the
HSEB building led to the formation of an interprofessional Health
Sciences Student Council (HSSC) that developed out of the sheer
interest in learning more about other professional students that were
seen within the building. Students took it upon themselves to
develop a means for them to learn more about each other’s
professions, practice parameters, and curricular structures.
Best practices of adult learning suggest that students be actively
engaged. There are several ways to accomplish this including using
networking opportunities, innovative technologies, and simulation
methodologies. Although, optimum approaches to teaching IPE are
not well understood, new and innovative strategies are emerging
(see chapter 3 for pedagogical perspectives for IPE). The Society for
Simulation in Healthcare (SSH) has developed simulation-enhanced
IPE models that have been endorsed by accrediting agencies and
healthcare organizations (2013). They recommend keeping the focus
on evidence-based care and highlighting safe quality patient-
centered outcomes.
Students can complete reflection activities addressing what they
learned, what they observe in practice, and how they can improve
future practice. Current practitioners can reflect on core tenants of
adding value to patient-centered care, improving care quality, and
enhancing patient safety through interprofessional practice
competencies.
Students find it meaningful to encounter IPE sessions that will
translate into their current and future practice. A common situation is
for students to learn about IPE within their curricula only to find it not
being practiced when they move into their clinical work settings.
Having students make a connection between these ideas and
applications to practice, while helping them to learn about
themselves, creates opportunities for significant learning (Fink 2003).
IPE faculty can enhance the value of student learning experiences
by tying IPE competencies to improvements in healthcare delivery.
As you design your curriculum, you will want to make choices
regarding assessment of student gains in interprofessional
competence. Several tools exist to evaluate student readiness,
knowledge, attitude, and skills regarding interprofessional
competencies (Blue et al. 2015). The National Center for
Interprofessional Practice and Education Resource Page
(https://nexusipe.org/resource-exchange) is an excellent place to
start when searching for currently available tools. This site is
updated regularly by members and includes references to aid in
decision making.

Tip #7 Do Not Underestimate Logistics (Plan)

Thoughtful planning and preparation helps to ensure that all

needed IPE program components are in place and will be sustained
over time. Establishing short-term goals congruent with long-term
goals is important. No doubt, one of the biggest challenges to be
addressed is scheduling IPE events and activities. Having a
dedicated time for IPE would be invaluable for multicollege and
multicampus-wide programs; few windows of opportunity exist,
however, with the different program calendars and already
established demands on time. It may be worthwhile to have a
subcommittee or team focus on the logistics of bringing students
together, whether in person or virtually, as this is one of the most
common barriers faced by IPE programs. Look for technological
solutions as well, such as scheduling software, to aid in scheduling
both students from various health sciences programs and grade
years within these programs, and also faculty. Librarians can help
with finding appropriate scheduling software, and with ensuring that
the mix of students scheduled is correct for different IPE events,
depending on the experience needed.

Tip #8 Develop Your Faculty (Implement)

Faculty development and active involvement will enhance IPE

program strength and endurance. Build upon current faculty who
demonstrate collaborative approaches and those who express
interest in being involved. Capitalize on those who already exhibit
appropriate strengths, who can, in turn, become future champions of
IPE. Recognize and mentor local IPE champions from each
profession, pulling them in for their creative ideas and potential
leadership in program planning teams.
Bringing together multiple perspectives, experiences and areas
of expertise will benefit future program growth. Cultivate faculty who
express enthusiasm for your program. Prepare faculty teams by
building a culture of interprofessional collaboration, capitalizing on
role modeling to students. Provide training opportunities that
reinforce IPE best practices (Hall and Zierler 2015). Training can be
accomplished during scheduled team meetings, via special
workshops or tailored training sessions. Utilize team-building
strategies to develop faculties’ own strengths, both personally and
professionally, and while teaching important content to faculty and
staff. Content areas to consider in the training include: (1) the
language and components of IPE, (2) benefits of developing
interprofessional teams to foster safe patient care, and (3) facilitation
skills in leading teams. Establish common ground and consistency.
Adopt and use a framework to guide and teach facilitation and
debriefing with faculty, including librarians. There may be faculty
already familiar with this process. Take advantage of individuals who
already possess these skills and ask them to be instructors. If
facilitating and debriefing are new skills for faculty, several resources
can be found in the literature (LeGros et al. 2015), particularly the
healthcare simulation literature, to assist them with learning more
about how to develop these skills. Both junior and senior faculty can
benefit from skill development efforts. For the most part, faculty see
themselves as life-long learners and can contribute in different ways.
Find those with strength in collaboration, communication, program
planning, and evaluation, and encourage them to be champions to
corral other faculty to get involved.
As your program grows and evolves, celebrate and share your
successes with faculty along the way. Build excitement and
enthusiasm for your work across your organization. Be sure to
promote your program’s achievements and efforts through local
venues and publications. Share student feedback that supports
continuation of your program and generate faculty interest. Faculty,
staff, and students can be ambassadors and will spread their
positive experiences through conversations with others. Partner with
public relations, clinical educators, student government, and
supervisors to share feedback and program successes.
Consider early on how faculty may be recognized for their
contributions, particularly in regard to retention and promotion. As
the field of IPE grows, there are opportunities for collaborative
projects to enhance their teaching, service, and scholarship. Without
this recognition, faculty may lose interest or decide to redirect their
efforts if IPE is not contributing to their career development
portfolios.

Tip #9 Communicate Early around

Implementation (Implement)

One shortfall IPE programs often experience is that they strive

to create a perfect program, without ensuring that all parties involved
are truly comfortable with the implementation plan. As with any
change in an organization, communication is critical to building and
sustaining commitment. Keeping communications open among the
governance teams and committees is a key component of a
successful program, especially in the early formation days.
Anticipate how the program will affect students, faculty, and
programs. Understanding the potential barriers and scope of
resources will bolster system-wide support (Lawlis, Anson, and
Greenfield 2014; Ogrinc et al. 2012). Ensure lines of responsibility
among the various governance teams are clear and understood.
Provide a forum for sharing questions that can be addressed quickly
and from reputable sources.
A common problem IPE programs face is who has the ultimate
authority for making key decisions and for program development.
IPE programs’ inherent nature of encouraging cooperation and
collaboration among disparate programs that are accustomed to
setting their own decision-making processes and techniques can be
difficult. Getting these individual programs to conform to a shared
governance style may be a challenge, but is one of the development
experiences faculty can gain from participating in an IPE program.
Learning how to share and how to compromise are invaluable
lessons for anyone to gain.

Tip #10 Document Your Process and

Disseminate Your Results (Implement)

Many IPE programs have been formulated over time, but very
few have documented their developmental journey, or their
experiences with creating their programs. The University of
Washington has done a great job with this (Willgerodt et al. 2015).
Grand Valley State University also has described its IPE program in
great detail in the literature (Grapczynski et al. 2015). The lack of
reporting is usually due to a lack of time as just getting programs
created tends to absorb most free time of faculty. There are several
ways to ensure that the process is recorded. One immediate step is
to take minutes of all meetings and to centrally house these minutes
for all to view. This not only records when decisions are made, but
who has actually made them. Minutes also give a timeframe for
when certain activities occurred as well as when milestones were
reached. A second way to ensure that your program’s development
is properly recorded is to appoint a committee to archive decisions
and to be responsible for coordinating what publications and
presentations come out of your program’s participants. Early on
discussions should be held as to who will share authorship for
publications as there are many health sciences schools represented.
Will all schools be included or is it ok to have some authors with the
rest of participants highlighted in a publication’s acknowledgments.
Some specific professional topics may need to be targeted and
written about by all IPE program developers, whereas other topics
might be okay to be shared at various health sciences programs’
professional conferences by the IPE professionals that are members
of the professional associations hosting the conferences (i.e., it is ok
for medical libraries to present at the Medical Library Association
annual meeting about the IPE program as other members of the IPE
team probably will not be in attendance). Deciding how to distribute
the intellectual property gathered and who gets credit for such early
on will hopefully prevent misunderstandings and hurt feelings among
IPE program participants.

ENJOY THE RIDE

Students love the opportunity to learn from, with, and about each
other, particularly in clinically relevant settings. IPE has a unique
place in providing this opportunity. Based on our experiences with
building an IPE program at the UU, we highly recommend that you
“just do it.” It is worth the challenges and barriers you might face in
creating an IPE program at your institution. Every problem seems to
melt when you see the students’ reactions and enthusiasm, as
ultimately they are what make all of your efforts worth it. Enjoy the
ride and the rewards that come from learning about each other at all
levels of an organization.

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Beck, Ellen. 2005. “The UCSD Student-Run Free Clinic Project:
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V. Maki, and John Tomkowiak. 2011. “Interprofessional
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Deborah Bambini, and Cynthia Beel-Bates. 2015. “The Integrated
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Core Competencies for Interprofessional Collaborative Practice:
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Education Collaborative.
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Education: A Literature Review.” Journal of Interprofessional Care
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and Ernest P. Schloss. 2015. “Using Learning Theory,
Interprofessional Facilitation Competencies, and Behavioral
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Interprofessional Care (July 31): 1–7. (Eprint ahead of pub.)
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to Provide Simulated Learning to Address Interprofessional
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 Chapter 6
Engaging Service Learning in
Interprofessional Education
Erik W. Black, Nichole Stetten, and Amy V. Blue
The University of Florida Experience

The 1998 Pew Health Professions Commission report

“Recreating Health Professional Practice for a New Century”
identified twenty-one different critical competencies for the twenty-
first-century health professional. Included among these
competencies was the ability to work as a member of an
interdisciplinary team of healthcare providers. Since the report’s
release, health professions accrediting bodies echoed the Pew
report’s recommendations for preparing a new generation of health
professionals. Seemly overnight, interprofessional education has
become a mainstream topic and an area of burgeoning interest
(IPEC 2011). Addressing the needs of diverse student bodies, each
with jam-packed curricula, is a formidable challenge. Many
institutions have adopted intersession activities or other brief
experiences to meet the needs of accreditation; others have built
complex experiences that provide students with early access to
clinics and patients (e.g., Vanderbilt’s VPIL experience [Schorn et al.
2014]). The University of Florida has a robust history of
interprofessional learning, its marquee activity is a service-learning
activity that all first-year students within the health science center
participate in (Davidson and Waddell 2005). The purpose of this
chapter is to describe how interprofessional education can be
incorporated into a service-learning experience through a description
of a unique service-learning experience for first-year students from
each of the six University of Florida Health Science Center (UFHSC)
colleges. The learning experience, Putting Families First (PFF), was
conceived as a vehicle for interprofessional learning among students
from diverse colleges and programs at large academic health
science center. Since its inception in 1997, over 7,500 students have
participated, completing nearly fourteen thousand home visits to over
2,500 local families. This chapter will begin with a brief overview of
PFF, define service learning and interprofessional education, and
then explore interprofessional service learning in the health sciences
education; finally the chapter will describe PFF in greater detail,
including outcomes data from students and recommendations for
faculty and administrators who wish to promote interprofessional
service-learning opportunities in their own health science institutions.

OVERVIEW OF PUTTING FAMILIES FIRST:

AN INTERDISCIPLINARY FAMILY HEALTH
EXPERIENCE
PFF is a required course for first-year health professions students
that has provided a foundational learning experience for University of
Florida Health Sciences students since 1997 (Davidson and Waddell
2005). Central to the PFF experience is a service-learning
requirement in which interprofessional teams of students participate
in home visits with local families. Other institutions (e.g., Jefferson
College of Health Sciences, Florida International University [Arenson
et al. 2015; Rock et al. 2014]) have adopted similar service-learning
outreach programs that incorporate local members of the community,
but PFF is recognized as the first and largest interprofessional health
sciences service-learning course in the world. Over the years PFF
has evolved to incorporate prevailing perspectives on
interprofessional education, health promotion, disease prevention,
and teams and teamwork, yet service learning has remained an
enduring component of the experience.

Service Learning

Service learning is a community-based education that allows

students to obtain a deeper level of learning in their field of interest
by engaging with members of the community (Borges and Hartung
2007; Moely, Furco, and Reed 2008). Service learning is an
experiential opportunity that comprises formal learning opportunities
that connect academic or classroom-based experiences to authentic
structured public-service activities (Furco 2007). These structured
experiences allow students to apply what they learn in settings
outside the classroom, as well as instill teamwork and leadership
skills among students who might not normally work together (Borges
and Hartung 2007; Buff et al. 2011). Service learning’s ability to
encourage diverse students to interact and work together in diverse
settings facilitates unique opportunities for students to confront
preexisting stereotypes about communities and the individuals within
them. For example, a study by Sauer (2006) provides evidence that
students who participated in service learning shed stereotypes they
held about specific or vulnerable populations, and obtained a deeper
and richer understanding of the community that surrounded them.
Numerous studies have detailed positive outcomes associated with
student service-learning experiences in higher education, identifying
increases in participant’s moral and ethical development,
development of personal identity, and increases in communication
skills (Astin and Sax 1998; Rockquemore and Schaffer 2000;
Schmidt 2000). Further, studies report that student service-learning
experiences have a positive effect on reducing stereotypes,
increasing cultural and racial understanding, promoting critical
thinking, and increasing learners’ sense of social responsibility (Astin
and Sax 1998; Eyler et al. 2001; Vogelgesang and Astin 2000). In
addition to helping students grow as community members, service
learning promotes student reflection. Reflection provides a means for
students to make sense of their personal observations and
experiences, furthering their growth as learners (Arndell et al. 2014;
Borges and Hartung 2007; Yorio and Ye 2012).

Interprofessional Education (IPE)

Interprofessional education is an emergent topic in the health

professions education, and while there are multiple definitions of
IPE, they all incorporate a similar thematic structure that asserts that
IPE occurs when two or more professions learn or work together
toward a common goal. According to Benner, Benner, Sutphen, and
Leonard (2009) the goal of IPE is to create cultures where systems-
based decision makers collaborate as a community to solve complex
problems and address issues that exceed the reach of any one
profession. In 2003, the Institute of Medicine (IOM) published data
that indicated patients are more likely to receive quality care when
health professionals work together (Knebel and Greiner 2003). Since
this publication, the IOM has recommended that health professional
students work together in order to learn from each other in order to
improve healthcare delivery, interdisciplinary respect, and health
outcomes (Bridges et al. 2011; De Los Santos, McFarlin, and Martin
2014; Iachini et al. 2015; Mulholland, Barnett, and Spencer 2013). To
this end, in 2011, the Interprofessional Education Collaborative
(IPEC 2011), representing multiple health professions societies,
identified four core competency domains within the context of patient
care that are key to interprofessional education; these include
values/ethics, roles/responsibilities, interprofessional communication,
and interprofessional teamwork and team-based care. The IOM and
IPEC recommendations, coupled with evolving societal, economic,
and academic expectations have redefined our understanding of
best practices in health professions education and prompted many to
endorse interprofessional education as a way to provide healthcare
that is safe, high-quality, and patient-centered. In a relatively short
time, the competencies domains identified by the IPEC collaborative
have become core expectations of twenty-first-century healthcare
providers (Baker et al. 2005; Commission on Collegiate Nursing
Education 2003; the Joint Commission 2008) , students (Vlasses et
al. 2008; Kirsch and Aron 2008; National League for Nursing
Accrediting Commission 2008), and resident physicians (Van Zanten
et al. 2008).
Since the initial 2003 IOM report, multiple studies have shown
that interprofessional teams can better address complex and
challenging health problems, provide increased quality care,
decrease medical errors, improve patient satisfaction, and improve
the overall resources available for marginalized/vulnerable
populations (Acquavita et al. 2014; Bridges et al. 2011; Iachini et al.
2014; Mulholland, Barnett, and Spencer 2013 ). In the classroom,
IPE allows students to learn about healthcare from a variety of health
professionals’ perspectives. This type of interaction facilitates a more
holistic understanding of healthcare, as well as improved
communication and leadership skills when students interact with
professionals from other healthcare fields (Acquavita et al. 2014;
Buckley, Vu, and Remedios 2014).

Interprofessional Service Learning in the

Health Sciences

Given the experiential and contextualized nature of health

professions education, which has traditionally included a focus on
community-based education and outreach (Seifer 1998), the shift
from uniprofessional to interprofessional service learning is not
novel. In fact, there are multiple publications describing
interprofessional service-learning activities during the last ten years
(e.g., Buff et al. 2011; Dacey et al. 2010; Freeth et al. 2001; Gillespie
et al. 2010; Mareck et al. 2005; Pilon et al. 2015; Schorn et al. 2015).
A closer look at these activities reveals several commonalities: a
limited number of students participating, short duration, the activity’s
classification as elective or volunteer and a lack of longitudinal
institutional commitment to the activity; that is, a majority of the
activities are funded through extramural or intramural temporary or
exploratory grant monies (Bridges et al. 2011). Yet, a nonsystematic
analysis of the outcomes data associated with these studies
provides evidence of multiple successful student-led quality
improvement projects, positive impact upon patient satisfaction,
increased feelings of patient well-being, and perceived increases in
patients’ ability to self-manage their care (Dacey et al. 2010;
Gillespie et al. 2010; Lee et al. 2013; Mareck et al. 2004; Pineda-
Herrero et al. 2015; Schorne et al. 2015). Further, there is evidence
that the incorporation of service learning and IPE into an integrated
experience negates a health science curriculum’s tendency to
devalue service and also increases quality of healthcare overall
(Arndell et al. 2014; Borges and Hartung 2007; Buff et al. 2011).

PUTTING FAMILIES FIRST: AN

INTERDISCIPLINARY
FAMILY HEALTH EXPERIENCE
Putting Families First has been a community-based interprofessional
learning experience since 1997. PFF was conceived and launched
by Dr. Richard Davidson and Dr. Rhondda Waddell and initially
funded with grant money from the Pew Foundation. In 2001, the
University of Florida Health Science Center provided full funding for
the program, ensuring the program would continue to exist
regardless of extramural funding status. At present, there are no
extramural funds used for the operation of PFF. PFF is housed in the
Office of Interprofessional Education within the Office of the Senior
Vice-President for Health Affairs. It is a required course for all first-
year students in the Colleges of Medicine, Dentistry, Pharmacy, and
Veterinary Medicine students; the traditional nursing students (four-
year bachelor of science) in the College of Nursing; the physical
therapy, health administration and clinical and health psychology
students from the College of Public Health and Health Professions;
and nutrition graduate students from the Institute for Food and
Agricultural Sciences. For the 2014 to 2015 academic year, the
course comprised 694 students, eighty-eight faculty facilitators and
more than two hundred volunteer families from the local community.
Curricular goals and specific objectives for PFF are detailed in tables
6.1 and 6.2; they primarily focus on introducing students to concepts
and skills related to teamwork, interprofessional practice, and public
health issues. Students will later build upon these concepts and skills
in uniprofessional activities associated with their program’s
curriculum.

PFF Goals and Taxonomic Classification.

PFF Course Goals Goal #

The goals of Putting Families First: An Interprofessional

Family Health Experience are for students to be able to:

Explain how cultural, social, economic, and political 1

determinants affect individual, animal, and population health.
(Knowledge—content)

Use the knowledge of one’s own role and those of other 2

professions to address the healthcare needs of populations and
patients served. (Knowledge—IPE)
 Propose a patient-centered interprofessional health 3
improvement plan based upon the patient’s perceived needs.
(Skill)

Communicate with other health professionals in a respectful 4

and responsible manner. (Skill)

Demonstrate interprofessional teamwork in a variety of roles 5

(e.g., team member, team leader, and role model). (Skill)

Advocate a patient-centered approach in healthcare. 6

(Attitude)

Recognize the importance of interprofessional collaboration in 7

healthcare. (Attitude)

PFF Objectives by Module.

Module Month Module Topic Objectives

1 Prior to Orientation -Describe the goals of the

September PFF experience.
Meeting -Describe what is expected
of students during the PFF
experience.
-Explain the principles of
patient-centered care.
-Articulate the importance
for advocating for patient-
centered care.

2 September Interprofessional -Describe effective

Teamwork in teamwork behaviors.
Healthcare -Recognize different
professions’ roles in healthcare
and a team.
-Apply communication skills
to establish rapport with another
individual (e.g., active listening,
use of open-ended questions,
facilitation, summarizing).
-Prepare for first home visit.

3 October Social -Describe social

Determinants of determinants of health.
Health -Evaluate how social
determinants of health influence
PFF families.
-Define health literacy.
 -Appraise the level of health
literacy associated with the
team’s PFF patient.
-Describe how health
interventions must be adapted to
meet the health literacy of
patients.
-Analyze possible health
improvement projects for PFF
families.
-Prepare for second home
visit.

4 November Access to Care -Discuss the structure of the

U.S. healthcare system.
-Evaluate how healthcare
access issues influence PFF
families.
-Identify community
resources applicable to PFF
families.
-Develop possible health
improvement projects for PFF
families.
-Evaluate peer’s teamwork
skills as a member of a team.
-Evaluate self as a team
member.

5 January Cultural -Discuss how culture

Influences on Health influences health behavior.
-Evaluate how culture
influences PFF families’ health
behavior.
-Prepare for third home visit.
-Work on health
improvement project for PFF
families.

6 February Roles and -Describe the roles and

Responsibilities in responsibilities of professions
Healthcare other than your own.
-Advocate for the role of
your profession in healthcare.
-Apply effective techniques
to maintain patient boundaries,
terminate professional
relationship, and if pertinent,
transition care with PFF families.
-Evaluate health needs of
PFF families.
 -Work on health
improvement project for PFF
families.
-Prepare for fourth home
visit

7 March Improving -Demonstrate completion of

Health a health improvement project for
an individual, family, or animal.
-Analyze the use of
interprofessional communication
and teamwork to complete a
health improvement project.
-Assess individual
professional growth during the
PFF experience.
-Evaluate peer’s teamwork
skills as a member of a team.
-Evaluate self as a team
member.

Logistical Structure

PFF runs from September to March, during which students meet

on six different occasions for two hours in small, interprofessional
groups facilitated by two interprofessional faculty during the fall and
spring semesters. The first-year student participants are subdivided
into interprofessional groups of sixteen students for the in-class
sessions, with two interprofessional faculty facilitators assigned to
each group. Groups are then further divided into four
interprofessional teams of four (see figure 6.1) to work with the
assigned volunteer family. Students are required to complete four
home visits with a local volunteer family, learning about the family’s
health and working with the family on a health improvement project
that is of interest to the family. Team assignments to family
volunteers is made in a semirandom manner, taking into account
volunteer preferences and needs, and student professional program.
For example, if the Office of Interprofessional Education is aware of
a poly-pharmacy concern associated with a volunteer, efforts are
made to include a pharmacy student in their volunteer team.
Demographics of the volunteer families closely match those of the
surrounding county in a geographically diverse fashion (see figure
6.2) and the distribution of families within groups is systematic; the
Office of Interprofessional Education strives to provide a range of
family types within each small group. For example, one group may
include an uninsured family with adult children living at home, a
widowed elder living alone, a retired affluent professional couple,
and a middle-class family whose child has cystic fibrosis. Volunteer
families sign Health Insurance Portability and Accountability Act
(HIPPA) releases at the time of their recruitment into the program.

2014 to 2015 PFF Student/Faculty Logistics.

Photo by author.
Geographic Distribution of PFF Volunteers (2013–2014).
Photo by author.

Each of the six small-group sessions has a different theme and

the faculty are responsible for covering content related to teams and
teamwork, cultural competencies, professional roles and
responsibilities, the U.S. healthcare system, and social determinants
of health, in addition to discussing the students’ volunteer families in
a case conference format. Table 6.1 features goals and objectives
associated with PFF. Course content associated with each small-
group session is delivered using blended instructional methods. All
course content is housed on the Canvas Learning Management
System (see figure 6.3) and students are able to access each of the
seven content modules (one for each small group visit and an
orientation module) from anywhere on or off campus. Short reading
assignments, quizzes, and other activities must be completed as
individuals or as a team prior to or following the small-group
meetings and home visits. From September through March (with the
exception of December), small groups meet on a monthly basis,
traditionally the third Tuesday of the month from 10:40 a.m. to 12:30
p.m. This means that the Office of Interprofessional Education is
tasked with the logistical challenge of organizing and reserving
meeting space for forty-four small groups on each of the six small-
group meeting dates.

PFF Course Site hosted on the Canvas LMS.

Photo by Author.

Volunteer Families

The primary focus of PFF is the volunteer families. Students are

encouraged to think of these volunteers as their first patients. While
students are strictly forbidden to provide invasive care to volunteers,
viewing the volunteer as a patient confers a sense of duty and
responsibility to the students that encourages them to place the
needs and desires of the volunteer ahead of their own. Each student
team is responsible for completing four home visits, two per
semester, with their assigned volunteer families. Home visits follow
the first and second small-group meeting in the fall semester and the
fourth and fifth small-group meeting in the spring semester. Students
are challenged to collaboratively plan their home visit with their
volunteer family at a time when all students can be present. Home
visits to volunteer families are scheduled by team members, who
contact the family and arrange an appropriate and mutually
convenient time. During home visits, students initially learn about the
family through use of health-related instruments and then broaden
visit topics to address particular health needs of the family. Students
are to implement a project that addresses a health improvement
need of the family. Health improvement is defined broadly; examples
may include education about a particular health condition, recipes for
a healthier diet, assistance with completing disability forms, creating
a garden for a family, or providing information on low-cost health or
pet services.

Faculty Facilitators

A cadre of core faculty representing each of the involved Health

Science Center colleges works in collaboration with the faculty and
staff in the Office of Interprofessional Education to provide curricular
guidance for PFF and ensure content is addressing subjects of value
within the respective academic programs. The eighty-eight faculty
facilitators who act as small-group leaders are recruited from across
the health science center. Participating colleges are expected to
provide sufficient faculty resources to enable PFF to function. As
interprofessional education has emerged as a more prominent topic
in the health sciences, the office’s ability to recruit and retain faculty
has sufficiently increased. In order to provide an equitable
experience across the many different small groups, PFF operates
with a standardized curriculum. Faculty are provided with a
facilitation guide for each small-group meeting that provides “talking-
points” to guide faculty through the required materials to be covered
during each meeting and how to link session topics with home visit
tasks (i.e., what are cultural influences on the health of your family
for the session focused on cultural issues in healthcare). Thus,
small-group leaders are responsible for leading their groups and
interacting with their students. Each year the Office of
Interprofessional Education hosts two faculty development kick-off
sessions. During these sessions the PFF curriculum is reviewed,
faculty are made aware of changes to the course and are provided
strategies for successful small-group instruction. Additionally, the
Office of Interprofessional Education offers one-on-one support for
faculty who may have specific concerns or questions about
facilitations.

Student Evaluation and Grading

Students earn points for completing individual assignments and

assignments as part of their team. As individuals, students are
required to complete short quizzes on each module’s content,
complete a home visit report for each home visit, assess their team
members’ teamwork skills, reflect on the results from their team
members’ feedback on their own teamwork skills, determine
personal learning goals for the experience, and complete a reflection
at the end of the experience reflecting on learning goals and the
overall experience. As a team, students complete questionnaires
based on information obtained from the family during the home visits
and must also present a Family Health Presentation at the end of the
year summarizing their work with the family. The small-group
facilitators also evaluate each student’s performance in the small-
group sessions. Because of the myriad differences in the operation
of the various different programs associated with PFF, PFF does not
exist as a course entity. Rather, PFF is a component of a course
within each of the different participating program’s curriculum. For
example, PFF makes up a component of the BMS 6810 and BMS
6812 Introduction to Clinical Medicine course in the College of
Medicine and is part of VEM 5008 Professional Development in the
College of Veterinary Medicine. Students’ final grades are
determined by each college. For example, in the colleges of
dentistry, medicine, pharmacy, and veterinary medicine, the course is
part of a larger first-year course in terms of credit. Grades earned in
the PFF course represent a proportion of total grade for the larger
courses.
Since its inception, PFF has included a peer evaluation
component. Historically, this peer evaluation has been nominally
effective. Often, students provided survey based feedback with little
variance that was highly negatively skewed. In essence, the
evaluations informed us that nearly all students are excellent peers
and productive members of their respective teams. Data derived
from this traditional evaluation process, in addition to being unwieldy
(providing student feedback on their peer evaluations for seven
hundred students is not a small undertaking) did not align with
students’ students reflections, which provided evidence of conflict
and challenges within some groups. In addition to being unwieldy,
providing student feedback on their peer evaluations for seven
hundred students is not a small undertaking; students’ evaluations
were not supported by qualitative evidence from students reflections.
In 2014, the PFF administration decided to pilot the Comprehensive
Assessment of Team Member Effectiveness (CATME) online system
(Ohland et al. 2012) for peer evaluation. CATME allows for
anonymous online peer evaluation of self and team competencies
and behaviors. Team members assessed themselves and their peers
across three different teamwork competencies: Contributing to the
Team’s Work, Interacting with Teammates, and Keeping the Team on
Track. The assessed competencies were scored from one to five.
These ratings were summed to provide a composite score for each
of the competencies, which could range from four to twenty. In
addition, team members provided feedback about team satisfaction
providing five-point Likert-style (strongly disagree to strongly agree)
responses to the following prompts: I am satisfied with my present
teammates; I am pleased with the way my teammates and I work
together; I am very satisfied with working in this team. Initial
responses show increased variance compared with prior methods of
peer evaluation, though in a strong majority of cases, students
described themselves and their peers in very positive terms. This
data was also supported by students’ satisfaction with their team.
Perhaps equally important, CATME's automated nature eliminated
the logisticaly hurdles associated with providing timely peer feedback
to students.
CATME will continue to be a component of the PFF evaluative
process; future studies will employ mixed-method procedures to
evaluate students’ peer evaluations and corresponding reflective
statements.

Lessons Learned and Recommendations for

Health Science Educators

PFF serves as a conduit for student exposure, growth, and

development at an early stage in their clinical education. Data exists
indicating that participation raises student awareness of the scope of
access and disparities issues in the local community. Students
experience firsthand the interdependent relationship between an
individuals’ health and their lived environment (Estrada et al.,
forthcoming). Through the experience, they also acquire
fundamental teamwork skills and knowledge of the roles and
responsibilities of a variety of health professions, thus the experience
provides an in-depth interprofessional education experience. PFF is
a mature interprofessional service-learning program whose success
has been facilitated by multiple factors known to effectively guide the
development and implementation of interprofessional education and
service-learning programs. These include institutional leadership
commitment, administrative structure and resources, broad faculty
support, established schedule, and faculty development.
Since its inception, health science leadership has been
committed to PFF, and over the years, as noted above has been
supported by institutional funding. Interprofessional education has
been a component of the health science center’s 2010 to 2015
strategic plan and remains a central component of the education
portion of the 2015 to 2020 strategic plan. Leadership commitment is
recognized as a key element for the success of interprofessional
education programs (Blue et al. 2010; Bridges et al. 2011).
Administrative resources, including an office with professional
staff and faculty dedicated toward interprofessional education is also
described as an essential factor for inculcating a culture that
appreciates and is able to advance interprofessional education
(Bridges et al. 2011; Oandasan and Reeves 2005) The University of
Florida Office of Interprofessional education includes two faculty for
a 1.5 full time equivalents (FTE) commitment, including a director,
two professional staff, and an administrative assistant.
Faculty support is necessary for the successful implementation
of IPE at an institution. Given the history of the PFF program and the
institutional commitment, faculty recognize the value of participating
in the program. Through a structure of core faculty from each
academic program to guide curricular revisions and program
improvement, faculty are engaged in shaping the students’ learning
experience.
Scheduling is often cited as challenge in IPE and for good
reason, given that academic programs have full curricula and often
varying academic calendars within an institution. Agreement was
reached several years ago that PFF in-class sessions would be held
on a particular schedule and all participating academic programs
need to respect that. Programs work with their own faculty for the
release time needed from other classes and ensure that students’
schedules allow them to attend the PFF sessions.
Faculty development is recognized as essential for effective
interprofessional education. In PFF, new and experienced faculty
attend orientation and training sessions held every year so they are
familiar with the overall PFF experience and any changes made for
the upcoming year. Additionally, faculty receive a facilitator guide to
provide important information and teaching points, including points
on how to address profession-specific perspectives on content. For
example, with the cultural issues in healthcare, facilitators are briefed
that different cultures view owning a pet differently than others.
In addition to recommendations related to interprofessional
education, several recommendations related to service learning are
derived from our unique experience. While many service-learning
activities exist within a cocurricular or elective learning environment
for students, a required service-learning activity necessitates several
considerations. These include support for participating family
members and students, recruiting sites (suitable families) for
students, and addressing student safety issues.
 While students in the program provide support for participating
families through their health improvement projects, in some cases
the nature of the family’s need is such that students are limited in
their ability to address particular needs. These may involve medical,
dental, or other healthcare advice from a provider, more substantive
assistance with navigating local, state, or federal agencies, or
assistance with accessing tangible support items (such as a walker).
The office employs a full-time case manager who provides additional
assistance to families, and in turn to students, when a family’s need
is above what students are able to help to facilitate or provide. In this
manner, our students know that a back-up system exists to further
help families. For example, if a student team suspects that a family
needs medical attention, the case manager can intervene and
ensure a visit to a physician.
Recruiting sites, or in the case of PFF, volunteer families, is a
time-consuming effort and two of the staff (one being the case
manager) have established numerous community contacts over the
years as venues through which to recruit families. Branding the
program with a specific identity and developing materials to distribute
to agencies and at community events is essential. The Office of
Interprofessional Education worked with marketing professionals to
ensure that materials are attractive (i.e., succinct, colorful, etc.).
Student safety is an utmost concern. All families are carefully
screened at intake, and a home visit by the case manager is
conducted to ensure that the environment is safe for the students.
Specific instructions are provided to students about home visits,
including that the entire team makes the visit together, no one should
drive alone to the home, and that if a safety suspicion arises, to
leave the home or neighborhood. We have a twenty-four-hour pager
that students can use if they need to reach the office during after-
hours and weekends regarding any concerns about a family visit. We
also ask students to inform the office if a family has moved to
another residence in the area and not conduct the home visit until
that new residence has been vetted by the case manager.

CONCLUSION
In conclusion, PFF represents a unique learning opportunity that
integrates service learning within an interprofessional education
context. Through working as an interprofessional team with a local
family, students learn about the social determinants of health in
relation to a specific patient and engage in teamwork to improve the
patient’s health.

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 Chapter 7
Interprofessional Education and
Patient Care
Karen McDonough and Brenda Zierler
Supporting Patient Safety

The complexity of modern healthcare demands that health

professionals practice in teams. The explosion of medical knowledge
and available interventions, combined with the aging population and
the prevalence of chronic illness, means that no single practitioner
can provide high-quality care alone. Unfortunately, the complexity of
modern healthcare has also increased the likelihood of error. The
Institute of Medicine’s (IOM) “To Err Is Human,” published in 1999,
attributed the deaths of ninety-eight thousand Americans per year to
medical error. This report focused the attention of healthcare
organizations, accrediting bodies, and the public on patient safety,
which is now recognized as a major public health issue. Based on a
detailed review of more contemporary medical records, James
estimated that the number of Americans dying prematurely because
of preventable adverse events is four times higher than the 1999
IOM report and suggests that over 400,000 hospitalized patients per
year suffer some type of preventable harm that contributed to their
death (James 2013).
The worst type of error affecting patient safety, a sentinel event,
can have multiple causes. A sentinel event is defined by the Joint
Commission as “an unexpected occurrence involving death or
serious physical or psychological injury, or the risk thereof” (Joint
Commission 2013, SE-1). The Joint Commission publishes an
annual report of the most frequently identified root causes (Joint
Commission 2015) of sentinel events, which focuses on systems and
processes of care delivery. Human factors, communication, and
leadership have been the top three contributing factors of sentinel
events in U.S. hospitals in 2013, 2014, and 2015. Although these
data are self-reported, they are used to identify areas for
improvement and to prevent similar patient safety events in the
future. Improving the safety of patients is not only a priority in clinical
settings, but must be a priority in academic settings.
Interprofessional education (IPE) provides an opportunity for health
professions students to not only learn about, from, and with each
other, but also to understand the rationale for why working together
is essential.

Adverse events are any unfavorable occurrence caused by medical treatment, rather
than the patient’s underlying condition. Some adverse events, such as a drug rash in
a patient without a known drug allergy, are not due to error and are not preventable.
Medical error is defined as the failure of a planned action to be completed as
intended or the use of a wrong plan to achieve an aim. Some medical errors do not
cause harm to the patient, either because of luck or because a system or health
professional prevented the harm. Medical errors that result in adverse events are
preventable adverse events.
Adverse events are any unfavorable occurrence caused by
medical treatment, rather than the patient’s underlying condition.
Some adverse events, such as a drug rash in a patient without a
known drug allergy, are not due to error and are not preventable.
Medical error is defined as the failure of a planned action to be
completed as intended or the use of a wrong plan to achieve an aim.
Some medical errors do not cause harm to the patient, either
because of luck or because a system or health professional
prevented the harm. Medical errors that result in adverse events are
preventable adverse events. Photo by author.

Human error is inevitable in a system as complex as modern

healthcare. Historically, medical errors have been attributed to
failures of individual clinicians, whose competence or attention were
less than adequate (Wachter 2016). In the last twenty years, most
experts have adopted a systems approach, which assumes that
preventable adverse events are caused by predictable human errors
occurring in the context of poorly designed systems. These systems
either facilitate the error or fail to prevent it from impacting the
patient. Figure 7.1 illustrates the differences between adverse
events, medical errors, and preventable adverse events (Wachter
2016).
Patient safety is defined as the prevention of injury due to errors
occurring in the course of healthcare (Wachter 2016). These may be
errors of commission, such as wrong site surgery, or errors of
omission, such as failure to prescribe a needed medication. The
injury may be immediate, or especially with errors of omission, may
occur years later.
Safety is one of six key characteristics of high quality healthcare
outlined in an IOM report “Crossing the Quality Chasm: A New
Health System for the 21st Century” (Institute of Medicine 2001) that
focused on redesigning the American healthcare system by
providing six “Aims for Improvement”:

1. Safety;
2. Effectiveness;
3. Equity;
4. Timeliness;
5. Patient-centeredness;
6. Efficiency.

Although IPE may impact all of these domains, patient safety

has become a key focus of IPE. Preventable adverse events are
rarely caused by the action or inaction of a single clinician. In order
to impact a patient, a typical error must pass through multiple
systems and clinicians from multiple professions.
In studies of errors that have led to patient harm or malpractice
claims, communication and teamwork failures were major
contributors over half of the time (Rabol et al. 2011; Singh et al.
2007). Errors happen in teams, and improvements in safety and
quality must also happen in teams. Interprofessional education aims
to prepare health professions students with the knowledge, skills,
and attitudes needed to provide safe and high quality team-based
care.

THE IMPACT OF IPE ON PATIENT SAFETY

In practice, interprofessional teams have been shown to improve
patient safety in many ways. For example, team-based depression
management in primary care improved mortality in patients with
multiple other chronic illnesses (Gallo et al. 2015). Collaborative care
improved glycemic control in patients with diabetes (McAdams-Marx
et al. 2015). Heart failure teams reduced the risk of hospitalization
(McAlister et al. 2004) and readmission (Eastwood 2014).
Interprofessional geriatric team consultation improved six-month
mortality in frail hospitalized elders (Deschodt et al. 2013). Palliative
care teams improved symptom control and decreased hospital
admissions (Higginson and Evans 2010), reduced emergency
department visits in the last month of life (Henson et al. 2015), and
improved refractory breathlessness (Higginson et al. 2014). The
literature is rich with other examples of interprofessional teams that
provided safer and higher quality care than any single profession
could alone.
Undergraduate health professions education must prepare
students for an interprofessional collaborative approach to practice.
Many IPE activities have been shown to improve learners’
knowledge, attitudes, and skills toward other professions and
collaborative practice (Balogun et al. 2015; Darlow et al. 2015; Gould
et al. 2015; Gunaldo et al. 2015). As with other educational
interventions, demonstrating any impact of IPE on long-term patient
and population outcomes has been more challenging. A 2013
Cochrane review identified fifteen controlled studies of objectively
measured patient or healthcare process outcomes following an IPE
intervention. Seven of these studies reported positive outcomes
compared to controls, in randomized, time-interrupted, and
controlled before-and-after trials. An additional four trials reported
mixed outcomes, and four published trials were negative. The
positive outcomes in these trials ranged from improved glycemic
control and diabetes guideline adherence to improved motor function
in stroke patients. The authors concluded that although the field of
rigorous IPE research is growing steadily, the heterogeneity of the
interventions and outcomes reported prevented them from drawing
generalizable conclusions about the long-term impact of IPE on
patient outcomes (Reeves et al. 2013).

INTERPROFESSIONAL COMPETENCIES AND

PATIENT SAFETY
The Interprofessional Education Collaborative (IPEC 2011) outlined
four key competency domains for interprofessional collaborative
practice (see figure 7.2). All four of these domains impact the safety
and quality of care provided by interprofessional teams.
Interprofessional Competencies that Impact Patient Safety.
Reprinted with permission from the National Academies Press.

Interprofessional Teamwork

Teamwork is the ability of a healthcare team to work together,

communicate effectively, and coordinate action, to use the collective
skills of team members to achieve their common goals. Teamwork
clearly impacts the safety and quality of patient care: in the
emergency room, the operating room, the intensive care unit, at
hospital discharge, and in the outpatient setting (Lingard et al. 2004;
Mazzocco et al. 2009; Reader, Flin, and Cuthbertson 2007). Failures
in teamwork and team communication contribute to a majority of
preventable adverse events. The key role of interprofessional
teamwork in patient safety has led to the widespread adoption of a
specific IPE strategy, team training in healthcare.
Team training has its origins in the Crew Resource Management
programs developed in another high-risk industry, commercial
aviation. These focused on leadership strategies, team
communication, and situational awareness, competencies that have
been adapted and expanded for healthcare teams.
Team training programs, such as TeamSTEPPS®
(TeamSTEPPS 2015), a program focused on improving
communication and teamwork skills among healthcare professionals,
and the Veterans’ Administration Medical Team Training program
(VA MTT), a program developed and implemented in forty-three VA
medical centers from September 2003 to May 2007 are now widely
used to improve interprofessional teamwork (Dunn et al. 2007). They
include well-developed content, tools, and delivery methods that can
be implemented and adapted for local groups of learners, as well as
facilitator training programs and planning support.
Recent high-quality studies of team training have shown
improvement in both process outcomes and patient outcomes
(Weaver, Dy, and Rosen 2014). For example, in a controlled study of
VA MTT, risk-adjusted surgical mortality was significantly lower in the
hospitals that implemented team training (Young-Xu et al. 2011). The
MTT hospitals also identified fewer handoff issues, fewer case
delays, better adherence to antibiotic prophylaxis guidelines, and
fewer equipment issues than those that had not implemented the
program. Team training has been recommended by patient safety
experts as a leading intervention to improve safety (Shekelle et al.
2013).
Usually implemented with practicing professionals, team training
has also been offered to students and other trainees, with
improvements in team behaviors and attitudes following training
(Brock et al. 2013). Training has shown positive effects in both
consistent, established teams as well as ad hoc teams that form and
disband quickly, suggesting that skills learned in team training are
transferable (Weaver et al. 2010).

Team Communication

Team communication, whether verbal, written or electronic, is

the underpinning of patient safety and teamwork. Information sharing
positively predicts the performance of teams in medical settings
(Mazzocco et al. 2009; Weller 2014). Teams that share information
well make fewer errors than those that do not.
Specific communication practices can help clinicians share
information accurately and improve patient safety. Examples of
interprofessional communication strategies include:

Closed loop communication, a key element of team training.

The sender clearly identifies the recipient of the information,
ideally by name, and the recipient acknowledges it by repeating
back the key points. Closed loop communication is used
frequently in direct patient care, for example, when a clinician
makes a request of another team member and the recipient
acknowledges the request. It is also applicable to clinician-
patient communication.
Graded assertion is another skill emphasized by both the
TeamSTEPPS and the VA’s Medical Team Training program.
This communication technique is used to respectfully share
safety and quality concerns, with increasing force if the issue is
not acknowledged and resolved. This approach is particularly
helpful for team members speaking up against the hierarchy
gradient that exists on medical teams.
Handoffs within and between professions are major sources
of information drop-off and error, and effective handoffs are
another focus of team training. A structured approach to handoff
communication has been shown to reduce the frequency of
preventable adverse events (Starmer et al. 2014).
Surgical checklists have been widely implemented to
improve safety in the operating room. This structured approach
to team communication levels the hierarchy present on many
 healthcare teams, and encourages information sharing by all
members of the interprofessional surgical team. The most
commonly used checklist, developed by the World Health
Organization (WHO), requires pauses at three points in the
procedure (Haynes et al. 2009):
1. Before the patient is anesthetized, to confirm identity,
procedure, surgical site, and consent.
2. Before the incision is made, to reintroduce all team
members, again verify patient identity and planned
procedure, and to plan for any anticipated critical events.
3. Before the patient leaves the operating room, to check
instrument counts, and to identify key concerns for ongoing
care.

Staff training and implementation of the WHO checklist has

been associated with improved patient safety: mortality was 0.8
percent in hospitals that implemented the checklist versus 1.5
percent in matched controls, and the rate of complications per 100
procedures was 16.7 in implementation hospitals and 26.7 in
controls (de Vries et al. 2010).

Structured interdisciplinary rounds have been shown to

decrease the frequency of preventable adverse events (O’Leary
et al. 2011). This daily meeting encourages all hospital team
members, including nurses, physicians, social workers, and
pharmacists, to share information and review patient plans,
following a consistent and well-defined format and process.

This model has been expanded to include the patient and family
in structured interdisciplinary bedside rounds (SIBR). Stein, the
associate vice chair for Quality at Emory School of Medicine
described features of SIBR utilizing a TeamSTEPPS framework
(retrieved from:
http://www.crepatientsafety.org.au/seminars/designing_hospital_unit
s/designinghospitalunits-dec11-jasonsteinsession2.pdf). The
interprofessional team meets at the bedside of each patient to review
interval events, identifies any safety issues, and formulates and
communicates the plan for the day. Supporting the role of structured
communication in encouraging inclusive teams, staff on a unit using
SIBR were more likely to say they felt comfortable bringing up an
issue for consideration, understood the plan for the day, and were
working on a team than controls who were working on another unit
(Gausvik et al. 2015).
At Emory University Hospital, where this model was developed,
specific competencies have been identified for SIBR and training
implemented. Nurses, medical students, and residents new to SIBR
are observed by a nurse manager or attending physician in an “in-
vivo” objective structured clinical examination (OSCE). Those who
can demonstrate SIBR competencies in five of six consecutive
patients are “certified,” a status that has been met by all daytime
nurses and rotating medicine residents who have participated in the
program (Stein 2015).

Values and Ethics for Interprofessional Practice

Values across professions impact the patient safety culture of an

organization, which is defined at a group level as shared values,
beliefs, norms, and procedures about patient safety. Perceived
organizational culture is an important predictor of clinicians’
willingness to report an error (Linthorst 2012), and a more positive
safety culture has been associated with a lower risk of adverse
events. Interprofessional team training may improve the safety
culture within an organization (Weaver et al. 2013).
Respect for the culture and expertise of all health professions
can also promote inclusivity in teams. A democratic approach to
problem solving, actively engaging the ideas and opinions of all team
members, is associated with better team performance (Woolley
2010). Mutual respect, eliciting input from all when in a team leader
role, and speaking up in a team member role are all encouraged by
team training.

Roles and Responsibilities for Collaborative

Practice
 A clear understanding of each professional’s roles,
responsibilities, and skills allows clinicians to engage all appropriate
professions in the care of a patient, and to distribute work
appropriately. This can enhance patient safety by ensuring that the
team member with the greatest expertise performs patient care
tasks. Knowledge of the care other professionals can provide also
increases the likelihood that unmet patient care needs will be
identified and addressed.

MODELS OF IPE FOR SAFETY AND QUALITY

Interprofessional education to improve patient safety can occur in
many different learning environments: small-group classrooms,
standardized patient exercises, and simulation labs, as well as in the
context of clinical care and project-based learning. Web-based
activities, in some cases interspersed with classroom sessions, are
an emerging way to overcome logistical barriers to IPE, such as
cross-program scheduling and space requirements. In a 2010 report,
the World Health Organization (2010) defined interprofessional
education as occurring “iwhen students from two or more
professions learn about, from, and with each other to enable
effective collaboration and improve health outcomes.”
Key features of IPE can occur in a variety of settings:
interactive, experiential, and is relevant to the goals and experience
of adult learners.

Examples of IPE by Approach and Setting

Classroom-based IPE

At the University of Washington, all third-year dental, second-

year medicine, senior nursing, third-year pharmacy, first-year
physician assistant, and dietetics masters students participate in a
series of four interprofessional small groups over the course of an
academic year. The primary goals of these small groups are to
increase knowledge of professional roles and skills, to enhance
attitudes toward interprofessional collaboration, and to practice team
communication skills.
In the first session, students are presented with a patient
admitted with heart failure, diabetes, and advanced periodontal
disease. Although this patient’s stated goal was to improve and go
home, she declined most treatments offered, as well as nursing
home placement and home care. She remained in the hospital for
weeks, creating professional and ethical challenges for her team. As
this case unfolds in text and video, students improve their
understanding of professional roles as they create a team-based
plan of care, consider the perspective of a profession other than their
own in caring for a “difficult” patient, and practice communication and
respectful disagreement as they attempt to resolve this challenging
situation.
The second session focuses on roles and responsibilities in
outpatient teams, assembled to address the care needs of a
complicated patient. It also addresses an educational gap identified
in across health sciences schools, asking about military service and
eliciting a military history from patients. After students observe a
faculty member elicit a military history from a classmate who served,
they identify the care needs and the professional(s) who could meet
each need in the cases of three veterans: a forty-three-year-old man
with diabetes and chronic pain; a thirty-five-year-old woman seeking
preconception counseling, and a twenty-two-year-old man who
suffered traumatic brain injury.
The third session focuses on community health and the role
each of the health professions can play in community health and
public policy. Students develop a model of the patient and family
contributors and the “upstream” community and policy level
contributors to a major public health problem, pediatric caries. The
students then consider interventions each profession could make at
each level to impact the prevalence and severity of the problem.
In the fourth session, students focus on teamwork and team
communication as they discuss a medical error—administration of an
antibiotic to a patient with a known allergy, resulting in anaphylaxis.
After reflecting on contributors to the error and on team performance,
students practice disclosing a medical error to a patient actor with
empathy and transparency.

Interprofessional standardized patient exercises

An interprofessional standardized patient exercise follows a

series of classroom based IPE sessions at the University of
California, San Francisco. In this half-day exercise, students work
with a team to assess and treat a simulated patient with multiple
chronic illnesses. After a brief orientation, they evaluate the patient.
Team members observe each other as each performs his or her
assessment. They then develop a team-based plan of care, and
meet with a facilitator to present their plan of care and debrief the
exercise. They also receive feedback on their communication and
teamwork skills from the standardized patient and their peers. Both
students and faculty value the exercise, and pre- and post-
administration of the—attitudes toward healthcare teams—survey
demonstrated overall improvement in scores for team value and
team efficiency. In focus groups, students reported that the exercise
allowed them to learn about the roles and skills of other team
members, and improved their ability to collaborate with others
(Wamsley et al. 2012).

Simulation

Simulation offers a realistic but low-risk opportunity for students

to practice working as an interprofessional team. At the University of
Missouri, groups of students from pharmacy, medicine, nursing, and
health administration programs participate in a yearly simulation
workshop. The student teams evaluate five simulated emergency
department patients, representing lower acuity patients seen after a
mass casualty event. Patients are portrayed by standardized
patients and high-fidelity simulators. Patient safety issues, such as
an unrecognized drug allergy, communication issues, pregnancy, or
an unlocked bed, are embedded in each scenario. After ten minutes
to form their team and plan how to approach their five patients,
students assess and manage each. The students then present their
assessment and plan, and debrief the experience with
interprofessional facilitators, focusing on teamwork, communication,
and the safety issues that the team did or did not identify. Facilitators
concluded the debriefing by highlighting safety issues and safety
goals. Almost all students agreed that the simulation had increased
their understanding of the importance of interprofessional
communication, of the roles of other professions, and of patient
safety issues, and a pre- and post-survey demonstrated
improvement in knowledge and attitudes about interprofessional
teamwork (Vyas et al. 2012).
Educators at Louisiana State University developed a two-hour
operating room-based simulation session for fourth-year medical
students entering surgery, nurse anesthetist trainees, and nursing
students. Teams of six students, two from each discipline, managed
two patients: a trauma patient and a patient with a reaction to a local
anesthetic. On a pre- and post-survey, participants demonstrated
significant improvements in self-efficacy in most teamwork and
communication skills. Observers also documented substantial
improvement in team communication and teamwork between the first
and second scenarios (Paige 2015).
At the University of Washington, senior nursing and medical
students and third-year pharmacy students participate in a half-day
workshop based on TeamSTEPPS training. After a one-hour didactic
introduction, student teams evaluate then debrief their team’s
performance with three simulated patients: an elderly hospitalized
man with dyspnea, a teenager in the emergency department with
asthma, and a postoperative patient with supraventricular
tachycardia. Results from the pre- and post-surveys demonstrated
improved attitudes and self-efficacy for team communication and
teamwork (Brock et al. 2013). The value of learning with other
professions has been the most prominent theme in post-workshop
debriefs and evaluations.

Shared clinical experiences

 In the training ward model, interprofessional student teams care
for a small number of patients in the hospital under the supervision
of faculty from each profession. In one recently developed program
in Melbourne, Australia, volunteer senior medical and nursing
students care for patients in two beds of either an emergency
department or a rehabilitation floor. Students take primary
responsibility for these patients’ care, working together and reporting
to senior staff on the ward. On the rehabilitation unit, they were
joined by students from other appropriate disciplines, such as social
work, dietetics, or occupational therapy. Overall student satisfaction
with this experience was rated highly. In focus groups, students
described improved teamwork and collaboration, and a better
understanding of other professions’ roles (Morphet et al. 2014).
Training wards have been established in Canada, Scandinavia, and
other sites in Australia.
Shared clinical experiences can also occur in the outpatient
setting. In one example, eight Australian Universities established the
Capricornia Allied Health Project, in rural Queensland. Exercise
physiology, dietetics, occupational therapy, pharmacy, podiatry, and
social work students are placed in an ambulatory clinic focused on
early interventions for clients with multiple chronic illnesses. Under
the supervision of clinic preceptors, students spend two-thirds of
their time in discipline-specific patient care, and the other third in
interprofessional work, including shared initial intake evaluations and
interprofessional communication and conferences. After completing
this experience, most students reported improved understanding of
team-based care and improved communication, as well as increased
profession-specific knowledge (Frakes et al. 2014).

Online

Online education is emerging as a flexible approach to IPE with

fewer time and space barriers to participation by students from
multiple schools. At Virginia Commonwealth University, fourth-year
medicine, nursing, and pharmacy students and second-year masters
of social work students participate in a web-based interprofessional
geriatrics module with a virtual electronic health record (EHR) (Dow
et al. 2015). This is an online, asynchronous model, based on
principles of team-based learning. Students are divided into
interprofessional teams of about seven students. Each student
receives a profession-specific narrative about an elderly woman, the
information their profession would collect. Students document this
information in the virtual EHR, then other students on the team can
view it. Individual and team knowledge are assessed: students first
answer multiple-choice questions independently, and then answer
again as a team, collaborating online with a team-specific discussion
board. Team members complete anonymous peer evaluations, and
then receive a new chapter of the patient’s story.
Teams that collaborated more, based on counts of log-ins and
discussion board posts and views, had higher individual and team
scores on the multiple-choice questions. Mean team scores were
also significantly higher than mean individual scores, supporting the
benefit of collaboration.
Grand Valley State University in Michigan uses a hybrid activity,
in which a case is presented online and students meet once in
person at a time and location of their choosing, without a need for
facilitators or reserved space. Physician assistant, pharmacy, and
physical therapy students are assigned to develop a written team-
based plan of care for an online patient case, a middle-aged man
with diabetic neuropathy.
In addition to their plan of care, they are asked to submit a brief
reflection on their experience. Qualitative analysis of these
reflections revealed three themes. The first was that the experience
gave students a better understanding of the benefits of team-based
care. The second theme was that the experience increased their
knowledge of the scope of practice and roles of other professionals.
The final theme was that the students felt better prepared to identify
the need for consultation and felt more confident in collaborating with
other professionals. Participating students also demonstrated
improvement in self-assessed ability to communicate with other
professionals and work with a team (Shoemaker et al. 2014).

CONCLUSION
Collaborative care, provided by interprofessional teams, clearly
improves the safety of healthcare in many settings, from the
emergency room to the ICU to the end of life. Undergraduate health
sciences education can prepare students for their roles as
collaborative team members with a variety of IPE strategies, many of
which have been shown to improve students’ knowledge, attitudes,
and skills for working in interprofessional teams. All IPE should be
interactive, experiential, and related to learners’ real life goals, to
maximize the educational impact for these adult learners.

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 Chapter 8
Medical Libraries Supporting
Interprofessional Education
Lauren M. Young, Susan B. Clark,
Connie K. Machado, Elizabeth G. Hinton,
and Mitzi R. Norris
From liaison programs to embedded librarians, medical libraries
have supported the educational activities of the healthcare
professions in their schools and programs through instruction,
outreach, and access to resources. As interprofessional education
(IPE) programs become incorporated into the institutions in which we
work, there is a need to support them as we have other disciplines
and activities.
Libraries are incredibly adept at gauging the needs of their
communities, patrons, and institutions. More specifically, academic
library initiatives are routinely founded upon the best practices and
guiding principles of information literacy and access to information in
conjunction with the didactic and accreditation needs of the
institution. As libraries participate in accreditation and assessment
conversations and activities on campus, they develop goals that
reflect the programmatic needs of individual colleges and
departments. By engaging with their units in these discussions,
librarians demonstrate their interest in and ability to contribute to
evolving needs within the institution. The outcomes of such
relationships can be small and focused, such as working closely with
a specific department to compile lists of the titles held in a discipline
for inclusion in an accreditation review, or larger in scope such as
ongoing instruction and collection development commitments.
Support of IPE falls into the latter category; rather than being specific
and finite in nature, these pursuits should be reflected throughout the
library’s offerings.
This chapter describes the ways in which librarians are
supporting IPE with three primary emphases: instruction, space, and
resources. Literature reviews highlighting activities at various
institutions will be included.
 SUPPORTING WITH INSTRUCTION
Traditional librarian roles have evolved, and outreach and innovation
in instruction have become an important part of this evolution. This
has been most notable for reference and instruction librarians.
Librarians have the knowledge, tools, and resources to expand their
roles and become an integral part of IPE initiatives at their respective
institutions. Librarians are appropriate leaders in IPE because of
their interest in education initiatives and their “neutral” position since
they generally serve each school within their institution and have
knowledge about all relevant programs.
The focus on IPE began in 1988 with the World Health
Organization report Learning Together to Work Together for Health
(World Health Organization 1988) that presented the concept of
multiprofessional education as a means to improve the competence
of health professionals. The Interprofessional Education
Collaborative (IPEC) was formed in 2009 to promote and encourage
substantive interprofessional learning experience to prepare
healthcare professionals (Interprofessional Education Collaborative
2015). Leadership in IPEC includes six national associations of
schools in the health sciences including the American Association of
Colleges of Nursing, the American Association of College of
Pharmacy, the American Dental Education Association, the
Association of Schools and Programs of Public Health, the American
Association of Colleges of Osteopathic Medicine, and the
Association of American Medical Colleges. Additionally, several
program-specific groups for healthcare professions require IPE as
part of their accreditation and competency standards, to include:

Medical (LCME Survey Report Template for Full Survey

Visit Reports. http://www.lcme.org/publications.htm#guidelines/).
Dental (Accreditation Standards for Advanced Education
Programs in General Dentistry.
http://www.ada.org/~/media/CODA/Files/aegd.ashx/).
Nursing (The Essentials of Baccalaureate Education for
Professional Nursing Practice.
 http://www.aacn.nche.edu/education-resources/Bacc
Essentials08.pdf/).
Pharmacy (Accreditation Standards and Key Elements for
the Professional Program in Pharmacy Leading to the Doctor of
Pharmacy Degree. https://www.acpe-
accredit.org/pdf/Standards2016FINAL.pdf/).
Occupational Therapy (2011 Accreditation Council for
Occupational Therapy Education (ACOTE®) Standards and
Interpretive Guide.
http://www.aota.org/-/media/Corporate/Files/EducationCareers/A
ccredit/Standards/2011-Standards-and-Interpretive-Guide.pdf/).
Physical Therapy (Standards and Required Elements for
Accreditation of Physical Therapist Education Programs.
http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CA
PTE/Resources/Accreditation_Handbook/CAPTE_PTStandards
Evidence.pdf/).

Because of the need for IPE and librarians’ evolving roles in

support of it, this section will examine ways in which librarians have
become involved in IPE and will provide examples of how libraries
can play vital roles in the development of new initiatives.

How Librarians Are Getting Involved

Examples of IPE instruction and outreach

Many librarians are using evidence-based practice (EBP) and

problem-based learning (PBL) as models for teaching IPE. Library
faculty develop curriculum, teach courses, create library resource
guides, and employ other means to augment IPE at their institutions,
working across disciplines to align their expertise and resources to
fulfill institutional needs. In 2013, a team of librarians and medical
faculty performed a review of the literature regarding evidence-based
medicine (EBM) training and undergraduate medical education.
Maggio and colleagues (2013) recommend teaching EBM in an IPE
environment in order to expose students to a wider variety of
evidence-based resources and to the challenges that other
disciplines face. Further, the authors found several studies that
incorporated medical librarians into the EBM teaching team and
noted that medical librarians add authenticity to the EBM experience.
Librarians serve as evidence-based practice consultants at
Northeastern Ohio Universities Colleges of Medicine and Pharmacy
(McEwen, Bruce, and Sutton 2010). In one instance, second-year
medical and pharmacy students were divided into groups of eight to
ten and given a case study about a heart patient in an EBP
component called “The Heart Disease Group Project.” During the
six-month course, the students gave oral presentations, submitted a
group paper, and performed self and peer evaluations. The
librarians’ main roles included serving as an EBP consultant during
six class sessions, providing reference services to the students,
grading two sections of the written assignment, and attending all oral
presentations. This project was considered successful because
students attained a greater awareness and understanding of library
resources, an appreciation for interprofessional (IP) teams, and an
understanding of the need for IPE training. Additionally, students
were able to recognize the medical librarian as an integral part of the
interprofessional team. The authors concluded that the integration of
IPE principles into the existing curriculum rendered the instruction
more effective than one-shot library instruction on the topic.
Librarians at the University of Minnesota Bio-Medical Library
teamed up with campus faculty members to present an
interprofessional train-the-trainer workshop on evidence-based
practice (Koffel and Reidt 2015). The workshop included twenty-five
faculty members from the university’s schools of medicine, nursing,
pharmacy, allied health, dentistry, and veterinary medicine, with nine
faculty members and librarians serving as instructors. After receiving
two separate requests from faculty members for EBP faculty
development opportunities, the library recognized a chance for
developing EBP skills in an IPE environment. The workshop
presented the basic EBP skills of literature searching, critical
appraisal of sources, and application, and reinforced the idea that
EBP belongs to all professions. Participating faculty members rated
the workshop favorably and enjoyed the IP learning environment.
 A problem-based learning IPE module was developed at the
University College Dublin School of Public Heath, Physiotherapy and
Population Science, Health Sciences Centre, in Ireland (Cusack and
O’Donoghue 2012). An interdisciplinary team of health professionals,
students, librarians, and an educational developer designed the PBL
IPE module. Ninety-two students from medicine, physiotherapy,
nursing, and diagnostic imaging evaluated the learning objectives,
library information skills, and intellectual stimulation, among
additional aspects of the module. Overall, students valued the unit.
Regarding the library component of the module, 70 percent
responded that the library information sessions were valuable, and
80 percent said the library information skills would be helpful
throughout their programs of study and their future careers (Cusack
and O’Donoghue 2012). Students reported that the best part of the
module was working with and learning from students in other
disciplines, which led to a better understanding of their own
professional roles.
The Himmelfarb Health Science Library at George Washington
University has embedded problem-oriented, case-based learning
into the curriculum design process since 2000 (Butera, Gomes, and
Kakar 2014). The library faculty are members of an interdisciplinary
team that designed and implemented a problem-based learning
course that is taken by first- and second-year medical students.
Library faculty coteach small groups of medical students in a weekly
course that instructs students how to best access information and
locate evidence-based resources. Library faculty also provide
lectures on professionalism and ethics, data searches, finding and
evaluating resources, and evidence-based medicine. In addition, the
library faculty monitor a blog for questions during the ethics lectures.
In annual evaluations, the value of this librarian integration into the
curriculum is consistently acknowledged as evident. The integration
of library instruction into the medical curriculum is a core value of
medical librarianship (Butera, Gomes, and Kakar 2014), and IPE
lends itself perfectly to this initiative.
Library guides (LibGuides) are a web-publishing platform for
libraries to collect and share information on a variety of topics.
Several libraries have chosen to support IPE initiatives by
incorporating IPE-based library guides into their subject guide
listings. The University of Nebraska Medical Center McGoogan
Library of Medicine, University of Massachusetts Medical School
Lamar Soutter Library, Nova Southeastern University College of
Osteopathic Medicine University Libraries, and University of Nevada,
Reno University Libraries are a few examples of libraries that have
embraced IPE by creating library guides (University of Nebraska
Medical Center McGoogan Library of Medicine n.d.; University of
Massachusetts Medical School Lamar Soutter Library 2015; Nova
Southeastern University Libraries 2015; University of Nevada, Reno,
University Libraries 2015).
Librarians have developed unique roles to promote IPE at their
institutions. At the University of Southern California (USC) Norris
Medical Library, librarians provide leadership in IPE. The school
created an extensive IPE portal committed to providing information
and resources for IPE. An IPE committee was formed with members
representing a mixture of students and faculty from the seven
schools within the institution including librarians. The library’s
representative provides a leadership role by scheduling and leading
the meetings, maintaining communication between the committee
members, and performing grant research (Brennan, Chatfield, and
Eandi 2012). The USC IPE portal contains information regarding IPE
initiatives at USC, upcoming IPE conferences, competencies and
evaluation, and scholarly materials to support IPE teaching and
research (University of Southern California Norris Medical Library
2011).
Another way librarians have led IPE programming is by creating
narrative-based educational offerings such as the Common Read
program. At Western Michigan University School of Medicine, a
year-long lecture course was developed around a selected book
(Lorbeer, O’Hagan, and Knuth 2015). A committee composed of
healthcare professionals and a medical librarian found a way to
incorporate IPE into the colleges of medicine, pharmacy, and nursing
and allied health programs and two local hospitals. The first year of
the program was successful; a diverse group of students, residents,
faculty, and practitioners were able to share their thoughts on the
reading and learn from one another in a structured IPE environment.
Based on course evaluations, participants saw value in the program
and expressed their desire to continue the program, albeit with
shorter readings. This type of narrative course also incorporates the
humanities, an emerging area of interprofessional education.
Consumer health librarians can help source interprofessional
teams with patient information, and point learning teams to literature
that addresses social issues in family care paired with clinical issues.
Two of the library faculty at the University of Florida Health Science
Center Libraries have been involved with the Putting Families First
course, which was formerly known as Interdisciplinary Family Health
(Edwards et al. 2015). Students from all six colleges participate in a
year-long course that focuses on teamwork in healthcare. Small
groups of students work with one family throughout the course with
the goal of improving health in nonclinical ways. Library faculty lead
discussion, give feedback to students, provide information on
resources for students to use, and grade papers (Edwards et al.
2015). Because of increased involvement among the different
colleges, the library is seeking ways to broaden the impact beyond
two faculty members working with small groups. See chapter 6 of
this book for a more in-depth discussion of the efforts being made at
the University of Florida Health in the unique Putting Families First
course.
In 2014, Olson and Bialocerkowski conducted a systematic
review of interprofessional education in allied health. The authors’
work suggests that the capacity for IP collaboration, understanding,
and attitude improvement may be greater with more mature or
experienced students. Similar findings emerged at Duquesne
University in Pittsburgh, Pennsylvania, when librarians partnered
with nursing, allied health, and pharmacy faculty to create an
interprofessional health sciences version of an existing information
literacy course (Nolfi et al. 2015). Ten first-year students from each
school were enrolled in the course, and were required to create
PICO (Patient/Intervention/Comparison/Outcome) questions, locate
and evaluate scholarly material, and work in IP groups. Instructors
administered pre- and post-class surveys and the Readiness for
Interprofessional Learning Scale (RIPLS) Questionnaire (Latrobe
Community Health Service and the Health and Socialcare
Interprofessional Network 2009) at the beginning and end of the
semester. Although the sample size was small, students in the IP
group reported that the course had higher relevance to their studies
and careers than either nonhealth sciences students or health
sciences students in the regular information literacy course.
Responses to the RIPLS survey were conflicting; students clearly
understood the importance of IP learning, but many also felt that
they would learn more in classes specific to their own discipline. The
authors suggest that appreciation for IP takes time to develop, but
starting IP learning early is beneficial to the student.

Identifying campus champions and forming

relationships

So how have libraries found success in developing

partnerships? Reaching out to nonlibrary colleagues is necessary,
but librarians must focus on partnering with someone who is willing
to be a champion of libraries in order to successfully implement a
library-supported IPE curriculum.
Pritchard (2010) described the role of librarians in providing
information literacy support to faculty teaching in the science
curriculum. The author describes the commonalities and differences
between “information literacy” and “academic literacy.” Information
literacy is the recognition of the need to understand, find, evaluate,
and use information. Academic literacy is the competencies of
successful students such as critical thinking, reading, writing,
communicating, being part of a team, managing self, and life-long
learning. Librarians are natural partners to effectively teach these
skills. Pritchard emphasizes the need for librarians to identify and
connect with specialists within their institutions. Additionally, she
cautions against the passive role of the “patiently waiting librarian”;
alternatively, librarians need to proactively seek and create
opportunities for participation in IPE.
As stated by Cusack and O’ Donoghue (2012), upper-level
campus management must be invested in the support of IPE.
Additionally, Butera, Gomes, and Kakar (2014) believe it is
imperative that librarians form and strengthen relationships with key
administrators on campus such as deans, directors, and other faculty
members who are spearheading campus IPE curriculum initiatives.
Librarians at the University of Florida HSCL also noted the
importance of connecting with other groups to encourage IPE
(Edwards et al. 2015). The authors stressed the importance of
meeting with administrators to identify ways for librarians to be a part
of IPE at their campus.
In 2010, two faculty librarians at the Health Sciences and
Human Services Library, University of Maryland, Baltimore, were
appointed to an academic task force along with the deans from the
institution’s seven academic schools (Betz and Raimondo 2015).
The charge was to plan and implement a campus-wide IPE program
for students and faculty. Librarian participation in the initiative led to
an IPE library guide, campus-wide IPE days, a presentation to
campus members about nationwide IPE centers, and a significantly
strengthened relationship with senior faculty and deans. The
librarians feel that involvement in campus IPE events has not only
increased visibility on campus and credibility among fellow faculty
members, but it has also positively influenced student opinions of the
library faculty.
The University of Mississippi Medical Center’s Rowland Medical
Library participated in ACRL’s 2014 to 2015 cohort of “Assessment
in Action,” a fourteen-month long assessment-based professional
development program. The team, composed of two librarians and
the executive director of Academic Effectiveness, chose a project
focused on using library resources to improve student learning and
to promote interprofessional growth (Hinton, Norris, and Young
2015). The library worked with the Office of Academic Affairs and the
Interprofessional Subcommittee of the Associated Student Body to
host an interprofessional student event in the library’s Collaborative
Learning Center (CLC) with a clinician/library faculty-led discussion
on Basic Life Support (BLS) and the role of interprofessionalism in
life-saving care situations. Outcomes were measured by discussions
and pre- and post-tests given to two separate focus groups. A nurse
educator administered a BLS pre-test and library faculty
administered an IP core competency survey. Following a short video
clip depicting an interprofessional BLS event, students were asked to
react to the video and share their opinions and feelings regarding the
role of interprofessionalism in life-saving care situations. Finally,
post-tests were administered in order to measure subjective
interprofessional growth and the retention of BLS training. Notes
were taken during the discussions so keywords could be analyzed
for themes upon conclusion. The initial sample indicated growth in
both objective and subjective measures. In both groups, BLS test
results showed the potential for increased retention in an
interprofessional education environment, and answers to the IP
competencies clearly indicated a stronger appreciation for
interprofessionalism after the sessions. The success of this
endeavor was made possible by the support of key administrators on
the institution’s campus.

Conclusion

The value of IPE is increasingly being recognized and required

by program-specific accreditation organizations. The accrediting
standards are being driven by the realization that healthcare is a
team effort and should be taught in an interdisciplinary manner in
order to improve patient outcomes. As healthcare education
demands the use of IPE, librarians are valuable resources.
Librarians must be willing to venture out from the library and
forge relationships with other departments on campus in order to
successfully support IPE. Librarians should look for opportunities to
become involved with campus IPE initiatives. Curricula that employ
problem-based learning or evidence-based practice present an ideal
environment in which librarians can assume a role in embedding
IPE. Many of the examples discussed in this section identify
opportunities for partnership with other campus departments, and
methods of embedding IPE into the existing curriculum.

SUPPORTING WITH SPACE

Planning for Space and Design

 The library in an academic medical center serving numerous
hospitals and schools has always been a solitary entity reaching out
to all the divisions and missions on campus. Originally its main
purpose was to house extensive print collections largely composed
of bound journals required to support all of the health sciences
curricula. As new technologies developed, electronic resources
displaced print materials physically. These volumes are often
removed to an off-site location; consequently, library floor space is
opened up and can look vacant, rendering it vulnerable to
reassignment by institutional administration to other divisions and
offices not affiliated with the mission of the library. Not only have
curriculum styles in the health sciences taken on new philosophies
and practices (Barr 2013), but the role of the library as a physical
space to house print resources and support solitary study has almost
ceased to exist and become outdated (Webster 2010).
“Our experts firmly believe that by 2015, while the manner in
which health sciences libraries develop and deliver services and
collections will drastically change, the health sciences library
would continue to exist, even in an era of easy desktop access to
information. . . . [B]y 2015, they predict that academic health
sciences libraries will house and manage instructional spaces for
activities such as distance-learning classrooms, media labs,
presentation facilities including auditoriums, and configurable
teaching spaces.” (Ludwig and Starr 2005, 321)

Students from the various health-related schools have always

gathered for the common purpose of study in the library. Before
there were IPE initiatives, the University of Mississippi Medical
Center’s Rowland Medical Library’s faculty observed that students
from one discipline studied in proximity to students in other
disciplines. “There was a time when study was always understood to
be a solitary activity, and collaboration was often seen as a form of
cheating” (Bennett 2007). This pattern of siloed study defined the
library as the neutral gathering space that provided a common area
for all students to “claim” as their own (Nordquist, Kitto, and Reeves
2013). This serves in today’s educational environment to equate the
library with a café, student union or any freely available space with
great Wi-Fi; neutral to all where resources are available on personal
devices without the need to be surrounded by voluminous bound
volumes for reference.
Since the library has shed its role as “the physical storeroom of
the collection of books and scientific journals” (Nordquist, Kitto, and
Reeves 2013) and many resources are available electronically 24/7,
it is imperative to redefine its direct role as a keeper of knowledge
resources and transition to a viable physical learning space. The
library acquires, manages, and makes accessible electronic
resources, but these activities are not visible to the user (Nordquist,
Kitto, and Reeves 2013). Warehoused print materials are available
by request, while the newest materials are only a click away on their
own personal devices. This is nothing new in the academic library
world, but where do you begin to reimagine the use of the large
vacant spaces left behind by this trend and remain relevant to the
educational mission?
“Designing and redesigning physical learning space is [of]
strategic importance for leadership in education. We need to pay
attention to it in order for us to stay relevant to society and
prepare the best and most valuable health professional to serve
society’s needs.” (Nordquist, Kitto, and Reeves 2013, 3)

We must survey the physical space, observe the patrons and

their study patterns, and derive a new purpose and role for the
library in medical education. As librarians have embraced new roles,
such as liaison librarians and embedded librarians, the physical
space of the library has not changed. What remains is the footprint of
a library designed decades before to meet needs that no longer
exist. With librarians now represented within the schools and
departments, the “new” library must take an active role in curriculum
design, teaching, and planning. Refer to Lewis’s five steps toward
redefining the academic library “at the end of the age of print
academic libraries” (Lewis 2007, 2). He goes on to provide
meaningful insight into managing this transition.
 PARTS OF THE PUZZLE (SUMMARIZED)
1. Complete the migration from print to electronic
resources.
2. Retire legacy print collections. . . . This will free space
that can be repurposed.
3. Redevelop the library as the primary information learning
space on the campus.
4. Reposition library and information tools, resources, and
expertise so it is embedded into the teaching, learning, and
research enterprises.
5. Migrate the focus of collections from purchasing
materials to curating content.
(Lewis 2007, 3–4)

Finding effective methods to monitor all the educational facets

and changes on campus, which would include interprofessional
education initiatives, curriculum changes, new programs or degrees,
and assessment activities, while continuing to meet the mission of
the institution and the library, is a good first step. The
interprofessional education initiative moves full circle to bring
students back into the library for their collaborative study needs.
Their needs are not for the print material, but for a neutral
environment, fully equipped to facilitate their interprofessional and
collaborative study needs. The library provides this space without
being aligned with one program or school. It is “program neutral” and
is available for longer hours than many other educational facilities
within the various schools on the medical campus, and is open to all
regardless of their school affiliation.
Where do we begin to put new life into the empty space left
behind? What are the first things to consider as we move into the
next century? And how can this space be redesigned to meet current
medical education curriculum needs, while still serving the needs of
the student/patrons and the mission of the library and university?
These are some of the many questions Rowland asked as the print
collections shrank or were relocated, and open space was becoming
the new reality.

Transforming Existing Space into a

Collaborative Student Space with an
Interprofessional Mission: Rowland Medical
Library’s Experience

After considering these questions and many others, Rowland

Medical Library incorporated some design changes to encourage
IPE experiences and adapt to the ever changing role of libraries in
an academic medical center. December 2013, Rowland, serving the
University of Mississippi Medical Center, opened the doors of its
newly created Collaborative Learning Center (CLC). Having
identified outdated, underutilized space within the library floor plan,
the librarians at Rowland endeavored to create a more functional,
collaborative space for library patrons, and tied the initiative to the
interprofessional didactic shift in which the institution was embarking.
The following section frames best practices from the literature within
the experience at Rowland.

Beginning the process

The first logical step for transforming space is research. The

changing uses of library space have been the subject of many
articles, dedicated issues of journals, books, and symposia for over
twenty years. Research from other disciplines as well, such as
interprofessional journals and websites, academic
construction/building, and general educational publications
comprises a significant body of materials for librarians gathering
knowledge and information to move forward.
Gathering information about current educational needs from the
students themselves is a key part of the process. When planning to
collect input about the space transformation, consider a survey of
students and patrons, and ask what they require for study (Jordan
and Ziebell 2009). Don’t forget to include library staff, faculty, and IT
personnel in this planning stage. Based on the survey conducted by
Jordan and Ziebell to investigate client behavior, Webster outlines a
simple method for surveying students on the features of library
learning spaces that support specific study activities (Webster 2010).
IPE learning spaces should be designed and developed “with the
express intention of supporting transparency, interactivity, and
collaboration between the health professions. It is also recognized
that new facilities must be able to adapt to changing needs”
(Cleveland and Kvan 2015). Contact the IPE committee within your
institution, or better, try to become part of the IPE initiative on
campus as it plans space to facilitate this new learning environment.
Questions to consider: On average, how many students would need
to be accommodated in an IPE group? How many groups would be
working simultaneously? Will this be the only space on campus?
Does the IPE planning group envision a need for scheduling the
space or just ad hoc use? Some answers to these basic questions
will give insight into the requirements for an engaged learning
redesign project.
Another method to gather data is to visit other campuses, either
virtually or in person, that have created any type of collaborative
commons within their library. Don’t limit these visits only to medical
campuses. Make notes on designs or concepts that you like or
dislike, and bring these back to the table for discussion. If possible,
involve student representatives and other faculty in offsite visits as
their input gives a different perspective. Inform these nonlibrary
participants of the project and its importance to the mission of the
institution.
Using Lamb and Shraiky’s framework for competency-based
collaborative learning design (see figure 8.1), the library can begin
testing the relationship “between physical design features and
competency-based performance in teamwork and collaboration”
(Lamb and Shraiky 2013). To begin planning for the new
collaborative space, analyze the library’s current available space
using Lamb’s four design themes: flexibility, visual
transparency/proximity, technology, and environmental infrastructure.
Address the facets separately, then work toward integrating these
ideas into planning, and finally, reality. We will add other facets for
consideration from Rowland’s own experience.

Collaborative Learning Environment Features and Collaboration-Readiness Model.

Reprinted with permission from Taylor & Francis.

Flexibility

Flexibility allows the students and other users to easily change

or adapt the environment to their specific needs, to include group
study, problem-solving, or presentations. Take a hard look around
the existing library and square footage that is available for
redesigned, engaged learning. Consider a variety of seating styles
that are easily rearranged to meet the needs envisioned for a new
IPE space and mentioned in student survey results. Vendors can
bring in a variety of seating/table options that can be displayed, and
students can vote on which style they consider most comfortable and
conducive to learning. With planning, this activity could be
incorporated into the overall student survey mentioned above. Other
flexible equipment includes wiring (often a major challenge in older
facilities), lighting, whiteboards (mounted or moveable), and access
to power, presentation needs, and projection needs (Lamb and
Shraiky 2013). Try to visualize this new flexible space encompassing
various seating arrangements that will encourage collaborative
learning. Involve all staff in the early stages of visualization. Many
staff observe different behaviors at different times during service
hours and can contribute their ideas to the planning.

Visual transparency/proximity

When in use by small or large groups, the space should provide

clear sightlines for participants and instructors. Consider instructor-
led sessions, ensuring that all students can see the activities without
obstruction. Also, is the space visible from the rest of the library
interior? Easy to find and access? Would there ever be a need for a
podium? Should the space be totally open and flexible, or should
some smaller rooms be available? Which would work better in your
space for visibility: glass storefronts, or partial walls such as
cubicles? See figure 8.2 for initial drawings for the Collaborative
Learning Center (CLC) at Rowland Medical Library, which did not
include the double glass storefront panels, which were incorporated
later.
Anterior View, Barefield Drawing.
Used with permission.

Technology

While it is difficult to envision the library housing a complete

medical simulation center, this repurposed space can become the
focal point for pre- and post-meetings for students and instructors to
share their mutual interprofessional experiences. With the use of
wired and wireless networks, software, distance learning,
videoconferencing, projection systems, graphics, science software,
and 3D visualization spaces, the opportunities for use are endless.
Work with the campus IT division to see what is included in their
future strategic plan for the campus and work together to replace the
original equipment and remain on the cutting edge of educational
needs (Sens 2010). Be part of the future; don’t be left behind with
empty, outdated space.

Environmental infrastructure
 Though vendors and construction companies have a great deal
of experience in this area, there is a need to learn what best serves
the use of the space. Lighting itself comes in a vast variety of styles,
but needs to work into the existing electrical infrastructure and flow
with existing fixtures. Even the variety of lightbulbs may become an
issue for the campus physical facilities unit.
Is this to be a quiet space in the library, or an area where more
discussion is allowed? Should walls separate the space from outside
areas to ebb this flow of sound? Should the HVAC have separate
controls to adjust temperature in the area? Considering these minute
details can play a pivotal role for students who will decide to either
use, or not use, the new space. It may be too cold, too noisy, or not
have enough electrical outlets. Try to conceptualize users’ needs as
the design becomes a reality.

Plans and drawings

Work with the construction or planning office of the campus to

learn what campus standards need to be incorporated into the
renovation. As a workable plan is visualized, begin to meet with
vendors. Be open to their experience and perspective for the
redesign, but be willing to express your specific needs without
hesitation; be persistent (Yearwood 2015). Begin working with upper
management to identify funding resources, emphasizing that this
mission is not just for the library, but will be effective campus-wide for
all students/patrons/staff. Any plans for redesign should align with
the university’s strategic plans. This show of support for institutional
goals might assist with fundraising and planning efforts. Figure 8.3
gives an aerial view of Rowland’s CLC, showing room for flexibility.
Aerial View, Barefield Floorplan.
Used with permission.

Policy considerations

Start to visualize library policies that may need to be revised or

newly written. Can the space be reserved? Will new services need to
be offered? What will the food policies be? Should staff be assigned
to the space to assist users? Our library gained a broad education
on the use of dongles and had to devise a method for checking out
these tiny links to the new Steelcase media:scapes. Training for staff
on how to troubleshoot or assist users with connectivity must also be
considered.

Publicity

Publicizing the newly redesigned space is a final step toward

inviting use. Work with the IPE committee and host an event
demonstrating the equipment and multiple purposes created by the
redesign project. Emphasize the positives such as longer hours and
neutrality to all schools. Seek publicity through campus news,
reaching out to students and schools specifically. Ensure that this is
not a competition for other spaces on campus with similar facilities,
but a neutral space for all. Expectations for the use of the space will
not be met unless patrons are aware that the space is available.
Host an open house and demonstrate the equipment using library
resources and databases, showing participants how to attach
various devices to the Steelcase media:scape consoles.

Conclusion

Remember that the visualized purpose for the space may not be
reflected in the actual outcome. Students tend to have their own
ideas for space and seating, so be open to their needs. “Students
use these spaces to take command of their own learning” (Bennett
2007). Start with a plan but expect numerous changes along the
way. Initially, invite focus groups (figure 8.4) composed of students,
faculty, and researchers to come, participate, and give feedback.
Focus Group in Action in Rowland’s New CLC.
Photo by author.

As academic medical libraries strive to redefine themselves and

serve evolving institutional needs, there has been a major role
reversal. Librarians now go outside the library and become
embedded, while the students still come to the library, not to retrieve
resources, but to enable them to thrive as engaged learners by
participating in interprofessional experiences in this new environment
designed for IPE.
Be proactive in choosing new partners to collaborate with to
optimize the use of library space. Form connections across the
campus from top administration, down to the faculty, researchers
and students. Have a voice in the library’s future.

SUPPORTING WITH RESOURCES

Providing access to resources is one of the primary functions of a
library. This is equally true for medical libraries, which specialize in
licensing niche, often very expensive, resources to meet the
programmatic needs represented on campus. Resources can be
viewed as falling into one of two categories: resources that are
discipline-specific and support a small group of researchers and
clinicians on campus; and resources that are cross-disciplinary in
nature and of broader interest and relevance. This section presents
a discussion of resources to meet both types of needs as it relates to
interprofessional education.

Library Resources Supporting IPE

Discipline-specific resources

Good news for libraries making initial efforts to support IPE with
resources is that they will already subscribe to numerous resources
that will prove very useful to students. For accreditation purposes,
the core journals for disciplines hosted on campus should already be
available to students. Librarians have likely spent time training
students and faculty on the use of these books, journals, and
databases, so they will be confident moving around within their
discipline’s offerings. In an interprofessional setting, one would
expect students to only be “expert” on the resources within their
discipline. A meaningful exchange would find students contributing to
the case study at hand employing evidence from their discipline’s
literature; their unique offering to the group. A sample list of journals
that have included articles and special issues specifically addressing
interprofessional education can be seen in appendix A of this
chapter. The list, by no means exhaustive of all journals discussing
IPE, represents the wide range of disciplines that are addressing IPE
in their professional literature.

Multidisciplinary resources
 Likewise, there is an increasing number of health sciences
multidisciplinary journals that discuss interprofessional education,
several of which are presented in appendix B of this chapter.

Interprofessional-specific resources

An extension of the discipline-specific resource discussion is to

address the growth of interprofessional education as a discipline in
its own right, with its own core journals. These journals provide
valuable research on IPE as its own subject and address its
integration into healthcare and education. Many have a target
audience of the hospital and academic administrators working to
negotiate the integration of IPE into their curricula in a meaningful
way. Titles include, but are not limited to:

Health and Interprofessional Practice (Pacific University

Libraries);
International Journal of Integrated Care (International
Foundation for Integrated Care);
Journal of Interprofessional Care (Informa Healthcare);
Journal of Research in Interprofessional Practice and
Education (Journal of Research in Interprofessional Practice
and Education).

Libraries would be well-advised to consider nonperiodical

resources in support of IPE, as well. For example, for students
seeking evidence to support the case of their discipline, core books
and textbooks with long-standing, discipline-specific protocols may
be the first place students will turn when considering their unique
approach to treatment within an interprofessional group. Databases
with cross-discipline applications can serve as a thread of
commonality and serve to unify students further in their discussions.
Ensuring access to these types of resources will add depth to
students’ access to sources informing their disciplines’ standards
and protocols in diverse care situations.

Application of Library Resources

 Interprofessional learning teams should be taught to utilize
professional literature in order to develop evidence-based
approaches for care. Learning exercises that successfully foster both
information literacy and interprofessional development will find each
team member researching their discipline’s literature to bring their
unique perspective to the group for consideration. Writing case
studies that meaningfully engage all involved disciplines can be a
challenge, particularly as the number of disciplines involved in the
exercise grows. Case study development will often be accomplished
by professors of the disciplines rather than librarians, but there are
foreseeably circumstances in which it would be beneficial for
librarians to provide case studies for learning teams.
Interprofessional case studies have been made available online by a
number of recognized authorities in the subject, to include:

The University of Western Ontario’s Office of

Interprofessional Health Education and Research offers
numerous, open-access case studies for interprofessional
learning applications. Each case study is tagged with icons
representing the disciplines represented in the exercise, making
it easy to identify the best case study to utilize with a given
group of students. Formats include video and text resources
(http://www.ipe.uwo.ca/Administration/case.html).
The Association for Prevention Teaching and Research
(APTR), a public health and preventive medicine-geared
association supporting education, has compiled an index of
interprofessional case studies organized by emphasis
(http://www.ipe.uwo.ca/Administration/case.html).
The National Health Services of England (NHS) offers a
collection of case studies for interprofessional learning, featuring
a wide range of health issues (http://www.cmft.nhs.uk/education-
and-training/ssp/interprofes
sional-learning-(ipl)/case-studies-for-interprofessional-learning).
A search of the American Association of Medical College
(AAMC) MedEdPORTAL for the term “interprofessional” brings a
large number of results in a wide range of formats, to include
 research articles, case studies, evaluation tools and more
(https://www.mededportal.org/ipe/).

A thorough web search will reveal numerous additional freely

available interprofessional case studies authored by associations,
organizations, and institutions of higher learning from around the
globe (suggested search terms include “interprofessional case
study,” “IPE case studies,” and “interprofessional practice case
studies”). Librarians seeking to supply content as well as other forms
of support for IPE exercises should consult these and other reliable
sources of case studies.

Conclusion

Librarians can begin supporting IPE in their institutions now.

Consider what might be the best approach for your library when
considering the axis of space, resources and instruction. What does
your library already have in place that it can maximize for this
didactic approach?
Refer to the planning guide in Appendix C as a place to start
mapping out where your campus is on the IPE timeline, where your
library is, and how you can begin work now to support your
academic programs in this initiative.

APPENDIX A: JOURNALS THAT HAVE PUBLISHED

ARTICLES AND SPECIAL ISSUES SPECIFICALLY
ADDRESSING INTERPROFESSIONAL EDUCATION

JOURNAL TITLE COPYRIGHT HOLDER / PUBLISHER

Academic Emergency Medicine Society for Academic Emergency

Medicine / Wiley

Academic Radiology Association of University Radiologists /

Elsevier

American Journal of Pharmaceutical American Association of Colleges of

Education Pharmacy

American Journal of Public Health American Public Health Association

 Anatomical Sciences Education American Association of Anatomists,
published in cooperation with the American
Association of Clinical Anatomists and the
Human Anatomy and Physiology Society/
Wiley

Australasian Journal on Ageing Wiley

BMC Medical Education BioMed Central

Internal Medicine Journal Royal Australasian College of

Physicians / Wiley

JCN Journal of Clinical Nursing Wiley

Journal of Allied Health Association of Schools of Allied Health

Professions / Ingenta

Journal of Dental Education American Dental Education

Association

Journal of Pain and Symptom American Academy of Hospice and

Management Palliative Medicine / Elsevier

Journal of the American Geriatric The American Geriatrics Society/Wiley

Society

Medical Dosimetry American Association of Medical

Dosimetrists / Elsevier

Medical Teacher Informa Healthcare

Nurse Education in Practice Elsevier

Nurse Education Today Elsevier

Surgical Clinics of North America Elsevier

The Journal of Law, Medicine and American Society of Law, Medicine

Ethics and Ethics, Inc. / Wiley

APPENDIX B: HEALTH SCIENCES MULTI-

DISCIPLINARY JOURNALS THAT DISCUSS
INTERPROFESSIONAL EDUCATION

JOURNAL TITLE COPYRIGHT HOLDER / PUBLISHER

Family Medicine Society of Teachers of Family Medicine / American

Academy of Family Physicians
 The Journal of The Alliance for Continuing Education in the Health
Continuing Education in Professions, the Society for Academic Continuing Medical
the Health Professions Education, and the Council on Continuing Medical Education,
Association for Hospital Medical Education / Wiley

Clinical Teacher Association for the Study of Medical Education / Wiley

Academic Medicine Association of American Medical Colleges / Wolters

Kluwer

APPENDIX C: SUPPORTING IPE @ THE LIBRARY

PLANNING GUIDE
What instructional programs does the library currently offer?

Within these areas, where does IPE best fit?

Who are the IPE champions on campus?

Of these people, with whom do we already have a relationship?

Whom do we endeavor to form a relationship with in this effort?

How is IPE instruction being delivered on campus?

How can the library support these existing efforts?

 Where are IPE activities being held on campus?

Does the library have space to support IPE activities?

Does the library have space that could be maximized with

collaboration and IPE in mind?

What information resources does the library have to support IPE

learning teams?

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Lamb, Gerri, and James Shraiky. 2013. “Designing for
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 Chapter 9
Clinical Medical Librarians and
Interprofessional Practice
Lisa Travis and Skye Bickett
To date, there is no agreed upon definition of or set of duties for
clinical medical librarians (CML); however, some authors have
created definitions and lists of duties for the purposes of their own
research (Aldrich and Schulte 2014; Banks 2006; Davidoff and
Florance 2000; Esparza et al. 2013; Plutchak 2002; Rankin,
Grefsheim, and Canto 2008; Tan and Maggio 2013). Some literature
suggests that a definition may limit the role of the CML and how it
can change with patient care, technology, and other transformations
that occur in interprofessional healthcare (Aldrich and Schulte 2014;
Banks 2006; Plutchak 2002; Rankin, Grefsheim, and Canto 2008).
Like a definition, the title of a CML may also vary. A person in this
position may be called a clinical informationist, patient care librarian,
hospital librarian, clinical medical librarian, librarian informationist,
liaison librarian, or health sciences librarian, to name a few (Plutchak
2002; Rankin, Grefsheim, and Canto 2008; Tan and Maggio 2013).
Even without a concise description, the justification for the need of a
CML to support interprofessional healthcare teams in a variety of
ways is clear (Urquhart et al. 2006). The incorporation of CMLs into
interprofessional practice has the potential to improve patient care
and safety, enhance the accuracy and timeliness of information used
at the point-of-care, and stress the importance of using current,
scholarly resources (Banks et al. 2007; Brandes 2007). For the sake
of consistency and to avoid confusion with terminology, those who
provide library services in the clinical setting will be termed clinical
medical librarians (CMLs) throughout this chapter; this term will be
used in place of other job titles and roles that are used in the
literature, such as clinical informationist.

JUSTIFICATION OF CML
Literature suggests that CMLs are useful as part of interprofessional
care teams for a variety of reasons. Changes in accreditation also
support the need for CMLs in the clinical setting. Some accreditation
standards include aspects of education for healthcare professionals
and residents with which CMLs could assist. The information in
these accreditation standards are for programs and institutions that
work with physicians and residents. They include life-long learning
programs, technology to enhance learning and practice, and
education and improvement based on practice initiatives
(Accreditation Council for Graduate Medical Education [ACGME]
2007). Perhaps the most important feature that points directly to the
use of CMLs in interprofessional care is that the standards call for
residents and physicians to be able to locate, evaluate, and
synthesize literature to assist with patient care (Aldrich and Schulte
2014; Esparza et al. 2013).
This last feature highlights one of the most obvious and
traditional roles of a librarian, which is to find and appraise literature
for their users. CMLs are expert searchers and can use their skills to
find and evaluate information pertaining to prognosis, drug
interactions, and other aspects of patient care (Esparza et al. 2013;
Jerome et al. 2001; Rankin, Grefsheim, and Canto 2008; Tan and
Maggio 2013; Turman et al. 1997). This role is important to
healthcare professionals and residents, because it allows them to
focus on direct patient care instead of on finding information. In fact,
physicians acknowledge the need to quickly locate literature to help
care for their patients and recognize that CMLs can help with this
task. Literature states that when CMLs help with this task, it not only
assists with patient care but saves physicians time and helps
increase physicians’ knowledge of medical advances (Aldrich and
Schulte 2014; Esparza et al. 2013). In some cases, CMLs have
expanded their roles with regard to literature searching to benefit
physicians. This role expansion involves reading the literature to
decide what information is most pertinent to a patient case and
summarizing the information for the physician (Jerome et al. 2001).
Another reason for the use of a CML in the clinical setting is to
educate healthcare professionals and residents. The topics covered
in educational sessions include accessing and using library
resources, searching the literature for relevant information, and
evaluating the literature (Algermissen 1974; Greco et al. 2009; Tan
and Maggio 2013). This element of a CMLs role is almost as
important as literature searching. These educational sessions can
take place in small groups or one-to-one interactions (Tan and
Maggio 2013). Instruction can assist in teaching healthcare
professionals and residents how to answer questions surrounding
patient care when the CML is not available and thus improve clinical
practice (Jerome et al. 2001). Research has shown that the literature
searching skills of those involved in educational sessions improve
(Greco et al. 2009).
Evidence-based medicine support is an aspect of the CMLs role
that can involve both literature searching and instruction, which have
been shown to improve the use of evidence-based practice (Greco
et al. 2009; Koonce, Giuse, and Todd 2004). Literature states that
physicians rely on evidence to make a decision. Using a combination
of knowledge, experience, and evidence assists physicians in
making informed decisions about patient care. CMLs play an
important role in the application and use of evidence in clinical
decisions. They connect the evidence found in literature to the care
of patients (Deshpande et al. 2003; Jerome et al. 2001; McKibbon
1998).
Perhaps the most justifiable reason for having a CML as part of
an interprofessional team in the clinical setting is to assist busy
physicians and residents find evidence to assist with patient care
(Aldrich and Schulte 2014). Databases contain millions of abstracts
and articles with more information added daily and new journals
regularly beginning publication too. This inundation of information
means that physicians and residents will never be able to peruse all
of the available information. In general, physicians and residents will
overlook some information and may not be aware of all of the
resources available to them. This type of oversight impacts patient
care and outcomes and, in some cases, means that evidence will not
be found for some questions raised in the clinical setting (Davidoff
and Florance 2000; Jerome et al. 2001). The use of a CML can
alleviate the burden of information overload faced by physicians,
residents, and other healthcare professionals. A CML, trained to find,
appraise, and distill information, can help healthcare professionals
and interprofessional healthcare teams obtain the evidence they
need to answer clinical questions and assist in patient care (Esparza
et al. 2013; Jerome et al. 2001; Urquhart et al. 2006).

CMLS AND THE HISTORY OF ROUNDING

The use of CMLs as part of interprofessional teams in the clinical
setting first appeared in the literature in the 1970s in institutions
around the United States (Algermissen 1974; Miller and Kaye 1985;
Roach and Addington 1975; Turman et al. 1997; Vaughn 2009).
According to these sources, the first CML position began in 1971 at
the University of Missouri-Kansas City Medical Library. The person in
this position worked mainly within the library to perform literature
searches but still worked closely with rotating students, residents,
and healthcare professionals. However, the CML soon began
attending rounds, participating in discussions, and seeing patients.
Two additional CMLs were added to this interprofessional team
along with a secretary and library clerk to handle the increased
workload (Algermissen 1974).
In 1973, the CML at the Cook County Hospital in Chicago began
attending weekly rounds and supplying information to the
interprofessional healthcare team based on these interactions. The
CML also provided bibliographies for weekly seminars that were
meant to orient students, residents, and healthcare professionals to
the department and provided articles that reviewed previous
evidence or included new information on specific topics.
Collaboration and coordination between the CML and the
department chair were very important to the success of this program
(Roach and Addington 1975).
An experimental, part-time CML position started at the Florence
A. Moore Library of Medicine in 1976 for the Department of
Pediatrics. Due to the success of this position, another part-time
position began for the Department of Surgery. By 1978, the library
developed a full-time position at the Hospital of the Medical College
of Pennsylvania for the Department of Medicine. In this position, the
CML attended rounds and the morning report. Following these
exchanges, the CML provided literature based upon information from
the reports or cases, whether or not there was a specific request for
information. Over time, the use of the CML increased and the
number of questions almost doubled, with the majority of questions
relating to patient cases. The CML provided educational sessions
and literature searches and proved to be a timesaving, cost-effective
service for the Department of Medicine (Miller and Kaye 1985).
The Tompkins-McCaw Library at the Medical College of Virginia
Campus of Virginia Commonwealth University had a CML program
from 1977 to 1983, when budget cuts forced the library to
discontinue the program. During this time, the CML participated in
rounds and was part of an interprofessional healthcare team. The
CML provided literature searches and educated healthcare
professionals about how to find information. In 1993, the library used
information from this program to guide a program intended for third-
year medical students. Instead of serving as an information provider,
this program would focus on the CML as an educator. The CML
provided education to the medical students on how to search for
information in the clinical setting. Specifically, the CML introduced
the medical students and their interprofessional healthcare team
members to library resources and services, literature and drug
information databases, and the document delivery service (Turman
et al. 1997).
In the past five years, the acceptance of CML has grown, and
more institutions have established the role. The CML is part of the
interprofessional healthcare team and is involved in aspects of
patient care. While some institutions, such as those in the previous
examples, have had the CML position for decades, others have only
recently employed this type of position. Instead of CMLs, some
institutions have opted for a subject or liaison librarian, who may or
may not be embedded in an interprofessional healthcare team
(Aldrich and Schulte 2014). These examples demonstrate the need
for and success of a CML since these types of service began.
The authors conducted a survey to gather information about
librarians’ experiences with rounding and serving as part of an
interprofessional team. The survey was distributed via local,
regional, and national listservs and individual e-mails in fall 2015.
Forty-seven librarians responded to the survey, twenty-five of whom
participate in rounding or are part of an interprofessional team at
their institution. However, only eighteen respondents answered the
remainder of the questions concerning rounding. The majority of
these respondents (72 percent) began rounding between the years
of 2011 and 2015. The next largest grouping of respondents (22
percent) began rounding between the years of 2001 and 2005.
Finally, one respondent replied that the CML began rounding in
1950. This answer implies that, even though the literature does not
mention CMLs participating in rounds until the 1970s, librarians may
have been participating in rounds for years before that date.
For those that do not participate in rounds or participate in an
interprofessional team, the survey asked why this was the case.
Twenty-two respondents replied to a question that asked them to
indicate all reasons that applied to their situation. Eight respondents
answered that they did not have enough staff or that they rounded in
the past, while seven respondents stated that they did not have
enough time. Six respondents indicated that they were in the
planning stages to begin a rounding program at their institution. Four
respondents stated that they believed clinical personnel did not want
them participating in rounds. Other comments indicated that
respondents were not asked to participate in rounds, were new to
the position and did not previously feel knowledgeable enough to
participate in rounds, or have not looked into the possibility of
rounding. Finally, it is interesting to note that no respondents
answered that they had no desire to participate in rounds.

THE PROFESSIONALS AND DISCIPLINES

COMPRISING THE INTERPROFESSIONAL TEAM
CMLs work with a variety of healthcare professionals and disciplines.
One of the first CMLs worked with physicians, nurses, social
workers, clerks, and administrators (Roach and Addington 1975). As
interprofessional teams grew, so did the variety of professionals with
which CMLs worked. One 1997 article reported that the CML mainly
worked with third-year medical students, but also supported
attending physicians, residents, interns, nurses, social workers, and
pharmacists (Turman et al. 1997). Similar articles reported that
CMLs rounded with more than one healthcare team, provided
reference services, and conducted lectures. The interprofessional
healthcare teams included medical students, residents, physicians, a
pharmacist, and a social worker (Burdick 2004; Sladek, Pinnock, and
Phillips 2004).
Other articles emphasized rounding with interprofessional
teams. These interprofessional teams could include students, clinical
clerks, nurses, physicians, pharmacist, nurse educators, case
managers, dieticians, wound care specialists, and respiratory
therapists. Depending on the situation, the team may also
incorporate chaplains, palliative care professionals, speech
therapists, physical therapists, and even family members. Some
interprofessional teams are not as well-defined, meaning that
healthcare team members are more broadly discussed as medical,
nursing, or allied health professionals or students (Aitken et al. 2011;
Aldrich and Schulte 2014; Brandes 2007; Esparza et al. 2013; Greco
et al. 2009).
The authors’ survey asked respondents to indicate all of the
healthcare professionals with whom they rounded. Sixteen
respondents rounded with physicians, fifteen with residents, twelve
with medical students, and eleven with pharmacists. Seven
respondents participated in rounds with RN nurses, four with a
dietician, three with a surgeon, and three with a social worker. One
respondent stated that they rounded with a physical therapist and
one with a nursing student. Other respondents indicated that they
rounded with interns and EPIC documentation specialists. One
respondent gave a detailed list of their rounding team, stating that
they rounded with physicians, residents, pharmacy students,
physician assistants, and nurse practitioners.
As with the types of professionals the CML rounded with, the
disciplines also varied. One of the most common disciplines that the
CML has rounded with is the internal medicine department (Aitken et
al., 2011; Aldrich and Schulte 2014; Burdick 2004; Esparza et al.
2013; Schwing and Coldsmith 2005; Turman et al. 1997). However,
literature states that CMLs also round with general surgery, family
medicine, obstetrics and gynecology, pulmonary medicine, intensive
care unit, general medicine, ambulatory care, sleep disorder, and
rheumatology departments (Brandes 2007; Greco et al. 2009; Roach
and Addington 1975; Vaughn 2009).
The majority of those who responded to the authors’ survey
(seven each) indicated that they rounded with an internal medicine
or critical/intensive care unit. Three respondents each stated that
they rounded with a family medicine or pediatrics team, while two
respondents rounded with the surgery department. Other
respondents indicated that they participated in psychiatric, bariatric,
chronic pain, endocrinology, cardiology, neonatal intensive-care unit,
gynecology, cardiothoracic surgery, and neurology rounds.

DEFINITION AND DESCRIPTION OF ROUNDING

Rounding has a variety of meanings in clinical settings. This chapter
will focus on bedside rounds in which healthcare providers go from
patient room to patient room while discussing cases along the way.
In addition to bedside rounds, there are other activities that are also
called rounds, such as table-top rounds in which healthcare
providers gather around a table to discuss a case (Lyons et al.
2015). Departments, committees, wards, and interprofessional
teams may host a variety of rounds, such as ethics rounds
(Svantesson et al. 2008) or turnover/shift change rounds (Lyons et
al. 2015). Many hospitals host grand rounds that are lectures on
topics of interest to a wide audience. One hospital calls its weekly
morbidity and mortality conference “quality of care” rounds (Greco et
al. 2009). CMLs may participate in a variety of rounds for the
purpose of supporting interprofessional teams (Lyons et al. 2015) or
patient education efforts (Lindner and Sabbagh 2004).
While rounding, CMLs work within an interprofessional team as
they discuss cases and move from patient room to patient room.
During rounds, CMLs may serve as patient advocates (Lyon et al.
2015), provide instruction, and respond to questions that arise from
healthcare providers or are thought of by CMLs (Aitken et al. 2011);
responses may be provided on the spot or within a short period of
time after rounding ends (Esparza et al. 2013). Because of the
nature of rounding, CMLs may only provide instruction in brief bursts,
if at all. Figure 9.1 shows how the CML’s presence affects how
clinical problems are handled (Deshpande et al. 2003).

Comparison of Traditional (a) and Evidence-Supported Ward Rounds.

Reprinted with permission from John Wiley and Sons.

Examples of Questions Asked and Resources

Used
 Questions that arise during rounds may cover the full spectrum
of patient care as well as institutional policies and procedures.
Common question types include those that focus on diagnosis and
therapy (Aldrich and Schulte 2014; Greco et al. 2009). Questions
may be either background or foreground in nature, and review
articles and guidelines are commonly requested items to meet
interprofessional teams’ needs (Aldrich and Schulte 2014).

The range of questions to which the CML responds extends

from the very general to the extremely specific. Often a faculty
member or senior resident will request a “few good general
articles” on a current patient problem, both as an update on
present management and for teaching purposes. At the other
end of the spectrum, there may arise the need to know
something specific as “a list of diseases and/or drugs causing
the urine to turn green,” and questions can be as specific as: “Is
the CPK elevated in Eaton-Lambert Syndrome?” (Miller and
Kaye 1985)

As previously mentioned, questions may be answered quickly

during rounds or require hours to answer after rounds. CMLs use a
variety of resources to answer questions. Some questions may be
answered quickly by using point-of-care tools, while other questions
may require use of MEDLINE® (U.S. National Library of Medicine
2015) and other similar large databases. Occasionally CMLs must
use nonmedical databases, such as business or legal databases, to
answer questions.

CMLs and Use of Time

As previously stated with interprofessional CML rounding

services, CMLs spend part of their time rounding and part of their
time searching literature. Some CMLs participated in rounds once
per week and held instructional sessions on other days (Burdick
2004; Deshpande et al. 2003; Turman et al. 1997). Other CMLs
rounded two to three times per week or daily with each of their
healthcare teams (Aldrich and Schulte 2014; Burdick 2004; Esparza
et al. 2013). Depending on the institution and the CML, the time
allotted to each of these activities varied. In some instances, the
CML spent three to six hours per week rounding, while others spent
ten to twelve hours per week rounding with healthcare teams (Aitken
et al. 2011; Aldrich and Schulte 2014; Esparza et al. 2013; Schwing
and Coldsmith 2005).
Eighteen respondents to the authors’ survey answered the
question regarding the frequency of rounds. Two respondents replied
that they rounded every two weeks as part of an interprofessional
team. Eight respondents stated that they rounded once per week
with their teams, with one respondent specifying that they rounded
as part of four to five different interprofessional teams and another
stipulating that they participated in rounds one to two times per
week. Six respondents indicated that they rounded twice per week,
with one clarifying that they may round two to three times per week
for each of their two teams. Three respondents said that they
rounded four times per week.
When specifying the number of hours dedicated to rounding,
respondents indicated a range of hours. Some respondents
identified the number of hours per interprofessional team, while
others simply identified their total number of weekly hours spent
rounding. For the purposes of this study, answers were calculated
per respondent. Two respondents rounded one hour per week, two
more rounded one to two hours per week, one participated in rounds
two hours per week, two other respondents rounded two to three
hours per week, and one rounded three hours per week. Additionally,
one respondent indicated that they rounded four to five hours per
week, two joined in rounds seven hours per week, one rounded eight
hours per week, and another rounded eight to nine hours per week.
Other respondents answered with broader ranges for the number of
hours they rounded per week. The ranges provided by these
respondents were two to five, two to seven, six to nine, and twelve to
fifteen hours per week. One respondent stated that they did not
round weekly but that each round took two to three hours to
complete.
When CMLs first began conducting literature searches in
conjunction with rounds for interprofessional healthcare teams, it
could take twenty-four hours to complete the request (Roach and
Addington 1975). However, with the introduction of online databases,
searches took less time. The literature indicates that a CML takes an
average of two hours to answer simple questions and five hours to
answer complicated questions, with one article stating that a CML
spent over 636 hours over a seventeen-month period to answer
literature searches (Esparza et al. 2013; Jerome et al. 2001). Other
literature suggests that CMLs conduct nineteen to thirty searches per
month for their healthcare teams (Aldrich and Schulte 2014; Vaughn
2009).
The survey also asked about the amount of time each week that
it took to respond to literature searches and other tasks arising from
rounds. One respondent spent less than an hour per week on
searches and tasks resulting from rounds, two indicated that they
spent an hour per week on these activities, three of the participants
stated that they spent one to two hours per week on tasks, while
three more devoted two to three hours per week on these
responsibilities. Furthermore, one respondent said that they spent
three hours on literature searches and other tasks, another stated
that they spent three to four hours on these activities, two more
respondents devoted four hours to these projects, and one spent ten
hours per week on tasks associated with rounding. As with the
number of hours spent rounding, some respondents provided a
larger hourly range for the time spent on activities and questions that
arose during rounds. Two respondents stated that they spent two to
four hours on literature searching and other tasks, another spent four
to six hours, and a final respondent said that they spent anywhere
from eight to fifteen hours and up to twenty depending on the types
of questions raised during rounds.
The authors’ survey asked participants whether they considered
rounding an effective use of their time. Seventeen of the
respondents stated that they found participating in rounds an
effective use of time, while one did not find rounding to be an
effective use of time. Two of the respondents who answered “yes”
added the caveat that rounding may not always be an effective use
of time because they may not be always be consulted during rounds.
Interestingly, the reason one respondent stated “no” was that they
felt they were too old. Several themes emerged from the comments
made by respondents. The main theme was that participating in
rounds was an effective use of time because it increases the visibility
and demonstrated the value of the library. The next two major
themes that surfaced were building rapport with interprofessional
healthcare teams and using evidence to support and improve patient
care. The next theme that arose from respondent comments was
that respondents found that they developed a greater understanding
of patient care and the disciplines with which they worked. The final
two themes emerging from survey answers were that respondents
garnered additional opportunities and saved healthcare teams time
so that they could focus more on their patients.

Devices Used When Rounding

When CMLs first began to round with healthcare teams, they

used clipboards, paper and pen, MEDLINE®, and indices to perform
their rounding, educational, reference, and literature searching duties
(Algermissen 1974; Roach and Addington 1975; U.S. National
Library of Medicine, 2015). As technology advanced, so did the
systems and devices used and the availability of these resources to
healthcare team members. The ACGME includes the use of
technology to enhance resident learning as part of accreditation
standards (ACGME 2007). The use of computers has increased, and
portable computer terminals are seen throughout medical facilities.
In addition to computers, tablets, cell phones, and other mobile
devices are used by CMLs to answer questions during rounds
(Aldrich and Schulte 2014; Brandes 2007; Burdick 2004). Fourteen
of those who responded to the authors’ survey stated that they
carried devices with them during rounds to answer questions. Eleven
used a tablet computer, six used a mobile phone, and one used a
laptop.

PLANNING TO SET UP A ROUNDING SERVICE

Feasibility Studies
 When planning to set up a rounding service as part of an
interprofessional team for an existing clinical librarian or a new CML
program for a hospital, one may want to conduct a feasibility study.
Existing feasibility studies may serve as effective models for such a
study. In one feasibility study, Sladek, Pinnock, and Phillips (2004)
questioned medical doctors, including clinical unit heads and
postgraduate trainees, about important issues related to a proposed
service that included rounding by CMLs. Later Sladek, Pinnock, and
Phillips (2004) conducted a prospective uncontrolled pilot study of
fourteen physicians working in the selected units in which a CML
attended ward rounds and clinical meetings. Lewis (1998) used a
structured questionnaire to interview thirty clinicians at the Leicester
General Hospital National Health Service (NHS) Trust about the
feasibility of a CML service. After a six-month pilot of the service, a
three-year project with a pre-planned evaluation was completed
(Ward, Honeybourne, and Harrison 2001). After providing an
introduction to a proposed evidence-supported delivery suite ward
rounds service at Birmingham Women’s Hospital, Deshpande and
colleagues (2003) employed discussion groups and interviews to
solicit opinions from fifteen clinicians as part of planning the service;
they also conducted a pilot of the rounding service.
The feasibility study by Sladek, Pinnock, and Phillips (2004)
examined “key issues in the development and delivery” of a CML
service (termed informationist in the article). These issues included
communication about the CML concept, perceptions of relevance
and potential use of a CML, and “willingness to participate in a pilot,
and identification of current barriers to searching for evidence or
concerns about” a CML service. When asked if a CML would be
useful, thirty-six of forty respondents (90 percent) indicated that a
CML would be likely or very likely to be useful. When asked to
identify a scenario in which a CML might be most useful, the most
common responses were inpatient settings and ward rounds. With
regard to the positive responses, the study acknowledged that social
desirability bias may have played a role. Respondents also
expressed concerns about the proposed service. Thirty-one of forty
respondents (77.5 percent) were concerned that a CML service
would likely have a high workload. Seven of forty doctors (17.5
percent) were concerned that a CML service could result in a
worsening of clinician skills/responsibility (Sladek, Pinnock, and
Phillips 2004).
Lewis concluded that clinicians were interested in the CML
concept and were willing to be project participants. She decided to
undertake a modified pilot project, with attending clinical meetings
seen as more beneficial than joining ward rounds (Lewis 1998).
Deshpande and colleagues (2003) aimed to identify concerns
about knowledge, skills, attitudes, and behaviors related to providing
a CML rounding service and devising methods to effectively address
barriers that were then employed in a pilot study. The study found
that clinicians had little awareness of possible advantages to having
a CML present during rounds. Clinicians were also unsure of their
evidence-based practice skills. Clinicians were skeptical about the
service, feared loss of autonomy, lacked motivation to change, and
were resistant to change. A specific concern that arose was that a
CML on rounds may “make the clinicians ‘diverge from patient care.’”
Deshpande and colleagues (2003) developed a variety of methods
to address the barriers (see figure 9.2).
Some Strategies to Deal with Barriers to Evidence-Supported Ward Rounds.
Reprinted with permission from John Wiley and Sons.

Integrating into the Interprofessional Team

In planning the integration of CMLs into an interprofessional

team, it is important to get buy-in. If the library has champions in
specialties in which the CML could round, approaching them with the
idea would be a great place to start. Champions may be found in
areas in which the library currently provides services, such as a
journal club. At Birmingham Women’s Hospital, time was used during
journal club to solicit opinions on a proposed rounding service; once
the rounding service was in place, questions and their related
appraisals were presented at journal club, thus working to receive
and increase buy-in (Deshpande et al. 2003). Rather than
participating in rounds for several hours per week when initiating a
rounding service, CMLs could ease into providing a rounding service
(e.g., by attending one round per week) so as not to overwhelm
themselves or the interprofessional healthcare providers and then
gradually gain more buy-in for expanding the service.
For members of clinical teams with whom the CML is
considering rounding, the CML could provide one or more relevant
articles to introduce them to the concept of CML’s participation in
rounds. Deshpande and colleagues (2003) provided an article by
Sackett and Straus (1998) to clinicians for this purpose as part of a
feasibility study for a rounding service. CMLs could provide copies of
the randomized trial by Marshall that showed that information-
seeking behaviors by healthcare providers served by a rounding
CML differed from others who did not receive the service (Marshall
and Neufeld 1981). Other useful articles that could be used to
promote the future service include studies by King (1987), Marshall
(1992), and Klein and colleagues (1994) that all determined that
services by CMLs affected patient care decisions and length of stay.

ACCREDITATION STANDARDS THAT ARE

SUPPORTED BY ROUNDING SERVICES
Explaining that rounding with interprofessional teams is a service
that supports accreditation standards may help a CML obtain buy-in
for the service. Following are relevant standards for medical schools
and graduate medical education that are supported by a CML’s
participation as part of the interprofessional team.

Relevant Accreditation Standards for Medical

Schools

The accrediting body for allopathic medical schools, the Liaison

Committee on Medical Education (LCME), developed the Standards
for Accreditation of Medical Education Programs Leading to the M.D.
Degree, which includes five relevant standards: Standards 3.2, 7.1,
7.4, 7.9, and 8. Standard 3.2 states, “A medical education program is
conducted in an environment that fosters the intellectual challenge
and spirit of inquiry appropriate to a community of scholars and
provides sufficient opportunities, encouragement, and support for
medical student participation in the research and other scholarly
activities of its faculty.” Standard 7.1 states, “The faculty of a medical
school ensure that the medical curriculum includes content from the
biomedical, behavioral, and socioeconomic sciences to support
medical students’ mastery of contemporary scientific knowledge and
concepts and the methods fundamental to applying them to the
health of individuals and populations.” LCME’s Connections: A
Detailed View of LCME Accreditation Standards and Elements for
the 2015 Academic Year includes a table of curriculum content in
support of Standard 7.1 that includes evidence-based medicine and
indicates for staff to check “whether the topic is taught separately as
an independent required course and/or as part of a required
integrated course” and in what year (first, second, or third or fourth)
the topic is taught. LCME’s Standard 7.4 states, “The faculty of a
medical school ensure that the medical curriculum incorporates the
fundamental principles of medicine, provides opportunities for
medical students to acquire skills of critical judgment based on
evidence and experience, and develops medical students’ ability to
use those principles and skills effectively in solving problems of
health and disease.” The detailed view document lists two skill sets
in tables that staff use to compile information in support of meeting
the standard: “skills of critical judgment based on evidence and
experience” and “skills of medical problem solving.” Entitled
“Interprofessional Collaborative Skills,” Standard 7.9 states, “The
faculty of a medical school ensure that the core curriculum of the
medical education program prepares medical students to function
collaboratively on health care teams that include health professionals
from other disciplines as they provide coordinated services to
patients. These curricular experiences include practitioners and/or
students from the other health professions.” Connections’s guidance
for standard 7.9 of the survey report states, “Provide three examples
of required experiences where medical students are brought
together with students or practitioners from other health professions
to learn to function collaboratively on health care teams with the goal
of providing coordinated services to patients” and lists five
descriptive items to include in each example. Schools are also
advised to “briefly summarize examples of learning experiences
where medical students are brought together with students or
practitioners from other health professions to learn to function
collaboratively on health care teams with the goal of providing
coordinated services to patients, including how medical students’
attainment of the objectives of each experience is assessed.”
Standard 8 covers curricular management, evaluation, and
enhancement; the detailed view document includes a table in which
staff are to “provide and review school and national benchmark data
from the AAMC Graduation Questionnaire (GQ) on the percent of
respondents that agree/strongly agree (aggregated) that they are
prepared in a variety of areas to begin a residency program” with
one of the areas being “basic skills in clinical decision-making and
application of evidence-based information” (LCME 2015).
For osteopathic medical schools, the accrediting body, the
Commission on Osteopathic College Accreditation (COCA), has a
document of standards entitled Accreditation of Colleges of
Osteopathic Medicine: COM (College of Medicine) Accreditation
Standards and Procedures that has four standards that are
supported by CML interprofessional rounding services. Standard 6.1
states, “The COM must develop and implement a method of
instruction and learning strategies designed to achieve its mission
and objectives,” and the guideline in support of it states, “The
curriculum should at least include, but not be limited to, the following
areas of biomedical sciences and disciplines related to osteopathic
medicine: . . . basic knowledge of the components of research.”
Standard 6.4 states, “The COM must help to prepare students to
function on health care teams that include professionals from other
disciplines. The experiences should include practitioners and/or
students from other health professions and encompass the principles
of collaborative practices.” COCA also states that “competencies for
interprofessional collaborative practice may include the ability to: (1)
Work with individuals of other professions in a climate of mutual
respect, (2) Apply knowledge of the osteopathic physicians’ and
other professionals’ training, knowledge, skills and competencies to
address the health care needs of the patients and populations
served, (3) Communicate with patients, families, communities, and
other professionals in a manner that supports the team approach to
the care of the patient, the maintenance of health and treatment of
disease, (4) Apply principles of team dynamics to plan and deliver
patient/population centered care that is safe, timely, efficient and
effective” (AOA COCA 2015). Standard 6.5 states, “The COM must
stipulate specific educational objectives to be learned in its
educational program,” and supporting Standard 6.5.1.3 states,

At minimum, a graduate must be able to: demonstrate medical

knowledge through one or more of the following: passing of
course tests, standardized tests of the NBOME (National Board
of Osteopathic Medical Examiners), post-core rotation tests,
research activities, presentations, and participation in directed
reading programs and/or journal clubs, and/or other evidence-
based medical activities.

Standard 7.2 states, “The COM must show its commitment to

research by having a strategic plan for research support,
development, and productivity that is linked to faculty adequacy,
facilities, outcome goals, and budget” with a guideline that states,
“growth and development of research is closely linked to availability
of human, financial, and physical resources required to support
research efforts, as well as the education of osteopathic physicians
to prepare them for conduct of research” (AOA COCA 2015).

Relevant Accreditation Standards for Graduate

Medical Education

An agreement for a single accreditation system for graduate

medical education programs in the United States has been reached
by the American Osteopathic Association (AOA), the ACGME, and
the American Association of Colleges of Osteopathic Medicine
(AACOM). Accreditation will be overseen by ACGME, with training
programs with AOA accreditation “transitioning to ACGME
accreditation between July 1, 2015 and June 30, 2020” (AOA 2015).
The accrediting body for many post-MD medical training programs
and soon-to-be accreditor for programs currently accredited by the
AOA, the ACGME, developed a competency for practice-based
learning and improvement that is defined in Competency Definitions
and Recommended Practice Performance Tools as “participation in
the evaluation of one’s personal practice utilizing scientific evidence,
practice guidelines and standards as metrics, and self-assessment
programs in order to optimize patient care through lifelong learning”;
the document provides four practice performance measurements to
use to indicate that the standard is met (ACGME 2007).
Interprofessional practice falls under the competency for system-
based practice, which states that trainees should “optimize
coordination of patient care both within one’s own practice and within
the healthcare system. Consult with other healthcare professionals”
(ACGME 2007).

When CMLs Are Most Effective during Patient

Care

Another factor to consider when setting up CMLs as part of an

interprofessional team is to consider when they will be most effective
during patient care. According to one feasibility study, there are
stages in patient care in which CML participation in rounds would be
“most useful.” These are “after admission and the initial diagnostic
tests, usually within 24–48 hours of admission. . . . Analysis showed
that suggested scenarios commonly related to questions about
treatment and management decisions” by 51 percent (twenty out of
thirty-nine) of respondents and “choice/interpretation of diagnostic
tests for” 21 percent of respondents (eight out of thirty-nine) (Sladek,
Pinnock, and Phillips 2004). In a study by Aitken and colleagues
(2011), the CML participated in intake rounds related to new patient
admissions.

Assessing the Rounding Service

CMLs should work with the department with which they will
round as part of an interprofessional team to determine how and
when a rounding service will be evaluated and whether the
assessment data should be qualitative or quantitative in nature
(Aldrich and Schulte 2014). To prove their worth to their institutions,
CMLs should assess their services, including rounding with
interprofessional teams. A variety of means can be used to assess a
rounding service—statistics, other data, and surveys. Ambitious
CMLs may even conduct a prospective uncontrolled study (Sladek,
Pinnock, and Phillips 2004) or a randomized controlled trial (Marshall
and Neufeld 1981; Mulvaney et al. 2008).
It is a good idea for CMLs to keep statistics and information on
serving and rounding as part of an interprofessional team. At the
bare minimum, the CML will want to keep statistics on number of
questions answered during rounds and as follow-up to rounds. The
number of questions answered may be used in a calculator for
assigning value to library services, such as the “Valuing Library
Services Calculator” available from the National Network of Libraries
of Medicine (NN/LM) MidContinental Region (2013) online. A
database of questions with notes about answers can help the CML
prove the value of the service and save the CML time when a new
question arises that is similar to one that has already been
answered. Information about questions can be provided to
healthcare providers to fuel further discussions in journal clubs and
other settings (Deshpande et al. 2003). Supplemental information
that the CML may want to keep includes type of question (diagnosis,
therapy, etc.) (Aldrich and Schulte 2014) and whether the question
came from healthcare providers or arose as the result of the CML
being proactive and anticipating information that would be helpful to
providers. In one project, each CML who participated in rounds
drafted a weekly report with a narrative on the CML’s activities.
Reports included the time spent rounding with the team, the patient
load of the rounding teams, opportunities for training by the CML,
and issues with equipment. “In addition, the librarians recorded
observations about team interactions, perceived effectiveness of
instruction, and overall success of the program” (Turman et al.
1997).
The CML may also want to conduct one or more surveys to
assess the effectiveness of the CML as part of an interprofessional
rounding service. One could administer a survey focused solely on
the rounding service or one may want to administer a survey that
has been used by other researchers; examples include a
comprehensive survey that assesses the value of all library and
information services, the survey by Marshall and colleagues (2013),
or a survey based on items from the aforementioned survey like
Aldrich and Schulte (2014) administered. The survey could be aimed
at determining satisfaction with the CML as part of the
interprofessional rounding service or delve deeper and look for
effects on clinical decision making (Vaughn 2009), length of stay, or
readmission rates (Aldrich and Schulte 2014). Regarding clinical
decision making, the survey could ask if the answer or evidence
summary confirmed existing ideas or stimulated new ideas (Steele
and Tiffin 2014), such as changes in diagnostic tests or therapies
used. The survey could also ask questions related to how well the
CML fit into the interprofessional healthcare team and whether the
CML was seen as a necessary member of the team.

OUTCOMES OF ROUNDING

Outcomes for Librarians

 In response to the survey question on the authors’ survey that
asked if they feel that rounding was an effective use of their time,
seventeen out of eighteen respondents answered “yes.” When asked
why or why not rounding is an effective use of their time, one
respondent replied, “Yes, many questions arise during rounds which
the residents, students, and faculty may not have time to answer at
that time and will forget and which I can answer for them.” When
asked if they feel that their participation in rounding was appreciated,
seventeen of eighteen respondents answered “yes.” When asked
why or why not in regards to their responses to the two
aforementioned questions and asked about benefits and drawbacks
of rounding, one or more of the respondents’ positive comments
noted that the CML formed relationships with interprofessional team
members, became aware of team members’ information-seeking
behaviors and time pressures, received positive feedback from
rounding team members, contributed to improved patient care and
safety without “being directly responsible/liable for patients,” saw
articles found by the CML used for discussion in journal club and
quality of care committee meetings, experienced increased visibility
for the library’s staff and services (resulting in additional requests for
assistance), were provided with additional service opportunities,
used the CML’s abilities and stretched them beyond the CML’s
comfort zone, and recognized that the CML became a valued team
member. One respondent noted that the CML is “thanked for
services almost every time they are used,” and another said, “I have
had physicians thank me for participating in rounds and filling in
knowledge gaps that they may not have filled on their own.” One
respondent said that a director calls him or her “librarian
extraordinaire.” One respondent who conducted an annual survey
said, “one of the questions is about the librarian’s presence on
rounds. It’s a scale of one to five, and I’ve never gotten below a three
from over 200 responses in three years.” One respondent who
began rounding in 2005 noted that “the longevity . . . speaks very
positively to their value to the programs in question.”
The survey also included some ambivalent and negative
comments about CML rounding services. One respondent noted that
CML services were not always needed (such as during table
rounds), and the other noted that rounding takes “a lot of time (apart
from the actual event)” and said, “I’m not totally convinced it’s a good
use of our resources.” One respondent noted, “There are some
physicians and some residents that really do appreciate having a
librarian present. I know this because they make statements to that
effect. There are also some physicians and some residents who,
frankly, don’t care whether or not there’s a librarian participating.”
One respondent to a question about benefits and drawbacks to
participating in rounds stated, “Occasionally the . . . service is taken
for granted. Seeing the same problem/issue/situation arise over and
over can be very disappointing/disheartening (but have to keep in
mind that the students/residents are often different every single
year).”
There is no doubt that participating in rounds as part of an
interprofessional team is stressful for the CML. There are a variety of
sights, sounds, situations, and smells that may cause the CML
stress in the clinical setting. The authors’ survey results and a study
reveal that difficulties with understanding the rounding discussion
may leave the CML feeling lost (Lyons et al. 2015) and wondering
whether to seek clarification during rounds or look up information in
the library after rounds. The fact that not all questions have clear-cut
answers can be stressful and disheartening. One respondent in the
authors’ survey noted, “physicians have seemed disappointed when
the evidence for a certain topic is vague or conflicting, and I wonder
if that causes them to question my searching skills.” Another
respondent summed up their experience with stress well by saying,
“you do need to have physical and emotional stamina. Physically,
one must consider that you’ll be standing for several hours each day.
While I am able to handle this, I do know that it is not for everyone.
Emotionally, one must consider that you will be seeing sick patients
and their families and working aside potentially stressed out
clinicians. Massages and meditation are key!”

Outcomes for Healthcare Providers

The effectiveness of the CML in interprofessional rounds and

with the provision of literature searches is evident in the literature. As
early as 1975, CMLs proved effective interprofessional team
members by improving patient care. The CML also saved healthcare
professionals time by conducting literature searches on specific
topics. Additionally, members of the interprofessional healthcare
team stated that CMLs would be useful in other areas and that
information provided by the CML could be used by other
professionals and departments (Roach and Addington 1975). CMLs
may be most useful to healthcare teams who provide care for
patients with difficult or multifaceted medical issues. Comparing the
effectiveness of CMLs can prove challenging due to the practice
setting, physician knowledge, how information is used, and the
specific patient (Esparza et al. 2013).
Healthcare providers within interprofessional teams benefit in a
variety of ways from having a CML participate in interprofessional
rounds. Studies show that CML services save healthcare providers’
time (Barbour and Young 1986; Davidoff and Florance 2000; Demas
and Ludwig 1991), provide them with literature to aid in clinical care
(especially diagnosis and treatment) (Barbour and Young 1986;
Veenstra and Gluck 1992), help them discover helpful new tools and
sources (Barbour and Young, 1986; Scura and Davidoff 1981), and
save them money (Grose and Hannigan 1982; Scura and Davidoff
1981). Another benefit of CML services for physicians is summed up
well by this statement from a randomized trial, “Several physicians
noted that the service made them aware of many patient care
questions which were discussed at rounds but not followed up”
(Marshall and Neufeld 1981). One study of healthcare providers
showed that information provided by the library was seen as being
more important than diagnostic images, lab tests, and discussions
with colleagues (Marshall 1992). The Rochester study showed that
information provided by CMLs helped providers avoid adverse
effects (see figure 9.3) (Marshall 1992).
Avoidance of Adverse Events Reported by Physicians (Percentage).
Reprinted by permission of the Journal of the Medical Library
Association (JMLA).

Outcomes for Patients

The information that CMLs provide to healthcare providers

sometimes results in changes in patient care. One example of this is
a CML-identified guideline that “indicated that a patient with
suspected placenta praevia could safely be examined with a
transvaginal ultrasound scan” (Deshpande et al. 2003). In another
institution, the CML’s information made a positive difference in the
management of pregnant women over the age of forty (Vaughn
2009). When a medical librarian rounded with a multidisciplinary
team in Colorado; a new intensive care unit (ICU) order set, a
change in a total parenteral nutrition protocol, a new oral care
protocol, and other changes in patient care resulted (Brandes 2007).
The Rochester study provided data on changes in patient care as
the result of information provided by CMLs (Marshall 1992). Marshall
(1992), King (1987), Klein and colleagues (1994), and Banks and
colleagues (2007) all concluded that CML services affect patient
care decisions and length of stay. In one study that compared
outcomes of patient cases for which CMLs supplied information to
providers with patient cases that did not receive such information,
“no statistically significant differences between the intervention and
control groups were found for median difference in the total number
of diagnostic codes, length of stay, or hospital cost” (Esparza et al.
2013). See figure 9.4 for a summary of changes in patient care
reported by physicians (percentage) in the Rochester study by
Marshall (1992).

Changes in Patient Care Reported by Physicians (Percentage).

Reprinted by permission of the Journal of the Medical Library
Association (JMLA).

CONCLUSION
Clearly CMLs provide benefits to interprofessional healthcare teams
and their patients by participating in interprofessional rounds. To
ensure that interprofessional rounding services continue and,
perhaps, are even expanded, CMLs must be sure that
interprofessional team members and hospital administrators are
aware of data that indicates that the CML rounding service benefits
the interprofessional team members and their patients. One method
for distributing data to support the rounding service is to publish
results in newsletters for the various professions represented on the
interprofessional rounding team. Successful CMLs offer services that
are appreciated by interprofessional healthcare teams (such as
rounding), market current and future services effectively, look for new
ways to serve interprofessional healthcare teams, and provide
assessment data to support the services that they offer.

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 Chapter 10
Assessing Interprofessional
Education
Erin Blakeney and Brenda Zierler
There are many factors to consider when developing
interprofessional education (IPE) content, but the most important thing to
consider is how the learners will be assessed and how the activity or
program will be evaluated to determine its effectiveness in meeting the
learning goals and objectives of the IPE intervention. The assessment
plan should be developed when the IPE activity/curricula is being
developed or iteratively throughout the implementation process as is
done in developmental evaluation (Patton 2011). Ideally, those engaged
in developing IPE would also participate in the evaluation of IPE.
There has been a lot of national and international attention on the
return of investment (ROI) of IPE—in other words:

1. Does IPE make a difference?

2. Should we be investing resources to promote IPE?

The answers to these questions are relevant to this chapter on

assessing IPE and the following discussion should help the reader (a key
stakeholder) understand the contributions they can make by being better
informed on the current state of IPE assessment.

IPEC COMPETENCIES
As a starting point, it is important for developers and evaluators of IPE to
be familiar with the four core IPE competency domains—teamwork, team
communication, roles and responsibility, and values and ethics. These
competency domains were defined by the Interprofessional Education
Collaborative (IPEC 2011) to clearly articulate core competencies for
interprofessional collaborative practice. In other words the purpose for
creating IPE activities/curriculum is to graduate health professionals who
can work together collaboratively to provide safe and high-quality care to
patients/populations (IPEC 2011). The national concern about ROI is
directly related to the quality of evaluation data and existing research on
the impact of IPE to promote collaborative practice. Every faculty
member developing activities/curricula should ask themselves how an
IPE learning activity will contribute to improving interprofessional
collaborative practice. In order to begin to answer the ROI question, a
Consensus Committee on Measuring the Impact of IPE on Collaborative
Practice and Patient Outcomes, sponsored by the Institute of Medicine
(IOM) published a report that included three conclusions and two
recommendations (IOM 2015). The report is available online at:
http://www.aacn.nche.edu/education-resources/ipecreport.pdf.

INSTITUTE OF MEDICINE REPORT ON THE IMPACT

OF IPE
Prior to discussing the impact of IPE on collaborative practice and patient
outcomes, the Consensus Committee drew three conclusions from the
available evidence and testimonials and all three are relevant to this
chapter on evaluation: (1) closely aligning the education and healthcare
delivery systems; (2) developing a conceptual framework for measuring
the impact of IPE; and (3) strengthening the evidence base for IPE
through more purposeful, well-designed and thoughtfully reported
studies. The committee also made two data-related recommendations
directed to IPE stakeholders, funders, and policymakers that will be
described below and threaded throughout this chapter.

Recommendation 1: Interprofessional stakeholders, funders and

policy makers should commit resources to a coordinated series of
well-designed studies of the association between interprofessional
education and collaborative behavior, including teamwork and
performance in practice. These studies should be focused on
developing broad consensus on how to measure interprofessional
collaboration effectively across a range of learning environments,
patient populations, and practice settings. (IOM 2015, 43)

Recommendation 2: Health professions educators and academic

and health systems leaders should adopt mixed-methods study
design for evaluating the impact of IPE on health and system
outcomes. When possible, such studies should include an economic
analysis and be carried out by teams of experts that include
educational evaluators, health services researchers, and
economists, along with educators and other engaged in IPE. (IOM
2015, 52)
 In order to demonstrate the association between IPE and
collaborative behavior, the first data-related recommendation highlighted
the need for resources to conduct a coordinated series of well-designed
studies. Otherwise, there will continue to be one-off reports of isolated,
nongeneralizable, descriptive studies if dedicated resources to conduct
robust evaluations or research are not committed. The second data-
related recommendation called attention to the most robust
methodological approach needed (e.g., mixed-methods approach) for
evaluating the impact of IPE on health and systems outcomes. The
Consensus Committee also suggested that economic analyses be
carried out by teams of experts to answer the ROI question. Without
clearly defining the ROI, including both quality and cost outcomes, there
will be little incentive for key stakeholders like health system leaders,
funders, or policymakers to support interprofessional collaborative
practice.

KIRKPATRICK EVALUATION FRAMEWORK AND THE

INTERPROFESSIONAL LEARNING CONTINUUM
MODEL
To encompass the education-to-practice continuum, the Consensus
Committee proposed a conceptual model, called the “Interprofessional
Learning Continuum Model” (see figure 10.1). The Interprofessional
Learning Continuum Model utilizes a modified Kirkpatrick Evaluation
Framework (IOM 2015) to describe a broad array of learning, health, and
system outcomes. The model was designed intentionally to align specific
interprofessional competencies with the professional’s developmental
stage (from prelicensure to continuing professional development) (IOM
2105). Having a comprehensive conceptual model provides a taxonomy
and framework linking IPE interventions to specific outcomes (e.g.,
learning, health, and system outcomes). Without such a framework,
evaluating the impact of IPE on health and systems outcomes is difficult,
if not impossible. The IOM Consensus Committee developed this model
as a framework and recommended that it be tested.
Interprofessional Learning Continuum Model.
IOM 2015.

When IPE is assessed, key stakeholders should pay attention to the

outcomes they are most likely targeting based on the intervention (e.g.,
learning [intermediate] outcomes versus health [final] outcomes). If the
goal of the IPE intervention is to increase attitudes or perceptions of other
professions, then the outcome would be a learning or intermediate
outcome. If the IPE intervention was developing an interprofessional
collaborative approach to managing heart failure then the outcome of the
intervention would more likely be a health or systems outcome. Faculty
leading IPE activities (courses, curricula, activities) should be able to map
their interventions to the outcomes presented in the model to get a sense
of the outcomes they are targeting with the IPE interventions. If the
outcomes of the IPE activities are always learning outcomes and not
targeted to health or systems outcomes, then they are creating IPE
activities for IPE sake, and not IPE for collaborative practice as was
defined by the IPEC in 2011. The model helps distinguish the level and
timing of outcomes based on the purposeful integration of IPE across the
learning continuum.

PLANNING FOR IPE ASSESSMENT AND EVALUATION

Assessment and evaluation are two different but complementary
activities. Assessment occurs when you are “making a judgement about
a learners and groups of learners” and is distinct from “evaluation” where
you are making a “determination of the value of the IPE program” (Blue et
al. 2015). In this chapter we will use the term assessment to describe
tools and materials used to assess learners and the term evaluation to
describe the process of determining the value of the overall IPE program.
This section describes important elements of evaluation design.
To start, the purpose for the evaluation needs to be clearly
understood among those who developed the IPE activities, because the
purpose and questions that need to be answered will influence the design
of the evaluation. An evaluation design will help determine whether and,
possibly, what parts of a project are working as intended and what parts
need to be changed. There are many potential evaluation designs for IPE
—just as there are for all types of evaluations in both education and
research. Evaluation can be formative or summative or both. A formative
evaluation is similar to process improvement and focuses on ways to
improve the IPE activity, whereas, a summative evaluation focuses on
the outcome or impact of the activity or program in nature (Reeves et al.
2015). Reeves and colleagues (2015) described several qualitative and
quantitative evaluation designs for IPE and similar to the
recommendations made from the IOM Consensus Committee on
Measuring the Impact of IPE (IOM 2015) a mixed-methods approach
(using both quantitative and qualitative designs) is recommended. See
table 10.1 for examples of the types of evaluation designs and their
associated strengths and weaknesses from the Reeves and colleagues
(2015) primer on evaluating IPE.
Careful construction of the evaluation questions by an
interprofessional team representing multiple perspectives should be the
first step in determining the direction and the nature of an evaluation.
From there it is key to gather as much information about how others have
approached similar types of questions (e.g., with a comprehensive
literature review) as well as to assess the type of information that it will be
possible gather during the IPE project to be evaluated (e.g.,
observations, pre/post surveys, interviews, simulations, etc.). With this
information it is possible to start outlining an evaluation design. It is much
easier to describe an evaluation plan and results to others by clearly
articulating the research design and approach.

Types of Study Designs Used in IPE Evaluation.

Design type Description Strengths Limitations Selected
IPE evaluation
examples

Qualitative

Ethnography A design Generates Time Freeth,

that investigates detailed consuming and Reeves, Parker,
the nature of accounts of expensive Haynes, and
social actual Pearson (2001)
interactions, interactive Reeves
behaviors, and processes from (2008)
perceptions that observational
occur within work
teams,
organizations,
networks, and
communities.
The central aim
of ethnography
is to provide
rich, holistic
insights into
people’s views
and actions, as
well as the
nature of the
location they
inhabit, through
the collection of
detailed
observations
and interviews.

Grounded This is an Provides Development Christofilos,

theory approach that is rich data; can of “micro” DeMatteo, and
used to explore generate new theories with Penciner (2014)
social theoretical limited Murray-
processes that insight generalizability Davis, Marshall,
present within and Gordon
human (2014)
interactions.
Grounded
theory differs
from other
 approaches in
that its primary
purpose is to
develop a
theory about
dominant social
processes
rather than to
describe
particular
phenomena.
Through
application of
the process
researchers
develop
explanations of
key social
phenomena that
are grounded or
derived in the
data.

Phenomenolo- This form Provides Focus on Price,

gy of inquiry brings rich and detailed very small McGillis-Hall,
individuals’ descriptions of number of Angus, and
perceptions of human-lived individuals can Peter (2013)
human experience generate Veerapen
experience with concerns about and Purkis
all types of limited (2014)
phenomena. transferability of
Phenomenology findings
is both an
approach that
allows for the
exploration and
description of
phenomena
important to the
developers or
participants of
an IPE activity.
The goal of
phenomenology
is to describe
lived
experience.
Phenomenology
is therefore the
study of
“essences.”

Action This Empowers Difficult and Seif et al.

research approach is research time consuming; (2014)
 known by participants to typically smaller Hall,
various names, make changes scale methods Brajtman,
including in practice Weaver,
cooperative Grassau, and
learning, Varpio (2014)
participatory
action research,
and
collaborative
research. Action
research is a
form of inquiry,
which involves
stakeholders in
a process of
evaluation and
change based
on professional,
organizational,
or community
action. It adopts
a more
collaborative
approach than
other evaluation
designs, as a
key role for the
evaluator is to
work with
participants in
processes of
planning,
implementing,
and evaluating
change.

Quantitative

Randomized This type of The Difficult to Barcelo et

control trials design randomization of generalize to al. (2010)
randomly individuals those who don’t Campbell
selects reduces bias meet the et al. (2001)
participants for related to selection criteria
inclusion in selection or (individuals do
either the recruitment not always
intervention or represent larger
control groups. populations)
Randomized
control trials
(RCTs) can
provide a
rigorous
understanding
of the nature of
 change
associated with
an IPE activity.

Controlled This design Can Less Janson et

before and after adopts a similar robustly rigorous than al. (2009)
studies approach to a measure RCTs due to the Rask et al.
RCT design, but change and lack of (2007)
does not controls for randomization.
randomize who differences Also, one cannot
receives the between study evaluate whether
intervention and comparison any reported
(i.e., an IPE groups change is sus-
activity). tained over time

Interrupted This is a Allows for Does not Hanbury,

time series studies nonrandomized statistical control for Wallace, and
design that investigations of outside Clark (2009)
uses multiple potential biases influences on Taylor,
measurements in the estimate outcomes. These Hepworth,
before and after of the effect of types of studies Buerhaus,
an IPE an IPE are also difficult Dittus, and
intervention to intervention; to undertake in Speroff (2007)
determine if it strengthens settings where
has an effect before and after routine outcome
that is greater designs as data are not
than the measurement collected
underlying occurs at
trend. This multiple time
design requires periods
obtaining data
at multiple time
points before
the IPE to
identify any
underlying
trends or any
cyclical
phenomena,
and at multiple
points
afterwards to
see if there is
any change in
the trend
measured
previously.

Before-and- This is a Relative Difficult to Brock et al.

after study nonrandomised ease of detect accurately (2013)
design where employing this whether any Cameron et
the evaluator design in change was al. (2009)
collects data comparison to attributable to the
other intervention or
 before and after quantitative another
an IPE activity evaluation confounding
designs data influence design
can help is methodolog-
generate more ically challenging
insightful
findings

Mixed These Comparison Combining Gould, Lee,

methods designs aim to between different data sets Berkowitz, and
gather different quantitative and when using a Bronstein
types of qualitative data convergent (2014)
quantitative and can help design is Lachman,
qualitative data generate more methodologically Fossum,
(e.g., surveys, insightful challenging Johansson,
interviews, findings Karlgren, and
documents Ponzer (2014)
observations) to
provide a more
detailed
understanding
of IPE
processes and
outcomes.
There are two
main types:
sequential
(where data are
gathered and
analyzed in
different stages)
and convergent
(where data are
combined
together).

At the University of Washington, we almost always carry out mixed-

methods IPE evaluations to help us triangulate answers to a number of
questions, including whether: (1) intended learning occurred, (2) behavior
changed among program participants, and (3) the approach/process was
effective and how it could be improved. We have established
interprofessional curricular teams and evaluation teams for various
programs—e.g., interprofessional faculty development training program
(Hall and Zierler 2015), advanced practice IPE activities (Willgerodt et al.
2015), interprofessional collaborative practice with advanced heart failure
population, and simulation-based IPE training (Brock et al. 2013). There
is overlap of faculty and staff on both teams with expertise in evaluation,
health services research, and “lean processes” (e.g., Evaluation Team)
and instructional design, curriculum development, conceptual models and
adult learning theories, and evidenced-base practice (e.g., Curricula
Committee). This infrastructure supports purposeful development and
evaluation of IPE for a variety of learning contexts (classroom, simulation
laboratory, and practice and community settings) and has created a
community of IPE scholars. Early in the development of an IPE activity,
the two teams collaborate to determine purpose of training, identify
conceptual frameworks for design and evaluation of the IPE activities,
create learning and program objectives, establish level of learners most
appropriate for the case, map the learning objectives to the IPE
competencies (IPEC 2011), and then determine timing in program across
the interprofessional learning continuum—foundational, graduate, or
continuing professional development (IOM 2015). Together the evaluation
questions are written to match the goals and impact of the training
(formative, summative, or both).
A formative evaluation can be used when piloting new content,
trialing new facilitators, or practicing innovative approaches to training
that can lead to improvement in content, processes, and evaluation
questions prior to rolling out a program and initiating a summative
evaluation. For example, a national Interprofessional Faculty
Development Program (Hall and Zierler 2015) was piloted for one year in
2012 with faculty from eight universities and then evaluated using
formative and summative evaluations (Blakeney et al. 2015). Even
though the program was well received and impact at local universities
was noted (Blakeney et al. 2015), improvements were made to the
content, length of training, approaches to teaching, faculty skill
development, and evaluation methods. The evaluation contributed to
improvements in processes and outcomes and subsequently, a four-year
Interprofessional Train-the-Trainer (T3) Faculty Development Program
was funded by the Josiah Macy, Jr., Foundation and a new curriculum is
being implemented and evaluated at three national sites in the United
States (Blakeney et al. 2015; Hall and Zierler 2015)
The IOM Consensus Committee (IOM 2015) identified the need to
use more robust evaluation designs and methods when evaluating IPE
projects—to determine whether IPE really does change learning
outcomes and behavior across the learning continuum (foundational,
graduate, continuing professional development). The first conclusion of
the report (2015) was to more closely align the education and healthcare
delivery systems. Bringing together educators and clinicians to cocreate
and evaluate IPE activities helps link IPE with collaborative practice. The
lack of alignment has also been described as a “gap” between the health
professions education and healthcare delivery systems. At the same
time, most IPE projects are not funded at the local level to examine these
types of questions. Therefore, it is important to use existing resources
(e.g., National Center for Interprofessional Practice and Education
https://nexusipe.org/; MedEdPORTAL https://www.mededportal.org/) as
much as possible to capitalize on lessons learned by others in developing
and implementing IPE.

TIMING OF IPE ASSESSMENT AND EVALUATION

Timing is a major factor to consider in IPE from both the perspective of
when you should start developing an evaluation plan, as well as when to
actually carry out assessment and evaluation activities. In order to be
successful in both of these areas, it is recommended to “begin with the
end in mind” and start developing an evaluation plan while developing
your curriculum or educational intervention (Blue et al. 2015; Kahaleh et
al. 2015; Reeves et al. 2015; Willgerodt, et al. 2015). For example, if the
goal of the IPE activity is to improve or increase knowledge, attitude,
skills, or other learning outcomes then obtaining measures at baseline
(pre-activity) and following the training (post-activity) may help in
determining effectiveness of the intervention (training). It is much easier
to plan for a pre/post evaluation with assessment of learning or to obtain
necessary human subject approvals (which can take weeks to months
depending on your project and institution) in time to evaluate a project if
you start at the beginning by thinking about: (1) what you are trying to
change (starting with your end in mind), (2) how to evaluate whether your
desired outcomes were achieved, (3) when are you going to carry out
those evaluations, and (4) how assessment data will be used by your
project team. If, however, an evaluation was not initially planned—it is still
advisable to start as soon as is feasible or even to plan an evaluation in
retrospect. While not ideal, it is better to attempt some evaluation of an
IPE activity than to not evaluate at all.
Starting early when planning an IPE project can also facilitate an
evaluation of the process of developing the curriculum, help a working
group track lessons learned in their project, and build in time for reflection
(Kahaleh et al. 2015; Willgerodt et al. 2015). Evaluation planning from the
beginning also allows the group time to develop thoughtful, relevant,
evidence-based evaluations that build off of existing research. It takes
time to develop new evaluation tools as well as to review existing tools to
determine whether they will be appropriate to your project—especially
when a new team has formed or when multiple institutions are working
together to implement assessment and evaluation activities (Blakeney et
al. 2015; Hall and Zierler 2015). Time is needed to work with team
members to review and pilot assessment tools and plan evaluation
approaches, because input from team members is essential to gaining
consensus prior to implementing IPE activities. Librarians can be of
particular help in this area by advising developers of IPE projects about
resources for identifying assessment tools and planning evaluations—for
example the National Center for IPE, existing IPE evaluations in PubMed
(Blue et al. 2015).
Creating assessment tools and an evaluation plan while developing
curriculum can also help to improve IPE content by helping to identify
places where the curriculum could be tightened or revised to better meet
its goals. For example, in a recent project at the University of
Washington, the content of a training for an interprofessional team of
healthcare professionals was framed more explicitly after initial drafts of
assessment questions, aimed at assessing learning, were reviewed by a
curriculum team with the realization that the overall learning goals might
not be as explicit to learners as we had hoped. As a result, both the
curriculum and assessment tools were revised to be better aligned with
overall project goals.
Timing also influences when and how you can carry out assessment
and evaluation activities. It is essential to plan time in the curriculum for
participants to complete assessment materials as well as to convey to
participants and other stakeholders how the program will be evaluated
and what will be requested of them (if anything) in terms of completion of
assessment materials, requests for interviews, and such. Academic
calendars and other competing demands (e.g., accreditation
requirements) should also be taken into consideration when planning
evaluations.

EVALUATORS: EXTERNAL OR INTERNAL?

Who will carry out assessments and evaluations is important to establish
early on in an IPE project. As described earlier an evaluation approach
needs to be determined and assessment tools to support that approach
have to be selected (and possibly developed or adapted). The identity
and the role of the person or team that leads this aspect of the project will
influence how the project is carried out and what type of evaluation
questions and approach needs to be pursued. Rossi and colleagues
(2004) identified four main approaches utilized by the person or team
carrying an evaluation: (1) participatory, (2) objective, (3) advocacy, and
(4) coaching. A description of each of these approach types can be found
in table 10.2. There are benefits and drawbacks of each approach, and it
is important for evaluators/evaluation teams to have a plan for how they
will mitigate disadvantages and benefit from advantages of the evaluation
role-type they choose to pursue (Grembowski 2016; Reeves et al. 2015).
Librarians can provide valuable guidance for faculty as they determine
what type of evaluator role would best meet their project needs and guide
them toward resources (Blue et al. 2015).

Evaluator Roles Summary.

Role Role Description Benefits Drawbacks

Participato- Evaluator works Increased Scope or focus of

ry closely with program likelihood evaluation may be co-opted
developers and decision evaluation will or biased toward positive
makers throughout produce findings; this process may be
development and answers that will conscious or unconscious
implementation process be useful to
decision makers

Objective External/outside Useful Unclear if can ever be

neutral evaluator who when decision truly unbiased (even if
uses research methods makers need external).
to produce an objective objective, External evaluator may
evaluation or a unbiased not be familiar and may miss
program/project information qualitative information that
about a program would provide important
to be able to insights about the
address program/project
competing
demands from
different groups

Advocacy Evaluators act as Increases Risk that evaluators will

advocates for spreading the likelihood no longer be impartial when
findings of an evaluation. that an framing questions, collecting
Based on the idea that it evaluation will evidence, and in fairly
is difficult, if not be implemented evaluating program worth
impossible, for evaluators
to be truly neutral so
instead should evaluate
whether a program meets
defined values

Coaching Evaluator offers Increases May lead to inaccurate

help, advice, and the likelihood or incomplete findings if
 guidance as project that the project members lack
members lead planning, evaluation will knowledge and experience to
implementation, and address conduct evaluation even with
evaluation of their own interests of help from the coach
programs. Often used in project
community settings members

At the University of Washington, we typically take a participatory or

coaching evaluation team approach. As described earlier, we have found
this type of approach beneficial as a diverse evaluation team contributes
multiple perspectives, requires that a common language be established,
and models an interprofessional approach to coproducing and
coevaluating IPE activities (Kahaleh et al. 2015; Reeves et al. 2015;
Willgerodt et al. 2015). Our evaluation teams include students or family
members, educators, researchers, and clinicians (as relevant to the topic)
so that we can iteratively develop, evaluate, and improve IPE activities
and projects (Willgerodt et al. 2015). This approach is also consistent
with the tenets of developmental evaluation (Patton 2011) and fosters
coproduction relationships among key stakeholders and end-users
(patients, families, students, and healthcare teams) (Bovaird 2007).
Involving students or families in evaluation can also help with real-
time feedback on faculty skills in facilitating IPE as well as with
integration of learning. For example, we have found that having students
observe interprofessional clinical simulations can be very informative for
those observing—particularly when they are provided with evaluation
rubrics to reference during observations. Insights of student observers
during debriefs of clinical simulations have proved effective as a way to
share feedback and learning among all of the students.

DISSEMINATING EVALUATION RESULTS

As referenced above it is very important to disseminate and share
lessons learned from evaluations so that others can learn from your
successes and challenges as well as to promote replication within the
field to improve efficiency and spread of effective programs (without other
sites needing to reinvent the wheel). There are many journals that accept
short reports, primers, or works in progress—for example the Journal of
Interprofessional Care—in addition to the traditional research
manuscripts and librarians can assist in identifying these opportunities
(Blue et al. 2015). There are also a number of domestic and international
conferences that focus specifically on interprofessional education and
collaborative practice, including: Collaborating Across Borders (every
other year; odd years), All Together Better Health (every other year; even
years), and an annual conference held in the United States (starting in
2016) cohosted by the National Center for Interprofessional Practice and
Education (NCIPE) and the American Interprofessional Healthcare
Collaborative (AIHC).
Dissemination to a variety of stakeholders—in addition to the IPE
research and education literature—should be considered. Potential
stakeholders include student participants, patients and families,
developers of IPE materials, administrators, grantors, and the broader
community (Blue et al. 2015; Reeves et al. 2015). These different
audiences are likely to be most interested/benefit from a variety of
different modes of communication including, blog posts, articles in
newsletters, summary evaluation letters for facilitators, and such. Health
systems leaders and managers are also included as a target audience to
receive data and an executive summary related to the interprofessional
team-based training that is implemented and evaluated within their health
system.
Different audiences also may be interested in different types of
information—with participants and facilitators often primarily interested in
formative feedback and the larger IPE research community most focused
on new knowledge or summative findings (Reeves et al. 2015). For
example, we have found that faculty participating in our programs have
appreciated hearing how their sessions went from an evaluation
perspective as well as receiving thank-you letters cc’ing their department
chairs to keep in their files for promotion and tenure. Students and other
IPE learners and facilitators also appreciate hearing how evaluation data
are used to revise or improve the education program and sharing
information with them helps them to become important partners in
dissemination of findings (Reeve et al. 2015).

Assessment and Evaluation as a Scholarly Activity

for IPE Faculty

Establishing an IPE committee, center, or organizing group that

focuses on dissemination of IPE activities helps to build a learning
community that creates opportunities for scholarly activities. At the
University of Washington, we hold at least two IPE writing retreats (one to
two days) per year to bring together those interested in developing
scholarship around IPE and collaborative practice. Graduate students
and family members who participated in the development of IPE activities
also contribute to the writing and dissemination of the IPE activities and
are invited to the writing retreats. Goals for the IPE writing retreat are
prioritized based on timing (responding to an external grant opportunity,
completing an IPE book chapter, writing a manuscript related to an IPE
activity, submitting an IPE curriculum to MedEdPORTAL, creating a
poster for a meeting, etc.). In addition to considering external funding
opportunities or national meetings that might influence the prioritization of
the writing retreat goals, the needs of individual faculty who need
scholarly writings for promotion are considered.
The topic of promotion and scholarly activities related to IPE should
be considered early in the formation of the team developing and
evaluating IPE activities. Criteria for promotion and tenure vary based on
profession, school criteria, and specific appointment. A discussion early
in the development of the IPE curriculum/evaluation team is essential for
planning subsequent scholarly activities. For example, if a member is in a
clinician educator’s track, then developing curriculum and receiving
feedback from learners would contribute to their scholarly activities,
whereas a member who is in a traditional research track might be more
involved with the scholarly writing related to the evaluation and
assessment. IPE requires a team approach and one of the core
principles of IPE is that it is cocreated by multiple professions, patients,
and students, so a paper related to an IPE activity should include multiple
professions.
Establishing team-writing principles early in the process is
necessary, especially when multiple institutions are collaborating. Other
key factors to support team writing include: identify the order of authors
early in the process (based on contribution and journal requirements);
identify key journals with librarians; establish writing deadlines with
consequences for missing the deadlines; develop strategies for
recognizing those who facilitated or supported the IPE activities but did
not contribute to the development or evaluation of the content; and
provide opportunities for graduate students and junior faculty (literature
reviews to inform an IPE activity).

FUTURE DIRECTIONS FOR IPE EVALUATION

The number of high quality IPE studies will be increased when evaluation
models are consistently employed and when more robust evaluation
designs (e.g., mixed-methods approach) are utilized by a team of
educators, clinicians, and researchers. One-off studies of small-scale IPE
activities will not contribute new knowledge to the literature, therefore
establishing and disseminating best practices in the design of IPE studies
will help to increase the evidence. As more IPE activities and studies
move to practice or community settings (IPE for collaborative practice),
the opportunity to evaluate the effects of IPE on health and system
outcomes increases.

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 Index

A
accreditation, 1
agencies, 1
Essentials of Baccalaureate Education for Professional Nursing
Practice, Essential IV, 1
library support of, 1 , 2 , 3.1-3.2
standards, 1 , 2 , 3 , 4
American Association of Colleges of Nursing (AACN), 1
Commission of Collegiate Nursing Education, 1
American Association of Colleges of Osteopathic Medicine
(AACOM), 1
American Association of Colleges of Pharmacy (AACP), 1
Association for Prevention Teaching and Research (APTR), 1
Association of Medical Colleges (AAMC), 1
Association of Schools and Programs of Public Health (ASPPH), 1
Australian Health Professional Regulatory Authority (AHPRA), 1

B
blended learning, 1 , 2 , 3
Bloom’s Taxonomy of Learning Domains, 1 , 2

C
Canadian Interprofessional Health Collaborative, 1
Centre for the Advancement of Interprofessional Education (CAIPE),
1,2
clinical medical librarian, 1 , 2 , 3.1-3.2
as part of the interprofessional team, 1.1-1.2
assessing, 1.1-1.2
justification for, 1.1-1.2
outcomes, 1.1-1.2
Comprehensive Assessment of Team Member Effectiveness
(CATME), 1.1-1.2
cognitive development, 1 , 2
dualists, 1
multiplicity, 1
course management system See Learning Management System
(LMS)

D
Duquesne University, 1

E
educational theories
adult learning theory, 1 , 2 , 3
social learning theory, 1 , 2
transformative learning theory, 1 , 2
educational theorists
Bandura, Albert, 1
Bruner, Jerome, 1
Chomski, Noam, 1
Dewey, John, 1
James, William, 1
Jung, Carl, 1
Lewin, Kurt, 1
Mezirow, Jack, 1 , 2
Piaget, Jean, 1 , 2 , 3 , 4 , 5
Skinner, B. F., 1
Vygotsky, Lev, 1 , 2 , 3
See also educational theories, adult learning theory See also
educational theories, transformative learning theory
e-learning, 1
electronic health record (EHR), 1 , 2
Emory University, 1
epistemological development, 1 , 2
epistemological paradigms
behaviorist perspective, 1 , 2
cognitive perspective, 1
constructivist perspective, 1 , 2 , 3
social cognitive perspective, 1 , 2 , 3
social constructivist perspective, 1 , 2 , 3
evidence based practice, 1 , 2 , 3 , 4
evidence based medicine See evidence based practice
evidence based nursing See evidence based practice

F
faculty development, 1 , 2 , 3 , 4
faculty training, 1
See also faculty development
Florida International University, 1
Framework for Interprofessional Capability See Interprofessional
Capability Framework

G
Grand Valley State University, 1.1-1.2

H
Health Insurance Portability and Accountability Act (HIPPA), 1
health science librarians, 1 , 2 , 3 , 4 , 5
as evidence based medicine consultants, 1
embedded librarians, 1 , 2
interprofessional education team member, 1 , 2 , 3.1-3.2
liaison librarians, 1 , 2
health science libraries, 1.1-1.2 , 2 , 3.1-3.2
learning spaces in, 1.1-1.2
hybrid learning See blended learning

I
Interdisciplinary Education Perception Scale (IEPS), 1
Interprofessional Educational Collaborative (IPEC), 1 , 2 , 3
Core Competencies, 1 , 2 , 3
interprofessional care, 1 , 2 , 3
standardized patient, 1 , 2
structured interdisiplinary bedside rounds (SBIR), 1.1-1.2
See also Interprofessional Education for Collaborative Patient-
Centered Practice (IECPCP)
Interprofessional Capability Framework, 1 , 2
interprofessional cultural change, 1 , 2
Interprofessional Education for Collaborative Patient-Centered
Practice (IECPCP), 1
interprofessional practice See interprofessional care
Interprofessional Capability Assessment Tool, 1
Interprofessional Socialism and Valuing Scale, 1
interprofessional Education, assessment See interprofessional
education, program evaluation
interprofessional education, factors influencing success, 1
macro, 1 , 2
meso, 1 , 2
micro, 1 , 2
interprofessional education, implementation, 1
communication, importance of, 1
champions for, 1 , 2 , 3
governance, 1 , 2 , 3 , 4 , 5
learning goals, 1
logistics, 1 , 2 , 3
librarians’ role in, 1
knowledge management, 1
organizational support, 1
Student fees, 1
interprofessional education, obstacles to implementation, 1 , 2 , 3 , 4
, 5 , 6 , 7 , 8 , 9 , 10 , 11
interprofessional education, program design, 1
evidence based, 1
funding, 1
learning Objectives, 1
standardized curriculum, 1
interprofessional education, program evaluation, 1.1-1.2
as a scholarly activity, 1.1-1.2
disseminating, 1.1-1.2
external evaluator, 1.1-1.2
formative feedback, 1 , 2 , 3.1-3.2
Interprofessional Learning Continuum Model, 1 , 2
internal evaluator, 1.1-1.2
Kirkpatrick’s Evaluation Outcome Model, 1 , 2.1-2.2
logic models, 1
patient outcomes, 1.1-1.2
planning for, 1
summative feedback, 1
timing of, 1.1-1.2
qualitative data in, 1
quantitative data in, 1
interprofessional education, resources for, 1.1-1.2 , 2.1-2.2
interprofessional healthcare teams See interprofessional care
interprofessional teamwork, 1.1-1.2
communication, 1.1-1.2
composition, 1
training, 1.1-1.2
Institute of Medicine, 1 , 2 , 3
report, “To Err is Human: Building a Safer Health System”, 1
report, “Crossing the Quality Chasm: A New Health System for the
21st Century”, 1
report, “Measuring the Impact of Interprofessional Education on
Collaborative Practice and Patient Outcomes”, 1 , 2.1-2.2
instructional and metacognitive strategies
active learning, 1
case based learning, 1 , 2
experiential learning, 1 , 2 , 3
group projects, 1
peer evaluation, 1
problem based learning, 1
self-directed learning, 1
scaffolding, 1
reflection, 1
L
Learning Management System (LMS), 1 , 2
Canvas, 1 , 2
literacy
information literacy, 1 , 2 , 3
health literacy, 1
Linkoping University, 1
library guides (LibGuides), 1

M
medical librarians See health science librarians
Medical Library Association, 1
medical humanities, 1.1-1.2
narrative medicine, 1 , 2
medical specialties, 1
Medical University of South Carolina, 1

N
National Center for Interprofessional Practice and Education, 1
National Health Services of England (NHS), 1
National Interprofessional Competency Framework, 1

O
online learning See e-learning

P
patient-centered care, 1 , 2
patient safety, 1 , 2 , 3 , 4
personal epistemology, 1 , 2 , 3
psychological theories
contextual relativism, 1
commitment with relativism, 1
Gestalt psychology, 1 , 2
psychological theories, organizational
field theory, 1.1-1.2 , 2
Hollenbeck Typology of Teams, 1
Input-Process-Output (IPO) Framework, 1 , 2
organizational change theory, 1 , 2.1-2.2 , 3 , 4
organizational theory, 1 , 2
Planned Behavior, Theory of, 1
organizational culture, 1 , 2 , 3 , 4 , 5
Social Categorization Theory, 1 , 2 , 3
team processes, 1
psychological theories, social
Common Intergroup Identity Model, 1 , 2
decategorization, 1 , 2 , 3
intergroup bias, 1 , 2 , 3 , 4
Intergroup Contact Theory, 1 , 2 , 3
intergroup hierarchies, 1
Optimal Distinctiveness Theory, 1 , 2 , 3
recategorization, 1 , 2 , 3
Self-Categorization Theory, 1
Social Dominance Theory, 1 , 2 , 3
Social Identity Theory, 1 , 2 , 3 , 4
social psychology, 1 , 2 , 3 , 4
stereotyping, 1

R
Readiness for Interprofessional Learning Scale (RIPLS), 1 , 2

S
service learning, 1 , 2 , 3 , 4
reflection in, 1
community based education and outreach, 1
community based learning, 1
simulation, 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13.1-13.2
simulated patient, 1
Sheffield Hallam University, 1
Society for Simulation in Healthcare, 1

U
University of British Columbia, 1 , 2 , 3
University of Florida, 1 , 2
University of Maryland, Baltimore, 1
University of Massachusetts Medical School Lamar Soutter Library, 1
University of Mississippi Medical Center, Rowland Medical Library, 1
, 2.1-2.2 , 3
University of Nebraska Medical Center, McGoogan Library of
Medicine, 1
University of Nevada, Reno, 1
medical library, 1
University of Southern California Norris Medical Library, 1
University of Utah, 1 , 2
Spencer S. Eccles Health Sciences Library (EHSL), 1
University of Washington, 1 , 2
University of Western Ontario, 1

V
Vanderbilt University, 1
Virginia Commonwealth University, 1.1-1.2 , 2.1-2.2 , 3.1-3.2
Center for Intperprofessional Education and Collaborative Care, 1 , 2
,3

W
World Health Organization (WHO), 1 , 2 , 3 , 4 , 5 , 6
 About the Editor and
Contributors

Mary E. Edwards is the reference and liaison librarian at the

University of Florida Health Science Center Libraries, where she has
worked since 2004. Dr. Edwards holds a MLIS degree from the
University of South Florida and in 2011 she earned a doctorate
(EdD) in Educational Technology from the University of Florida. In
addition to supporting distance education, she liaises to a number of
clinical and research departments in the Colleges of Medicine and
Public Health and Health Professions. As part of her liaison duties
Dr. Edwards collaborates on instruction and research with faculty
from her departments and is currently teaching in the course “Putting
Families First,” which is the cornerstone of the university’s
interprofessional education (IPE) program. In addition to her
numerous library-specific publications (journal articles and book
chapters), she has coauthored scholarly works related to medical
education. These include a systematic review (on using video
feedback in medical education) and a book chapter (on assessing
the learning needs of medical students) coauthored with faculty from
the Department of Anesthesiology. Dr. Edwards’s research interests
include medical education topics (how health science students
employ self-directed learning strategies), instructional design in
libraries, online teaching and learning, and new literacies including
media, digital, and information.

***

James Ballard is executive director of the Indiana Area Health

Education Center (AHEC) and associate professor in the
Department of Family Medicine at the Indiana University (IU) School
of Medicine. Before joining the faculty at IU, he held the position of
associate director of the University of Kentucky (UK) Center for
Interprofessional Health Education. During his tenure at the center
he was instrumental in designing and implementing a required core
interprofessional curriculum for all entering students in the five health
professions colleges in addition to a number of voluntary curricular
and cocurricular interprofessional opportunities for students.
Additionally, he served as an educationist in the UK Department of
Family and Community Medicine. Prior to this he held positions as
the associate director of the UK Area Health Education Center
(AHEC), manager of the Community Faculty Program, and director
of the Medical Professions Placement Service. Nationally, he has
served as a steering committee member of the Generalists in
Medical Education, cochair of the National Area Health Education
Center (NAO) Education Committee, and member of the Research in
Medical Education (RIME) committee within the AAMC Southern
Group on Educational Affairs (SGEA). He is a graduate in
psychology from the University of Notre Dame and received a
masters of educational psychology at UK and a doctorate in
educational leadership at Northern Kentucky University.

Skye Bickett is the assistant director for the Georgia campus of

the Philadelphia College of Osteopathic Medicine. She was a
hospital librarian from 2008 to 2011 and joined the Philadelphia
College of Osteopathic Medicine in 2011. She provides support to
faculty, staff, and students by assisting with research activities,
offering education on research and the use of library resources,
creating online material to supplement course work, and serving on
campus committees. Ms. Bickett is an active member of the Medical
Library Association (MLA), Southern Chapter of MLA (SC/MLA),
American Association of Colleges of Pharmacy (AACP), Georgia
Health Sciences Library Association (GHSLA), and the Atlanta
Health Science Libraries Consortium (AHSLC). She has served, and
continues to serve, on several committees and in leadership roles.
Ms. Bickett’s hobbies include hanging out with her husband and kids,
playing video games, photography, and cooking.

Erik W. Black is an assistant professor of pediatrics and

educational technology and serves as the associate director of the
Office of Interprofessional Education at the University of Florida (UF)
Health Science Center. He earned a PhD in curriculum and
instruction with focuses in educational technology and research and
evaluation methodology from the University of Florida, a masters of
arts from the College of New Jersey, and a bachelor of science from
Virginia Tech. In addition to roles in medical student and resident
physician education, Dr. Black is responsible for facilitating
interprofessional learning involving more than two thousand learners,
150 faculty, and two hundred volunteer families across the six UF
Health Science Colleges and three geographically diverse campuses
annually. Dr. Black maintains an active research agenda focused on
the development of professional identity and the evaluation and
assessment of learning and media environments across a broad
range of ages and life stages. Dr. Black was the first assistant
professor to be inducted into the University of Florida College of
Medicine’s Society of Teaching Scholars, a society for faculty who
excel as instructors and educational researchers. The author of more
than sixty journal articles, book chapters, and monographs and one
book, Social Media in Medicine, his research has been funded by the
United States Department of Education, the National Institutes of
Health, United States Health Resources and Service Administration
and the Josiah H. Macy Foundation.

Erin Abu-Rish Blakeney is a nurse with a background in

community health, public/social policy and interprofessional
education. She completed her PhD at the University of Washington
(UW) School of Nursing with a concentration in social science
statistics and has over 10 years of experience in interprofessional
education research—with a particular focus on evaluation. Starting in
2006, while working as a research scientist and master’s student at
New York University, she helped integrate graduate nursing students
into international service learning projects with dental students in
Honduras and Nicaragua. During her doctoral work at the UW (2009-
2014), Erin worked as a graduate research assistant on
interprofessional education grants with the UW Center for Health
Sciences Interprofessional Education, Research and Practice
(CHSIE). In her role as a graduate research assistant, she was the
lead author on a review paper on the state of IPE and developed a
structured reporting tool for describing IPE interventions for
replication that won the 2012 Baldwin Award (awarded for “research
that adds significantly to the evidence base informing
interprofessional care and education worldwide”) (Journal of
Interprofessional Care, 2012) and was also invited to speak about
IPE at the Institute of Medicine and an international conference
plenary session (Collaborating Across Borders IV). She also helped
to establish UW Health Science Students IHI Open School Chapter.
Currently, Erin is on faculty at the UW School of Nursing and where
she leads the evaluation teams on three interprofessional education
and collaborative practice grants including a Macy Foundation
faculty development grant and two federal HRSA-funded grants that
focus on improving team function and patient outcomes among
advanced heart failure patients at the University of Washington
Medical Center and throughout the WWAMI (Washington, Wyoming,
Alaska, Montana, Idaho) region.

Amy V. Blue is the associate vice president for interprofessional

education, health sciences and the associate dean for educational
affairs in the College of Public Health and Health Professions at the
University of Florida. She holds a doctorate in medical anthropology
from Case Western Reserve University and completed a National
Institute of Mental Health (NIMH) postdoctoral fellowship in
behavioral science at the University of Kentucky. Dr. Blue has been
engaged in medical and health professions education for over twenty
years. In 2007, she became the founding director of the
interprofessional education program at the Medical University of
South Carolina and served there as the assistant provost for
education until her move to the University of Florida in 2013. Dr. Blue
has authored numerous publications regarding medical and
interprofessional education and her research has been funded by the
National Board of Medical Examiners, the United States Health
Resources and Services Administration, the Robert Wood Johnson
Foundation, and the Josiah H. Macy Foundation. Dr. Blue was a
founding member of the American Interprofessional Health
Collaborative (AIHC) and served as a member of the
Interprofessional Education Collaborative Expert Panel that wrote
the Core Competencies for Interprofessional Collaborative Practice
Report in 2011.

Sue Chase-Cantarini has been a clinical faculty member at the

University of Utah College of Nursing since 1998. She has taught
multiple courses in the baccalaureate program and has helped
develop many innovative programs. Her interests range from cultural
diversity, health literacy, health promotion, clinical teaching, online
learning, simulation in the undergraduate program, and now
interprofessional education. Her work has been widely presented at
several national and international conferences. She has been
involved in interprofessional collaborations for the past decade. This
has included the development, implementation, and evaluation of the
Health Sciences Leap Program, Health Professions Academy,
Cultural Competence and Mutual Respect Modules, Health Literacy
Tutorial, and now interprofessional simulation. For three years, she
represented the College of Nursing on the Interprofessional
Oversight Committee and chaired the IPE Scenario Development
Committee. She currently cochairs the Interprofessional Advisory
Committee and immerses herself in future program development
opportunities.

Susan B. Clark serves as director of the Rowland Medical

Library and chair of Academic Information Services at the University
of Mississippi Medical Center (UMMC). She oversees the integration
of information seeking and life-long learning skills into the curriculum
of all six schools housed at UMMC. She is particularly invested in
positioning the library as an active partner in the educational,
research, and clinical missions. Her previous roles at UMMC include
head of reference and instruction. She received the master of
librarianship degree from Emory University. She holds memberships
in various library associations statewide, regionally, and nationally.
Throughout her career in librarianship, she has worked in academic,
school, special, and medical libraries.

John Cyrus is an assistant professor at the Tompkins-McCaw

Library for the Health Sciences at Virginia Commonwealth University
(VCU). As research and education librarian, he serves as liaison to
the VCU School of Medicine and the VCU Health System. Mr. Cyrus
works closely with students, residents, and faculty to support
research and incorporate information resources and best practices
into their curricula.

Robyn Dickie is an experienced registered nurse and health

professional educator within the university and hosptial settings. Ms.
Dickie currently works as the interprofessional education coordinator
at Mater Health Services, Brisbane, Australia. In this role, Ms. Dickie
coordinates the development, implementation, and evaluation of
simulation-based educational opportunities for medical, nursing, and
allied health graduates and students. Over the past five years, Ms.
Dickie has been led a number of interprofessional projects focusing
on the introduction of interprofessional student placements,
simulation-based interprofessional education to replace clinical
placement hours, and the develeopment of an interprofessional
health science student cirriculum. Ms. Dickie has a keen interest in
simulation-based training to enhance health professional teamwork
and collaboration to improve patient outcomes. During this time, she
has commenced doctoral studies to evaluate postgraduate
experiences of interprofessional education.

Alan Dow is the director of the Center for Interprofessional

Education and Collaborative Care and the Ruth and Seymour Perlin
Professor of Medicine and Health Administration at Virginia
Commonwealth University. Under his leadership, the center
develops, implements, and studies programs related to
interprofessional education and practice. He has been funded in this
work by the Josiah H. Macy Foundation, the Donald W. Reynolds
Foundation, the Health Resources and Services Administration, and
the Center for Medicare and Medicaid Services. Dr. Dow is a
practicing internist and serves on the editorial board of the Journal of
Interprofessional Care and the Journal of Interprofessional Education
and Practice.
 Paulette Hahn is a physician in the University of Florida
Department of Medicine and Division of Rheumatology. Her
experience as a nurse prior to entering medicine nurtured her
interest in interprofessional healthcare collaboration, and she
continues to meld the practice of nursing and medicine. Her current
leadership roles include associate vice chair of education in the
Department of Medicine and course director for the second year
medical student Dermatology/Musculoskeletal Module. She has
taught courses in biomedical ethics, evidence-based medicine,
Interdisciplinary Family Health, and Introduction to Clinical Medicine
with a focus on communication and patient-centered interviewing. Dr.
Hahn’s other educational involvement includes her work as portfolio
advisor for the Medicine Clerkship, which incorporates reflection as a
key pedagogical method. She has designed an elective for medical
students, The Art and Scholarship of Physical Diagnosis and Clinical
Reasoning, with a capstone educational experience in visualization
and observation at the Harn Museum of Art. Her longstanding
interest in medical humanities enhances her understanding of the
patient and family life experience. She was inducted into the
Chapman Chapter of the Gold Humanism Honor Society, and
received the American College of Rheumatology Clinician Scholar
Educator three-year Grant Award.

Elizabeth G. Hinton is reference librarian at the University of

Mississippi Medical Center’s Rowland Medical Library. After
receiving her MSIS from the University of Tennessee, Knoxville, she
completed a postgraduate internship at the University of Tennessee
Medical Center. In her current position, she serves as library liaison
to the School of Nursing and the School of Pharmacy. Her
professional interests include systematic literature reviews, library
and educational assessment, and interprofessional education.

Tanya Huff is a clinical assistant professor at Virginia

Commonwealth University’s School of Nursing. She has over thirty
years of critical care experience as a clinician and nurse educator.
She has worked with communication and team training exercises
throughout her career with a focus on simulation for the last fifteen
years. She is the nursing lead faculty for the Interprofessional Critical
Care Simulation Course where senior nursing students and fourth-
year medical students use simulation to practice rapid response and
code scenarios. A current DNP student, she is studying how learning
in simulation transfers into practice and translates into patient
outcomes.

Colleen Lynch is assistant director for quality improvement

education at the Center for Interprofessional Education and
Collaborative Care at Virginia Commonwealth University. Colleen
has extensive background in quality improvement, risk management,
and patient safety in a variety of healthcare settings to include
academic medical centers, primary care physician practices,
federally qualified health centers, the Centers for Medicare and
Medicaid Services Quality Improvement Organization (QIO)
program, and the medical malpractice industry. She has served as
project director for multiple health outcomes-focused grants from
HRSA and CMS focused on organizational culture change, IT
systems improvement, care process redesign, and clinical
performance measurement and improvement. At VCU, she is the
course director for the Interprofessional Quality Improvement and
Patient Safety course, as well as the Interprofessional Quality
Improvement Capstone experience.

Connie K. Machado, associate professor, is the head of

technical services/associate director at Rowland Medical Library.
She has worked in the areas of cataloging and library automation,
special libraries, and private industry libraries. In over twenty years
at Rowland Medical Library, she has assisted with multiple systems
changes as electronic resources have become the norm instead of
the exception. She earned her MLS from Louisiana State University,
and is a distinguished member of the Academy of Health Information
Professionals. She is an active member of the Southern
Chapter/Medical Library Association, and is chair elect for 2018 and
a member of the state library association. She serves on the
Madison County (MS) Library Board.
 Karen McDonough is an associate professor in the Division of
General Medicine at the University of Washington School of
Medicine, and co-directs clinical skills education for preclinical
medical students. She received her bachelor of science degree in
biochemistry and later her MD from the University of Washington. Dr.
McDonough has coordinated classroom-based IPE for early
students, and works on the inpatient medical service at the university
hospital.

Mitzi R. Norris is the executive director for academic

effectiveness at the University of Mississippi Medical Center where
she oversees academic accreditation, assessment, new program
development, and continuing medical education. She also is an
associate professor in the School of Health Related Professions
where she teaches leadership. Dr. Norris earned both her BS and
MS in microbiology from Mississippi University for Women. Her PhD
in educational leadership is from the University of Mississippi.

Andrea Pfeifle is assistant dean and director of the Indiana

University Interprofessional Health Education and Practice Center
and associate professor of family medicine. Dr. Pfeifle graduated
from the University of Kentucky with a BHS in physical therapy. She
holds a master of science in instructional systems design and a
doctor of education degree in educational administration and
curriculum and instruction also from the University of Kentucky. Prior
to coming to academics, she was the owner and president of
Physical Therapy Services, a contract rehabilitation business
managing and staffing multiple ambulatory care, outpatient, home
health, nursing home, and hospital-based rehabilitation services in
Kentucky. She leads the implementation of Indiana University’s
Foundational Interprofessional Curriculum, TEACH (Team Education
Advancing Collaboration in Health Care) across the health science
education programs and academic health centers. Through TEACH,
Indiana University intends to prepare all of its health sciences
students to work together to improve individual and population
health.
 Jean P. Shipman is director, Spencer S. Eccles Health
Sciences Library, the MidContinental Region and National Training
Center of the National Network of Libraries of Medicine at the
University of Utah and director for information transfer, Center for
Medical Innovation. She served as president of the Medical Library
Association from 2006 to 2007 and promoted health literacy as her
primary presidential initiative. Ms. Shipman graduated from Case
Western Reserve University and Gettysburg College. She has
worked in academic health sciences libraries (Johns Hopkins
University, University of Washington, VCU), a hospital library
(Greater Baltimore Medical Center) and with the
Southeastern/Atlantic NN/LM, University of Maryland, Baltimore.
Professional interests: health literacy, scholarly communications,
innovation, and LEAN principles.

Nina Stoyan-Rosenzweig is on the faculty of the University of

Florida Health Science Center Libraries, where she serves as
archivist and historian. She also teaches in the College of Medicine,
serves on the advisory council of the Center for African Studies and
has held courtesy appointments in the Department of History and the
Center for the Arts in Healthcare Research and Education. She
works developing medical humanities programming in the College of
Medicine and at UF and teaches both undergraduates and medical
students. Undergraduate courses include Culture, Health and the
Arts in Sub-Saharan African and the United States, Medical
Humanities and Clinical Practice, a variety of courses in the honors
program focused on single books, including The Island of Dr.
Moreau; Animal, Vegetable, Miracle; Molokai, Cutting for Stone; and
The Man Who Mistook his Wife for a Hat. Courses in the College of
Medicine include an elective for first and second year students,
leading small group discussions in biomedical ethics, and a number
of fourth-year electives including teaching in the elective HEART IM,
a month-long course organized and run by fourth-year students with
faculty input. She also teaches in the interprofessional course
Interdisciplinary Family Health. She has been deeply involved with
the Arnold P. Gold Foundation’s efforts to promote humanism in
medicine, for whom she has served as reader for the essay contest,
on the Gold Humanism Honor Society advisory council and
membership committee, and she has served as advisor and
coadvisor for UF’s Chapman Chapter of the Gold Humanism Honor
Society. She also has presented widely on her work with medical
humanities and developed and co-developed exhibits on aspects of
the history of medicine.

Nichole Stetten is a PhD student in public health with a

concentration in social behavioral sciences at the University of
Florida and serves as a graduate assistant for the Office of
Interprofessional Education. She earned a MPH at the University of
Florida and bachelor of arts at Berea College. At Berea College, Ms.
Stetten was actively involved in running service-learning programs in
the local community for four years. In addition to interprofessional
health service-learning research, Ms. Stetten is actively involved in
research involving public health and technology use, and obesity
among people with disabilities.

Lisa Travis worked in a variety of positions during college and

for a few years post-graduation prior to becoming a librarian. While
studying criminal justice at Texas Christian University, she worked as
a legal secretary and spent two semesters, a fall and a summer,
working at Walt Disney World as part of its College Program. While
completing her information sciences studies, she worked as a
bookseller and library specialist. In her first professional position, she
spent four of the five years of her tenure as a branch manager for a
library that served nursing and allied health students. She then spent
the next six-and-a-half years choosing databases and library
resources, negotiating license agreements, providing reference
assistance, and earning an educational specialist degree as a
medical librarian for a newly opened osteopathic medical school.
Currently she is a clinical informationist for Emory University. In her
free time, she enjoys swimming, volunteering, reading, and playing
Scrabble and other board games.

Alice I. Weber worked at Spencer S. Eccles Library beginning

in 2001, and retired as of July, 2015. She is now emeritus faculty.
Ms. Weber worked as collection development librarian, research
librarian, coordinator of educational technologies, a research
coordinator, and interprofessional education librarian. She was active
in professional organizations such as Utah Library Association
(ULA), Medical Library Association (MLA), Midcontinental Chapter of
the Medical Library Association (MCMLA), Utah Academic Library
Consortium (UALC), and Utah Health Sciences Libraries Consortium
(UHSLC).

Rebecca D. Wilson is an assistant professor in the College of

Nursing at the University of Utah, with director responsibilities for the
nursing education specialty track. In her previous position, Dr. Wilson
was the director of Interprofessional Education in Health Sciences,
which included providing direction and oversight for the
interprofessional education program for health professions students
from five health science colleges/schools at the University of Utah.
She has coordinated a variety of simulation-based interprofessional
education, been involved in faculty development, and is cochair of
the IPE curriculum subcommittee.

Lauren M. Young is instruction coordinator/reference and

research services librarian at Samford University Library. Her library
career has seen equal time spent in academic technical services and
public services roles, and she specializes in serving the information
needs of health sciences programs and patrons. Ms. Young earned
her MLIS from the University of Southern Mississippi and her MA in
English from the University of Mississippi. She is an active member
in state, regional, and national associations and is a senior member
of the Medical Library Association’s Academy of Health Information
Professionals.

Brenda Zierler’s research explores the relationships between

the delivery of healthcare and outcomes—at both the patient and
system level. Her primary appointment is in the School of Nursing at
the University of Washington (UW), but she holds three adjunct
appointments—two in the School of Medicine and one in the School
of Public Health. Currently, Dr. Zierler is Co-PI on a Josiah Macy
funded grant with Dr. Les Hall, to develop a national train-the-trainer
(T3) faculty development program for interprofessional education
and collaborative practice. She also leads three HRSA training
grants—one focused on technology enhanced interprofessional
education for advanced practice students, the second focused on
interprofessional collaborative practice for advanced heart failure
patients, and the third training grant focused on an education-
practice partnership to improve advanced heart failure training and
outcomes for rural and underserved populations in an accountable
care organization. Dr. Zierler is the co-director for the UW Center for
Health Sciences Interprofessional Education, Practice and Research
and director of Faculty Development for the UW Institute for
Simulation and Interprofessional Studies in the School of Medicine.
Dr. Zierler is a board member and past chair of the American
Interprofessional Health Collaborative, and a member of the Institute
of Medicine’s Global Forum on Innovation in Health Professions
Education.
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