2014

http://informahealthcare.com/jicISSN: 1356-1820 (print), 1469-9567 (electronic)

J Interprof Care, 2014; 28(3): 212–217! 2014 Informa UK Ltd. DOI: 10.3109/13561820.2014.890581

THEMED ARTICLE

Designing and evaluating an effective theory-based continuinginterprofessional education program to improve sepsis care byenhancing healthcare team collaboration

John A. Owen1,2,3, Valentina L. Brashers2, Keith E. Littlewood3, Elisabeth Wright3, Reba Moyer Childress2 andShannon Thomas2

1Office of Continuing Medical Education, 2School of Nursing, and 3School of Medicine, University of Virginia, Charlottesville, VA, USA

Abstract

Continuing interprofessional education (CIPE) differs from traditional continuing education (CE)in both the learning process and content, especially when it occurs in the workplace. Applyingtheories to underpin the development, implementation, and evaluation of CIPE activitiesinforms educational design, encourages reflection, and enhances our understanding of CIPEand collaborative practice. The purpose of this article is to describe a process of design,implementation, and evaluation of CIPE through the application of explicit theories relatedto CIPE and workplace learning. A description of an effective theory-based program deliveredto faculty and clinicians to enhance healthcare team collaboration is provided. Resultsdemonstrated that positive changes in provider perceptions of and commitment to team-based care were achieved using this theory-based approach. Following this program,participants demonstrated a greater appreciation for the roles of other team members byindicating that more responsibility for implementing the Surviving Sepsis guideline should begiven to nurses and respiratory therapists and less to physicians. Furthermore, a majority (86%)of the participants made commitments to demonstrate specific collaborative behaviors in theirown practice. The article concludes with a discussion of our enhanced understanding of CIPEand a reinterpretation of the learning process which has implications for future CIPE workplacelearning activities.

Keywords

Collaboration, continuing interprofessionaleducation, interprofessional learning,interprofessional practice, theory,workplace learning

History

Received 28 January 2013Revised 19 December 2013Accepted 29 January 2014Published online 4 March 2014

Introduction

Traditional continuing education (CE) is primarily focused on thetransfer of clinical knowledge delivered from experts to those lessknowledgeable and often is provided in settings removed from thepoint of care. Continuing interprofessional education (CIPE)differs both in the learning process and the content, thereforerequiring that different theories and new approaches be used indesigning and implementing CIPE activities (Sargeant, 2009).In addition, learning transfer is improved by providing a strongrelationship between what is taught and the learners’ work roleswithin the workplace environment (Merriam & Leahy, 2005).Workplace learning, defined as ‘‘the physical location, sharedmeanings, ideas, behaviors, and attitudes that determine theworking environment and relationships’’ (AACN/AAMCLifelong Learning, 2010), is a logical approach to match whatis taught to the leaners’ work roles. Educators have utilizedworkplace leaning in many ways such as by creating simulated

IPE workplace scenarios to reflect the workplace environment(AACN/AAMC Lifelong Learning, 2010). To maximize theeffectiveness of CIPE, it is essential to underpin the development,delivery, and evaluation of CIPE activities with a soundtheoretical framework relevant to the complexities of the work-place context (Hean, Craddock, & O’Halloran, 2009; Reeves &Hean, 2013).

A University of Virginia (UVA) CIPE program for team-basedsepsis care, targeted for physicians, nurses, advanced practicenurses, and respiratory therapists who care for patients with sepsis,was recently developed using a theoretical framework for CIPE ina simulated workplace setting. Recognizing that effective work-place learning occurs when the goals and interests of theworkplace and those of individuals who participate in itare shared (Eraut, 2004), this program reflected the UVAHealth System priority to implement the 2004 Surviving Sepsisevidence-based clinical guidelines. The guideline consists ofmultiple emergent steps for the resuscitation and managementof patients with severe sepsis, and teamwork is essential foroptimal implementation of these complex and time-dependentinterventions. The CIPE program was developed to enhancehealthcare team collaboration within the workplace setting wheresepsis care is delivered. The purpose of this article is to describethis program and the process of its design, implementation, andevaluation through the application of explicit theories relatedto CIPE and workplace learning.

Correspondence: John A. Owen, Office of Continuing MedicalEducation, University of Virginia, McKim Hall, Charlottesville, VA22908, USA. Tel: +14 349245318. Fax: +14 349821415. E-mail:jao2b@virginia.edu

Background

There is substantial evidence that patient outcomes improve byenhancing professional healthcare team collaboration (Frenket al., 2010; Josiah Macy, Jr. Foundation, 2012). In the Instituteof Medicine (IOM) report, Redesigning Continuing Education inthe Health Professions, one of the numerous recommendationsfocused upon the vital role of CIPE: ‘‘Continuing educationefforts should bring health professionals from various disciplinestogether in carefully tailored learning environments. As team-based healthcare delivery becomes increasingly important, suchinterprofessional efforts will enable participants to learn bothindividually and as collaborative members of a team, with acommon goal of improving patient outcomes’’ (IOM, 2010).

Workplace learning, which is situated within the context ofcomplex systems of practice (AACN/AAMC Lifelong Learning,2010; Sargeant, 2009), is emerging as an important considerationfor CE educators and researchers (Newton, Billett, & Ockerby,2009). Its importance is underscored because workplace learningserves as a ‘‘process of reasoned learning towards desirableoutcomes for the individual and the organization. These outcomesshould foster the sustained development of both the individualand the organization, within the present and future context oforganizational goals and individual career development’’(Matthews, 1999). CIPE in the workplace involves explicitinteractive learning (e.g. group reflection, opportunities topractice behaviors) where various health professions and othersparticipating in some part of a shared care delivery effort learn‘‘about, from and with’’ each other (IOM, 2010).

Application of theory to CIPE

Explicit use of theories in creating effective CIPE providesnumerous benefits: (1) Theory is integrated into educationalpractice by informing the development and delivery of inter-professional programs, (2) Reflection is encouraged through asystematic, disciplined and critical approach to thinking aboutthese activities; and (3) Rationale is provided for makingdecisions and testing propositions (Barr, Koppel, Reeves,Hammick, & Freeth, 2005; Clark, 2009). It is important torecognize that theories applicable to CIPE are not mutuallyexclusive and that selecting a single theory is insufficient for thecomplexities of interprofessional education (Hean et al., 2009).

Recent publications have described many relevant theories andselecting the appropriate theories relevant to the educationalcontext and content of CIPE workplace activities can beconfusing. Theory should be selected based on the context(Hean, Craddock, & Hammick, 2012), such as an interprofes-sional team practicing in an acute care setting, and on theunderstanding that interprofessional education is both product andprocess-oriented (Sargeant, 2009). This selection process can besimplified by following a recently published guide (Hean et al.,2009). Three theories that are foundational to CIPE programdevelopment include social identity theory, reflective and experi-ential learning, and learning within communities of practice(Hean et al., 2009, 2012; Reeves et al., 2007). These theoriesunderpinned the design and implementation of the learningobjectives, learning activities, and outcome measures.

Social identity theory

Social identity theory is the recognition that the identities ofpeople are developed through membership in social groups whosemembers have shared knowledge and values (Ellemers, Spears, &Doose, 1999). These socially derived identities influence howindividuals perceive and relate to others, and provide individualswith positive feelings and self-esteem from their estimation of

being part of a distinct ‘‘in-group’’ (Sargeant, 2009). Workingin collaborative teams can pose a threat to social identity, andcan mean having to give up some of this identity (Sargeant,2009); by implication, CIPE must develop methods to counterthe influence of traditional professional group identity and toencourage cooperation and collaboration with professionalsof other groups (Clark, 2006).

Reflective and experiential learning

Self-reflection is a learning strategy that entails learning fromexperience (Clark, 2009), and is particularly effective whenprofessionals are faced with unique experiences not easilyunderstood from established practice patterns. Schon (1987)approach for educating the ‘‘reflective practitioner’’ accountsfor health professionals’ need to be well prepared both in thescience of their profession as well as in the ‘‘gray’’ areaswhere uncertainty and value conflicts are likely to occur.Interprofessional practice often encompasses gray and value-laden areas, and developing the ability to learn by reflectingon one’s own experiences and interactions with other healthprofessions is an important attribute (Clark, 2006).

The major tenant of experiential learning is that learning is acontinuous process emanating from experience, and is not simplya product or an outcome (Clark, 2006). Experiential learningentails both individual and group reflection on the process, andrequires that health professionals learning to work as interprofes-sional teams have opportunities to engage collaboratively in realclinical situations, or in CIPE settings that use realist case studiesand problem-based learning experiences that reflect ‘‘real world’’situations (D’Eon, 2005; Harden, 1998).

Learning within communities of practice

Learning within communities of practice is learning that occursthrough social activity within a specific context (situatedlearning), such as a healthcare team (Lave & Wenger, 1991;Sargeant, 2009). The two principle elements are as follows:(1) learning is strongly influenced by the context and (2) learningoccurs through interaction or ‘‘co-participation’’. Both elementshave implications for CIPE (Sargeant, 2009).

Communities of practice are comprised of individuals who,as they work together on a joint goal and share their expertise,create experiential knowledge and learn together; learning andwork are inseparable in this context (Wenger, McDermott, &Snyder, 2002). Learning is not a discrete activity separate fromwork and practice, it is integral to it. Both occur at once.Conceptually, communities of practice necessitates a reexamina-tion of how teaching and learning are envisioned (Sargeant,2009). The content and process of IPE, and its integration into CEactivities, can be improved by understanding how communities ofpractice work and learn together (Sargeant, Hill, & Breau, 2010).

Education activities

At the University of Virginia, a CIPE program was developed forenhancing teamwork during implementation of the SurvivingSepsis Guidelines (http://www.survivingsepsis.org). The learningobjectives were as follows: (1) Describe the differences betweenIPE and uniprofessional education based upon participants’personal experiences, (2) Identify collaborative behaviors neces-sary for the effective implementation of the sepsis guidelines, and(3) Recognize which interprofessional team member(s) is(are)responsible for implementing each sepsis guideline step.

This program, which consisted of three separate activities,continued over a period of 6 months. The first activity involvedthree days of faculty/clinician training. The second and third

DOI: 10.3109/13561820.2014.890581 Designing and evaluating a theory-based CIPE program 213

activities, which focused on the healthcare professionals’ rolesand responsibilities related to effective sepsis care, began2 months following the first activity and extended for a total of4 months. These activities were designed as work-based CIPEthrough the utilization of a high-fidelity IPE sepsis simulationcase which linked the program content to the learners’ work rolesand workplace environment.

Thirty-two people (9 MDs, 19 RNs and 4 PhDs) participatedin the first activity. Applying social identity theory to counterthe influence of traditional professional group identity and toencourage team cooperation, facilitators assigned participants tostable 5–6 member interprofessional groups to enable participantsto experience and reflect on their own dynamic interprofessionalgroup process and apply what they were learning about thesetopics throughout the course. Reflective and experiential learningwas applied by encouraging participants to interact actively withthe facilitators and with the members of their interprofessionalgroup, and to engage in reflective journaling that stimulatedreflection on what was happening in the experiential learningprocess, and to assess the effectiveness of their collaborationskills. The overall goal of this training, entitled ‘‘EducatingHealth Professionals for Interprofessional Care’’ (ehpic�), was‘‘to engage professionals in learning how to work togetherby providing the knowledge, skills, and attitudes required toeffectively collaborate’’ (Oandasan & Reeves, 2005). Learningactivities included icebreakers, didactic lectures, small group casestudy work and discussions.

Eleven people (3 MDs, 8 RNs) participated in the second andthird activities. Learning in communities of practice was appliedin designing the second activity. Clinical simulation that demon-strates a collaborative practice approach is a powerful educationalmethod to prepare healthcare providers for interprofessionalpractice (Morton, 1999). Participants were asked to code eachstep in the Surviving Sepsis Guideline as the responsibility/roleof a physician, nurse, advanced practice nurse, and/or respiratorytherapist. They then viewed a videotape in which four participantsassumed the roles of a physician, nurse, advanced practice nurse,and respiratory therapist engaging in a high-fidelity simulation ofa sepsis management case. They were asked to repeat theresponsibility/role coding of the guideline steps after viewing thevideo recording. One, two, three, or all four of the healthcareprofessionals could be assigned the responsibility for each step ofthe guidelines. By having participants watch the simulation viathe videotape and identify ways to improve care by working moreeffectively together, individual learning was shifted to situated,team-based learning.

Reflective and experiential learning was applied in designingthe third activity. Participants were presented a list of 10interprofessional practice behaviors and asked to respond to thefollowing question: ‘‘Drawing on your expertise in collaborativecare, which of the following behaviors are most importantfor ensuring optimal care of patients with sepsis?’’ The sixbehaviors most frequently identified were used to create a sepsis‘‘Collaborative Care Best Practice Model’’ (Owen, Brashers,Peterson, Blackhall, & Erickson, 2012). Participants were thenpresented the same ten interprofessional practice behaviors andasked to reflect on the question, ‘‘Which of the followingcollaborative behaviors are you willing to make a personalcommitment to demonstrate and promote in your practice?’’

Methods

For the first activity, it was recognized through social identitytheory that participants likely would encounter some internalresistance to incorporating the views of other professions.Thus, there was a need to assess that resistance and address

it positively before learning could be optimized. Based on thistheory, the Readiness for Interprofessional Learning Scale(RIPLS) Questionnaire (Parsell & Bligh, 1999) was used toassess readiness related to interprofessional learning as thislearning pertained to the roles of other healthcare professionalsand their scope of practice. The RIPLS consists of 19 items usinga 5-point Likert scale (1¼ strong disagree to 5¼ strongly agree).RIPLS data were collected ‘‘pre and post’’ activity one.

Reflective and experiential learning created the basis for theevaluation form in which participants were asked to exploretheir experiences working in teams in two ways: improving theirknowledge of teamwork for implementing the sepsis guidelinesand improving the CIPE learning experience itself. The evalu-ation, which consisted of open-ended questions and 12 statementsmeasured by a 5-point Likert scale, was given at the end of eachof the 3 days of the program so that daily as well as cumulativeresponses could be assessed.

Social identity theory was applied in the evaluation ofoutcomes for the second activity. Effective collaborative teambehavior can threaten social identities especially if certainresponsibilities comprising a health professional’s identity arerelinquished. Based on this theory, it was hypothesized thatcertain responsibilities in the implementation of the sepsisguidelines would be viewed by participants as the exclusivedomain of certain professions prior to their CIPE training.A comparison of pre/post coding of physician (MD), nurse (RN),advanced practice nurse (APRN), and respiratory therapist(RT) roles was made to assess whether the identification ofresponsibilities and practice behaviors necessary to implement thesepsis practice guidelines would change after viewing theinterprofessional teamwork demonstrated in the sepsis simulationvideo recording.

Reflective and experiential learning, as well as communitiesof practice learning, guided the development and evaluation ofoutcomes for the third activity. In communities of practiceindividuals create experiential knowledge as they work together.By identifying and committing to collaborative behaviors afterhaving participated in the communities of practice CIPE experi-ence with colleagues from other professions, it was anticipatedthat participants would have more incentive to implementnew practice behaviors and to learn from that experience.The ‘‘Commitment to Change’’ strategy of asking participantsto identify specific behaviors that they planned to promote intheir practice has been demonstrated to predict actual changesin practice behavior (Wakefield, 2004).

Results

For the first activity, the means of the pre/post scores in theRIPLS survey did not change significantly (73.5 pre facultydevelopment and 72.9 post faculty development; n¼ 17), thusindicating that attitudes related to interprofessional learningremained basically unchanged. Program evaluation data variedover the 3 days, with a drop in positive responses on Day 2.Noting these changes in quantitative data following Day 2 andin response to participant suggestions to modify the material, theoriginally planned content and delivery was modified for Day 3.Evaluations improved and participants’ increased interest andenthusiasm on Day 3 was palpable. Averaged over the 3 days, 92%of the participants agreed or strongly agreed that the materialwas relevant to their work, 86% agreed or strongly agreed thatit encouraged them to change their practice, and 87% agreedor strongly agreed that overall the workshop had met theirexpectations.

Since only 11 participants completed the second activity,statistical significance could not be achieved with these limited

214 J. A. Owen et al. J Interprof Care, 2014; 28(3): 212–217

data. However, pre/post changes in the assignment of responsi-bilities for the roles of physician, nurse and respiratory therapistwere noted, most often with less assignment of responsibilitybeing given to physicians and more assignment of responsibilitybeing given to nurses and respiratory therapists after havingviewed the video. By way of illustration, data for three of theguidelines steps are presented in Table I.

These same 11 people participated in the third activity andidentified behaviors needed to provide optimal sepsis carecollaboratively. They then made commitments to demonstrateand promote specific collaborative behaviors in their practice(Table II).

Discussion

Foundational to the design of this CIPE workplace programwas the assumption that ‘‘there is nothing so practical as a goodtheory’’ (Lewin, 1951), and that underpinning the design withexplicit theories would enhance our understanding of CIPE andcollaborative practice (Reeves, 2013). The application of theoriesto the various aspects of this CIPE program encouraged system-atic, methodical, and analytical thinking (Barr et al., 2005), andsupported our articulation, reflection, and potential reinterpret-ation of the learning processes linked to these theories (Hean,2012). For example, as described in the results for activity one,participants were encouraged to reflect on what was happeningin the learning process. As participants obtained new knowledge

and skills, they desired to adjust the content and delivery of theCIPE experience to better meet their needs while learning wasstill in progress. This observation illuminated our understandingof CIPE, and revealed that using continuous feedback from thelearners to adjust the content and delivery of instruction enhancedthe learning process.

The observation that the means of the pre/post scores in theRIPLS survey differed only slightly was at first surprising.However, on further reflection, we realized that the participantswere likely already to be positively biased towards interprofes-sional learning based on their self-selection for this intensiveworkshop. This realization raises the possibility that CIPE maynot change the attitudes of participants already favorable towardsinterprofessional learning. This conclusion was supported bya previous study which revealed that students with high self-reported IPE exposure had more positive attitudes towardsIPE than those students who reported no IPE exposure (Lie,Fung, Trial, & Lohenry, 2013).

Although interpretation of results for the second activityis limited by the small number of participants, the changes inthe assignment of responsibilities for the physician, nurse andrespiratory therapist relative to the sepsis practice guidelinessuggest a change in knowledge pertaining to collaborativeteam practice and a better understanding of the responsibilitiesand practice behaviors necessary to implement the sepsis practiceguidelines interprofessionally. Findings from a previous studyrevealed that difficulties in team collaboration occurred

Table II. Importance of and commitments to demonstrate collaborative behaviors.

‘‘Drawing on your expertisein collaborative care, which

of the following behaviors aremost important for ensuring optimal

care of patients with sepsis?’’

‘‘Which of the followingcollaborative behaviors are

you willing to make a personalcommitment to demonstrate and

promote in your practice?’’

Behavior % Response (n¼ 11) % Response (n¼ 11)

Ensure that information exchanged is being heard and under-stood correctly through active listening and reflection.

91% 82%

Display interest, trust, and mutual respect across theprofessions.

91% 100%

Effectively exchange knowledge and ideas with otherprofessions.

82% 82%

Identify which team member will take the appropriate leader-ship/facilitator role in specific contexts.

73% 55%

Define individual responsibility for implementing joint deci-sion and follow-up.

73% 18%

Integrate collective knowledge to develop alternative solutions. 64% 27%Implement joint decisions taking into account all options and

evidence provided, discussed and evaluated for risks andbenefits.

64% 36%

Share discipline specific knowledge with the team. 45% 55%Identify strategies for addressing disagreements and

approaching situations in which conflict is likely to occur.27% 9%

Determine whom to involve depending on the needs of thepatient/client.

18% 18%

Table I. Comparison of pre- and post-test selections of the appropriate providers for 3 sepsis care guidelines steps.

Please indicate which provider(s) would be appropriate to perform each resuscitation activity described below.

MD RN RT APRN

Resuscitation activity Pre Post Pre Post Pre Post Pre Post

Obtain serum lactate and blood pressure 64% (7) 36% (4) 100% (11) 100% (11) 9% (1) 27% (3) 82% (9) 82% (9)Obtain blood cultures 64% (7) 55% (6) 73% (8) 91% (10) 9% (1) 27% (3) 64% (7) 82% (9)Provide stress ulcer prophylaxis using

H2 blocker or proton pump inhibitor91% (10) 82% (9) 64% (7) 82% (9) 0% (0) 0% (0) 91% (10) 91% (10)

DOI: 10.3109/13561820.2014.890581 Designing and evaluating a theory-based CIPE program 215

‘‘when team members acted towards one another as representa-tives of their professions’’ (Kvarnstrom, 2008). Noting thesechanges in the assignment of responsibilities enhanced ourunderstanding that CIPE has the potential to minimize thethreat to peoples’ professional identities that naturally occurswhen healthcare professionals work together collaboratively.

For the third activity, it was interesting to note that thepercentage ranking of the list of behaviors necessary to provideoptimal care of patients with sepsis compared to the list ofbehaviors participants were willing to demonstrate and promotediffered. For example, 73% (8) of the 11 participants listed‘‘define individual responsibility for implementing joint decisionand follow-up’’ as one of the behaviors most important foroptimal care of sepsis, yet only 18% (2) of the 11 participantsidentified this as a behavior to demonstrate and promote intheir practice. A possible explanation for this change in prioritycould be that a collaborative behavior needed for optimal careof sepsis already was being practiced due to a supportiveworkplace environment, thus making it unnecessary to list thatbehavior as one to demonstrate or promote. This explanationfurthered our understanding that effective CIPE and learningwithin communities of practice must recognize that learning isstrongly influenced by the unique aspects of each workplaceand the associated collaborative behaviors required of those whoparticipate in it.

Evaluation of the results of this study is limited by the smallnumber of participants who completed the second and thirdactivities. Clearly, the well-recognized barriers of limited timeand complicated scheduling apply to CIPE activities as well asCE. Finally, participants were overwhelmingly physicians andnurses; very few professionals from other disciplines were able toattend. Future programs will explore additional ways of retainingparticipants and recruiting a broader range of professionals.

Concluding comments

Knowledge of theoretical foundations for learning enhanced ourunderstanding of factors that influence the effectiveness of CIPEand workplace learning, and the application of explicit theoriessupported the design, implementation, and evaluation of thisinnovative CIPE program. In addition, this enhanced understand-ing enabled us to reinterpret various aspects of the learningprocess linked to theory, which in turn suggested a new learningstrategy to employ in future CIPE workplace learning programs.Results suggest that positive changes in provider perceptions ofand commitment to team-based care can be achieved with well-designed CIPE programs.

Acknowledgements

The authors would like to thank Mandy Lowe, MSc, BScOT, IvyOandasan, MD, CCFP, MHSc, FCFP, and Belinda Vilhena, MEd, BScwho served as the University of Toronto, Centre for IPE, facilitators forthe faculty development program entitled ‘‘Educating HealthProfessionals for Interprofessional Care’’ (ehpic�) and who providedfeedback on this manuscript.

Declaration of interest

The authors report no conflict of interest. The authors alone areresponsible for the writing and content of this paper. This Program wasfunded by Pfizer, Inc. Grant ID: 030608.

References

American Association of Colleges of Nursing and Association ofAmerican Medical Colleges (2010). Lifelong learning in medicineand nursing: final conference report. Washington DC. Retrieved fromwww.aacn.nche.edu/education-resources/MacyReport.pdf.

Barr, H., Koppel, I., Reeves, S., Hammick, M., & Freeth, D. (2005).Effective interprofessional education: Argument, assumption, andevidence. Oxford, UK: Blackwell.

Clark, P. (2006). What would a theory of interprofessional education looklike? Some suggestions for developing a theoretical framework forteamwork training. Journal of Interprofessional Care, 20, 577–589.

Clark, P. (2009). Reflecting on reflection in interprofessional education:Implications for theory and practice. Journal of Interprofessional Care,23, 213–223.

D’Eon, M. (2005). A blueprint for interprofessional learning. Journal ofInterprofessional Care, 19, 49–59.

Ellemers, N., Spears, R., & Doose, J. (1999). Social identity. Oxford:Blackwell.

Eraut, M. (2004). Informal learning in the workplace. Studies inContinuing Education, 26, 247–273.

Frenk, J., Chen, L., Bhutta, Z.A., Cohen, J., Crisp, N., Evans, T.,Fineberg, H., et al. (2010). Health professionals for a new century:transforming education to strengthen health systems in an interdepend-ent world. The Lancet, 376, 1923–1958.

Harden, R. (1998). AMEE guide No. 12: Multiprofessional education:Part 1 – Effective multiprofessional education: A three-dimensionalperspective. Medical Teacher, 20, 402–408.

Hean, S, Craddock, D., & O’Halloran, C. (2009). Learning theories andinterprofessional education: A user’s guide. Learning in Health andSocial Care, 8, 250–262.

Hean, S, Craddock, D., & Hammick, M. (2012). Theoretical insights intointerprofessional education: AMEE Guide No 62. Medical Teacher, 34,e78–101.

Institute of Medicine. (2010). Redesigning continuing education in thehealth professions. Washington DC: National Academy Press.

Josiah Macy, Jr. Foundation. (2012). Conference on InterprofessionalEducation. Retrieved from www.macyfoundation.org.

Kvarnstrom, S. (2008). Difficulties in collaboration: A critical inci-dent study of interprofessional healthcare teamwork. Journal ofInterprofessional Care, 22, 191–203.

Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheralparticipation. New York, NY: Cambridge University Press.

Lewin, K. (1951). Field theory in social sciences: Selected theoreticalpapers. New York: Harper & ROW.

Lie, D., Fung, C., Trial, J., & Lohenry, K. (2013). A comparison of twoscales for assessing health professional students’ attitude towardinterprofessional learning. Medical Education Online, 18, 21885.Retrieved from http://dx.doi.org/10.3402/meo.v18i0.21885.

Matthews, P. (1999). Workplace learning: Developing an holistic model.The Learning Organization, 6, 18–29.

Merriam, S., & Leahy, B. (2005). Learning transfer: A review of theresearch in adult education and training. Journal of Lifelong Learning,14, 1–24.

Morton, P. (1999). Using a critical care simulation laboratory to teachstudents. Critical Care Nurse, 17, 66–68.

Newton, J., Billett, S., & Ockerby, C. (2009). Journeying through clinicalplacements – an examination of six student cases. Nursing EducationToday, 29, 630–634.

Oandasan, I., & Reeves, S. (2005). Key elements for interprofessionaleducation. Part 1: The learner, the educator and the learning context.Journal of Interprofessional Care, 19, 21–38.

Owen, J., Brashers, T., Peterson, C., Blackhall, L., & Erickson, J. (2012).Collaborative care best practice models: A new educational paradigmfor developing interprofessional educational (IPE) experiences.Journal of Interprofessional Care, 26, 153–155.

Parsell, G., & Bligh, J. (1999). The development of a questionnaire toassess the readiness of health care students for interprofessionallearning (RIPLS). Medical Education, 33, 95–100.

Reeves, S., Suter, E., Goldman, J., Martimianakis, T., Chatalalsingh, C.,& Dematteo, D. (2007). A scoping review to identify organizationaland education theories relevant for interprofessional practice andeducation. Calgary Health Region. Retrieved from http://www.cihc.ca/files/publications/ScopingReview_IP_Theories_Dec07.pdf

Reeves, S., & Hean, S. (2013). Why we need theory to help us betterunderstand the nature of interprofessional education, practice and care.Journal of Interprofessional Care, 27, 1–3.

Sargeant, J. (2009). Theories to aid understanding and implementation ofinterprofessional education. Journal of Continuing Education in theHealth Professions, 29, 178–184.

Sargeant, S., Hill, T., & Breau, L. (2010). Development and testing of ascale to assess interprofessional education (IPE) facilitation skills.

216 J. A. Owen et al. J Interprof Care, 2014; 28(3): 212–217

Journal of Continuing Education in the Health Professions, 30,126–131.

Schon, D. (1987). Educating the reflective practitioner. San Francisco,CA: Jossey-Bass.

Surviving Sepsis Campaign. Retrieved June 6, 2013, from http://www.survivingsepsis.org.

Wakefield, J. (2004). Commitment to change: Exploring its role inchanging physician behavior through continuing education. Journal ofContinuing Education in the Health Professions, 24, 197–204.

Wenger, E., McDermott, R., & Snyder, W. (2002). Cultivatingcommunities of practice: A guide to managing knowledge. Boston,MA: Harvard Business School Press.

DOI: 10.3109/13561820.2014.890581 Designing and evaluating a theory-based CIPE program 217

Copyright of Journal of Interprofessional Care is the property of Taylor & Francis Ltd and itscontent may not be copied or emailed to multiple sites or posted to a listserv without thecopyright holder's express written permission. However, users may print, download, or emailarticles for individual use.