Nurse Educator

Vol. 40, No. 1, pp. 10-15

Nurse Educator Copyright * 2015 Wolters Kluwer Health |

Lippincott Williams & Wilkins

A Framework for the Design, Implementation, and

Evaluation of Interprofessional Education
Karen T. Pardue, PhD, RN, CNE, ANEF

The growing emphasis on teamwork and care coordination within health care delivery is sparking interest in interprofessional
education (IPE) among nursing and health profession faculty. Faculty often lack firsthand IPE experience, which hinders
pedagogical reform. This article proposes a theoretically grounded framework for the design, implementation, and evaluation
of IPE. Supporting literature and practical advice are interwoven. The proposed framework guides faculty in the successful creation
and evaluation of collaborative learning experiences.

Keywords: educational models; experiential learning; interprofessional education; nursing education; professional education

A
cross the academic landscape, there is substantial in-
terest and momentum surrounding interprofessional
education (IPE). Interprofessional education provides
opportunity for health profession students to intentionally
learn together to inform future team-based, quality care delivery.
This contrasts a more typical approach in health profession
education in which students are taught in isolated, discipline-
specific silos. Health systems are now seeking professionals
who are prepared in teamwork and communication, as these
abilities support safe and effective care delivery.1,2
The discipline of nursing patently acknowledges the con-
tributions of teamwork and communication in shaping an
effective professional practice environment.3,4 The American
Nurses Credentialing Center Magnet RecognitionA program
defines professional practice to include collaboration and
consultation across team members.5 This emphasis on inter-
professional competency highlights an emerging challenge
in health professions education: to graduate students with
exemplary disciplinary knowledge and skills as well as the
ability to participate in and lead interprofessional teams.6
Reform in nursing and health professions education is there-
fore needed to provide students with learning experiences
preparatory for interprofessional collaborative practice.
The need for IPE heralds a new pedagogical approach
that faculty are apt to have little firsthand knowledge or ex-
perience. This limited frame of reference impedes educa-
tional change. This article describes the current context for
Author Affiliation: Associate Dean and Associate Professor of Nursing,
Westbrook College of Health Professions, University of New England,
Portland, Maine.
The author declares no conflicts of interest.
Correspondence: Dr Pardue, Westbrook College of Health Profes-
sions, University of New England, 716 Stevens Ave, Portland, ME 04013
(kpardue@une.edu).
Accepted for Publication: August 22, 2014
Published ahead of print: October 17, 2014
DOI: 10.1097/NNE.0000000000000093
IPE and proposes a theoretically grounded framework for
the design, implementation, and evaluation of collaborative
learning. Practical advice and guidance are included to sup-
port success in each phase of the educational process.
Background
The calls advancing IPE may seem contemporary, but advocates
have been promoting collaborative practice for decades.7,8
The literature is replete with reports of miscommunication
and poor teamwork, resulting in medical error and unfa-
vorable patient care outcomes. The Patient Protection and
Affordable Care Act proposes new delivery models (eg,
patient-centered medical home), upholding the imperative
for health professional competency in communication, care
coordination, and teamwork.2 This is congruent with IPE,
which is defined as ‘‘2 or more professions who learn with,
from, and about each other to improve collaboration and
quality of care.’’9 The promulgation of the Interprofessional
Education Collaborative (IPEC) Expert Panel report in 2011
further champions this momentum.1
The IPEC report, authored by 6 different professional
organizations, includes representation from the American
Association of Colleges of Nursing, Association of American
Medical Colleges, American Association of Colleges of Os-
teopathic Medicine, American Association of Colleges of
Pharmacy, American Dental Education Association, and As-
sociation of Schools of Public Health. Leaders from these
diverse professional organizations synthesized the literature
and identified 4 core competency domains for interprofes-
sional collaborative practice in the United States: knowledge
of roles and responsibilities, interprofessional communication,
teams and teamwork, and values/ethics for interprofessional
practice.1 The report puts forth a compelling case for IPE and
the need for nursing and health profession students to engage
in deliberate interactive learning so as to acquire collaborative
practice capabilities.1

10 Volume 40 & Number 1 & January/February 2015 Nurse Educator

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
 For the profession of nursing, these tenets are not new.
This work aligns with the 2007 Quality and Safety Education
for Nurses (QSEN) led by Cronenwett and colleagues.3 The
QSEN framework is evidence based and informed by the
work of the Institute of Medicine (IOM), Health Profession
Education: A Bridge to Quality. This IOM report concluded
that all health profession graduates need ability to deliver
patient-centered care, work effectively on interdisciplinary teams,
and demonstrate capacity with informatics, evidence-based
practice, and quality improvement methods.8 These historical
efforts now coalesce with recommendations by IOM’s Future
of Nursing report,4 upholding IPE as a strategy for advancing
nursing as leaders within the health care system.10 These col-
lective initiatives highlight the nursing imperative for IPE, from
associate degree to graduate, and the concurrent need to sup-
port faculty in developing expertise in this pedagogy.
Exploring IPE Pedagogy
Theoretical Grounding
The development of collaborative learning reflects a delib-
erate pedagogical process. A useful model informing this
instructional design is found in the work of educator/scholar
John Biggs. The Biggs 3P model asserts 3 distinct phases to
any well-planned educational experience: presage, process,
and product (3P).
The presage phase is characterized as planning activi-
ties, which occur prior to the educational encounter.11-13
Presage includes consideration of students’ prior knowledge
and learning expectations, as well as faculty perceptions and
orientation to teaching.11,13 Presage factors additionally con-
sider the climate or environment where teaching and learning
occur.12,14 The process phase involves the educational expe-
rience itself and the instructional strategies used to promote
learning.11,13 Product addresses the outcomes of learning
and the determination of knowledge or abilities subsequently
demonstrated by participants.11-13
Figure. Pardue framework for interprofessional education. The author acknowledges the artistic assistance of Joanne Smith, staff
assistant, University of New England, in drawing this figure. Copyright Karen T. Pardue, July 30, 2014. Reprinted by permission of Karen Pardue,
July 31, 2014.
Nurse Educator
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Proposed Framework
This work of Biggs11-13 informed the development of this IPE
framework. Whereas the 3P model is diagramed as linear in
form, this newly proposed IPE model is circular and con-
tinuous (Figure). The following narrative provides elabora-
tion on each component, and practical advice is offered to
support successful execution of each phase.
Desired Learning Outcomes
The maxim for the initial step in the IPE process is to begin
with the end in mind. What are the interprofessional knowl-
edge, skills, or abilities (KSAs) desired from the collaborative
learning experience? For example, the domain of knowledge
might address the outcome of students examining various
roles and responsibilities of team members, describing com-
munication theory and tools, or comparing different profes-
sional codes. Acquisition of skills might include participants
being able to demonstrate communication techniques or ap-
proaches to conflict resolution. Learning addressing partic-
ipant attitudes might include reports of enhanced respect
across team members or the valuing of divergent viewpoints.
The IPEC report1 is a helpful resource for composing learning
outcomes. This document delineates 38 competencies/
behaviors, thereby providing an excellent reference for faculty
in defining the desired learning outcomes. Table illustrates
4 sample interprofessional competency behaviors, one drawn
from each domain of the report.
Practical advice includes clearly identifying the desired
IPE outcome(s) and keeping the objective(s) prominent
throughout the planning process. Faculty often err in designing
IPE when they construct learning from a familiar vantage point:
diagnosis and management of a health condition. While IPE
provides the context to embed diagnosis and interventions, the
focus of the learning experience is not on disease, but rather on
the interprofessional knowledge and abilities needed to work
effectively with others. Interprofessional practice is concerned
with the process of care and how it is delivered, as opposed
Volume 40 & Number 1 & January/February 2015 11

Table. Sample Core Competencies for
Interprofessional Collaborative Practice
Interprofessional Core Sample Competency
Competency Domain Behavior
Roles and responsibilities for Explain the roles and responsibilities of
collaborative practice other care providers and how the
team works together to provide care.1(p21)
Interprofessional communication Listen actively and encourage ideas and
opinions of other team members.1(p23)
Values and ethics for Embrace the cultural diversity and
interprofessional practice individual differences that characterize
patients, populations, and the health
care team.1(p19)
Teams and teamwork Engage self and others to constructively
manage disagreements about values,
roles, goals, and actions that arise
among health care professionals and
with patients and families.1(p25)
From IPEC 2011.1
to what type of care is provided.1(p4) This presents a new
orientation for faculty more accustomed to teaching precise
discipline-specific responses to patient care. Clearly identi-
fying the intended interprofessional learning outcome is an
imperative first step in designing quality IPE experiences.
Student Considerations
After establishing the learning outcomes, it is necessary to
examine the appropriate audience for instruction. This pro-
cess can be challenging and is notably curriculum dependent,
as students across the health professions acquire knowledge
and skills at varying points in time. For example, the com-
petency outcome: ‘‘Engage diverse health care professionals
who complement one’s own professional expertise to develop
strategies to meet specific patient care needs’’1(p21) requires
that the participants have firsthand knowledge of their own
discipline’s role as well as a solid understanding of the ex-
pertise they bring to patient care. For nursing students, prow-
ess such as this may not emerge until the later part of their
academic program. The design of the IPE experience would
then bring together these nursing learners with other health
profession students who possess a similar level of under-
standing about their professional role. The other health pro-
fession students may or may not be in their final year of
study, but rather at a point in their curriculum where they
possess a similar ability to articulate role and practice con-
tributions. Thibeault10 describes this as finding the ‘‘sweet
spots’’ across diverse programs of study whereby students
possess parallel readiness to exchange ideas and effectively
learn with, from, and about each other.
Educational diversity is readily apparent with IPE, as this
pedagogy commonly brings together undergraduate and
graduate students. In planning collaborative education, fac-
ulty need to consider differences in student age, maturity,
and life experience.14 This diversity mirrors the real-life practice
considerations inherent in actual team-based care.
Practical advice includes starting small to promote high-
quality and successful IPE; it is not necessary to include all
12 Volume 40 & Number 1 & January/February 2015
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
health profession programs in a collaborative learning event.
Beginning with just 2 different cohorts of students provides
an intentional and thoughtful approach when initiating the
design, delivery, and evaluation of IPE. Collaborative learning
can later be expanded to include other disciplines as faculty
gain experience and confidence.
Faculty Considerations
In this model, the faculty-student dyad is complementary;
the identification of one often serves to inform the other.
Once the faculty are determined, it then becomes necessary
to unite with colleagues from other programs in creating IPE
experiences. The cultivation of new cross-disciplinary re-
lationships provides a surprisingly parallel interprofessional
learning opportunity for teachers as differing curricula, pro-
fessional roles, and disciplinary language are explored. It
has been this author’s experience that bringing faculty to-
gether from diverse programs positively impacts campus
culture, enhancing community, collaboration, and respect
across previously siloed units. The emergence of faculty
champions is an important first step for the development
of IPE.
The process of collaborative learning presents another
opportunity for faculty development. Collaborative instruc-
tion emphasizes student engagement and the experience of
learning with, from, and about each other. This highlights an
important tenet of IPE, distinguishing between approaches
to shared teaching and those of shared learning.
Shared teaching occurs when students from diverse pro-
grams come together for faculty to impart information.11,15
The focus in shared teaching is on faculty expertise and the
economy of scale gained when combining various disciplines
into 1 class. In this design, the teacher is active, and the stu-
dents are more passive. Lecture represents a common in-
structional strategy. For many faculty, shared teaching presents
a familiar and comfortable educational approach and one
that has utility when common content needs to be taught.
In contrast, shared learning reflects pedagogy where
diverse programs come together for intentional interaction
with each other.15 Lecture is minimal; instead, students dia-
logue and problem solve with each other addressing real-life
situations. Shared learning emphasizes teamwork, commu-
nication, and discovery, processes consistent with IPE and
collaborative practice. Faculty in the health professions are
often less familiar and facile with this teaching approach.
Practical advice includes once again starting small and
identifying a few instructors receptive to IPE. This requires a
degree of faculty risk taking in working with lesser known
colleagues and students. Those involved should recognize
the potential discomfort with trying something new, uncer-
tainty with shared facilitation, and the additional planning time
required. The faculty modeling of interprofessional behaviors
is integral, as students will note their native faculty’s level of
engagement. Teachers learning about each other and
mirroring the desired student learning outcomes serve to
model and advance collaborative competency attainment.
Structural/Organizational Considerations
The institutional environment, culture, and values present
important considerations in planning and implementing IPE.
Freeth and Reeves14 distinguish this as the ‘‘context’’ for
Nurse Educator
teaching and learning. Faculty need to consider whether IPE
will be mandatory or elective. Will collaborative learning be
embedded as part of a course, or will it be cocurricular?
Should all students attend, or is it optional? Proponents ad-
vancing mandatory education cite the essential contribution
of interprofessional skills to quality patient care.1,16 In con-
trast, those opposing mandatory IPE assert collaborative
instruction detracts from disciplinary education and may
cultivate a student perception of unimportant learning.16,17
Collaboration and teamwork may be regarded as ‘‘softer’’
skills or more trivial when juxtaposed to the ‘‘hard’’ sciences.17
Context and faculty inform the elective or optional nature
of IPE.
Similarly, the timing for interprofessional pedagogy
heralds much debate.1,16 Will IPE be introduced early in
the curriculum, or later on? Will the education involve pre-
clinical students, or will the participants already be engaged
in practice site learning? The institutional culture and the
faculty influence decisions surrounding the timing appro-
priate for IPE.
Academic scheduling presents another organizational
consideration. It is typically difficult to mesh curricula and
schedules to find a unified time for IPE. Additional constraints
include adequate meeting space and seating. The ideal pre-
sentation allows students to work together at roundtables,
but traditional academic architecture commonly reflects more
stadium-style tiered seating. Practical advice includes not
getting mired in the barriers but rather capitalize on creativity
and pedagogical innovation. Scheduling and room con-
straints might be eased by having cohorts of students rotate
through IPE sessions rather than having an entire class attend.
A nursing skills laboratory may provide needed space to set
up stations or seating where teams of students can work
together.
Instructional Strategies
After thorough consideration of the learning outcomes, stu-
dents, faculty, and institutional context, the planning process
shifts to the design and implementation of the IPE experi-
ence itself. The selected instructional strategies should pro-
vide learners the opportunity to engage with one another
and practice interprofessional collaboration skills.1,16 Teach-
ing methods congruent with active learning include case stud-
ies, problem-based scenarios, role play, discussion prompts,
and live or videotaped simulations.1,16
Practical advice includes limiting the amount of time
faculty present actual content. While faculty may need to
briefly set up a situation, the focus should be on active group
work. Paper or video case studies, role play, or live interviews
with actual patients and families have been successful in pro-
moting dialogue among participants. The use of arts and hu-
manities through Readers Theater18 or presentation of an actual
play has also been effective for engaging students in commu-
nication, teamwork, ethical analysis, and role exploration.
Group work should be guided by faculty-prepared
prompts. These open-ended questions serve to stimulate
student dialogue and align with the desired IPE learning
outcomes. Faculty need to be keenly attuned to group dy-
namics and watchful for evidence of student opposition,
negative stereotyping, role assumptions, or discourteous in-
teraction.19 The teaching team often problem solves in
Nurse Educator
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
tandem, thereby modeling an interprofessional approach. After
the small group work, faculty debrief together promoting a
united class discussion. During this time, concepts and obser-
vations are synthesized, and role similarities and differences
are highlighted. Faculty can pose additional questions to illus-
trate disciplinary as well as team-based approaches.
Reflection is another instructional strategy that supports
interprofessional learning.16,20 Mann and colleagues20(p597)
describe reflective learning in the health professions as an
intellectual process where experiences and actions are exam-
ined in light of their impact and outcomes. Interprofessional
reflective learning activities may include a single focused-
writing assignment after an IPE experience or student journal-
ing over time exploring personal awareness of interprofessional
competency development. Examples of reflection prompts
for roles and responsibilities include the following: What are
the role similarities and differences on your team? Are there
assumptions about each role? What can you learn from each
other? How will this influence you as a professional and
future team member?21(pp11,12) Developing students’ capacity
to reflect on their own interprofessional experience and abilities
supports competency development for future collaborative
practice.
Evaluation of Learning
It is imperative to dedicate planning time to the evaluation
of IPE. This process is multifaceted, as initially faculty seek
feedback regarding the program itself and an immediate de-
termination of student learning.19 As learners advance in
their studies, it then becomes important to discern if inter-
professional KSAs are being enacted in patient care. This
highlights the lengthy and complex process of IPE evalua-
tion, as this education is meaningful only if students transfer
skillful communication, teamwork, role understanding, and
ethics to practice and favorably impact patient outcomes.1,19
As with any educational endeavor, the evaluation needs
to be linked directly to the identified learning outcomes. Will
instructor-developed methods (eg, examinations, simulation
performance) be used? Could qualitative approaches such as
reflective papers or focus groups provide data? The literature
reveals a commonly accepted interprofessional evaluation
hierarchy adapted from work of Kirkpatrick.22 Faculty need
to determine congruence of their intended IPE with the fol-
lowing hierarchy proposed by Kirkpatrick.
The lowest level of evaluation determines student re-
action or attitudes toward interprofessional learning and
represents a widely reported domain.19,22 The IPE literature
advocates expanding beyond receptivity, as what is ulti-
mately important is the ability of students to use collabora-
tive skills when rendering patient care.1 With this in mind,
determining participants’ perceptions toward IPE reflects a
first step and informs future collaborative learning.
Kirkpatrick’s22 second level addresses the evaluation of
learning that occurs through the pedagogical experience.19,22
This reveals participants’ acquisition of new knowledge and
skills, or modifications of attitudes on communication, team-
work, roles, or ethics. Data can be obtained through instructor-
developed examinations, focused-writing exercises, written
responses to case reports, and 1-minute papers. Validated
IPE measurement tools also may be useful in documenting
both levels 1 and 2 outcomes. In 2014, the National Center
Volume 40 & Number 1 & January/February 2015 13
for Interprofessional Practice and Education posted a curated
collection of peer-reviewed instruments. These measure-
ment tools are currently catalogued by outcome to include
attitudes, behaviors, KSAs, organizational practice, and
‘‘other.’’23 This repository provides a helpful and practical
resource for measuring the effects of IPE on learning and
quality care delivery.
Level 3 evaluation captures student behavior and dem-
onstration of communication, ethics, role understanding,
and teamwork practices.19 Evaluation at this level provides
evidence of newly acquired or changed behaviors and may
be secured via simulation, role play, or the use of standard-
ized patients. This can be documented through videotaping
or the utilization of a behavioral expectation rubric. Creation
of detailed performance rubrics substantiates level 3 outcomes
and alerts to future learning needs. One useful resource for
faculty is the Interprofessional Collaborator Assessment Rubric.
Using a 2-round expert Delphi survey method, Curran and
colleagues24 constructed 6 interprofessional rubrics. Each
rubric is leveled by competency ranging from minimal to
mastery and delineates performance behaviors for com-
munication, collaboration, roles and responsibilities, team
functioning, family-/patient-centered approach, and conflict
resolution.24
The pinnacle of IPE evaluation occurs as students engage
in actual clinical practice. Kirkpatrick’s level 4 reflects results
of learning and in the case of IPE, the impact of communi-
cation, role understanding, ethics, and teamwork on care
delivery, patient outcomes, and health systems.1,19 Incorpo-
rating specific interprofessional competencies into disciplin-
ary clinical evaluation forms, with accompanying descriptive
narrative, provides one approach for outcome data. In ad-
dition, demonstration of collaborative competencies can be
secured through clinical journals or student focus groups.
What IPE behaviors were actually exhibited in patient care?
Was there an impact on team functioning? On patient out-
comes? On the health care system? Level 4 IPE evaluation
requires determination as to whether students execute col-
laborative behaviors and any associated impact to patient
outcomes and care delivery.
Pedagogical Reflection
All well-developed education culminates with faculty de-
briefing and reflection. With IPE, the teaching team needs to
exchange perspectives as to what aspects went well and
what challenges arose. What did the evaluation of student
learning reveal, and were there different outcomes among
the various disciplines? Are there recommendations or revi-
sions for future experiences? Reflection on these questions
provides ongoing quality improvement for IPE.
In addition to reflecting on the experience itself, faculty
need to consider the particular cohorts involved and next
steps to advance students’ competency attainment up the
evaluation hierarchy. If the initial IPE addressed learning
new knowledge or skills (level 2), can this be revisited later
in the curriculum and then evaluated behaviorally (level 3)?
Can interprofessional capabilities be assimilated into future
clinical evaluation tools to determine student performance
in practice? The answers to these questions re-engage faculty
back to the beginning of the model in designing newly iden-
tified IPE learning outcomes for future educational endeavors.
14 Volume 40 & Number 1 & January/February 2015
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Conclusion
Substantive change is occurring in health care, with increased
emphasis being placed on the ability of providers to engage in
teamwork, effective communication, and care coordination
across disciplines. This heralds a new pedagogical require-
ment for IPE within nursing and health professions education
in order to graduate collaborative, practice-ready clinicians.
Interprofessional pedagogy is commonly unfamiliar to faculty.
This article provided a theoretically grounded framework to
guide educators in the design, implementation, and evaluation
of IPE. Graduating students with strong disciplinary capabilities
as well as capacity for communication, ethics, role understand-
ing, and teamwork serves to address the collaborative practice
requirements for changing health care delivery.
Acknowledgments
The author thanks Diane Whitehead, EdD, RN; Lynne Bryant,
EdD, RN; Wallace Marsh, PhD; and faculty at the University of
New England who contributed to the design, implementation,
and evaluation of the Westbrook College of Health Profes-
sions interprofessional curriculum.
References
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2. Thibeault G. Reforming health professions education will require
culture change and closer ties between classroom and practice.
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3. Cronenwett L, Sherwood G, Barnsteiner J, et al. Quality and
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Student Clinical Contract Struggles: A Long History, 1976 to 2015

In 1976, arranging for a clinical placement contract often involved nothing more than a ‘‘Gentlemen’s Agreement’’ and a
handshake. Written clinical contracts were infrequent. Not all agreements were honored, and more schools of nursing
and clinical sites converted to contracts. In an effort to ascertain best content in contracts, a study was done that gathered
information from 34 schools and was published in Nurse Educator in the May/June 1976 issue. Terminology defined
in contracts included considerations, bilateral contract, and ‘‘between 2 or more parties.’’ Some important considerations
included cooperation, nondiscrimination, staffing, insurance, and instructors. Today, all of these considerations and
much more are detailed in contracts between schools of nursing and clinical sites and can account for many pages of reading.

Currently, clinical sites are in demand, and schools compete for sites. Faculty spend much time creating other types of clinical
experiences for students. When Nurse Educator began 40 years ago, there were no online nursing education programs. Today,
online education is more pervasive, and contracts often involve more complicated out-of-state placements, even for 1 student.
There also were no high-fidelity simulation laboratories in 1976, and state boards of nursing did not have to decide on the
percentage of time that simulation could replace clinical experience. Other creative solutions published in Nurse Educator in the
last few years include dedicated education units and clinical placements in prisons, schools, long-term care facilities, and rural
areas. Academic and clinical institutions have moved far beyond a handshake to a comprehensive contract. Whether viewed as
good or bad, clinical sites are more in demand, but the options for replacement are more abundant. What is similar today
between 1976 and 2015 is the shared goal of educating nurses and maximizing the student experiences in each setting.

Submitted by: Alma Jackson, PhD, RN, COHN-S, News Editor at NENewsEditor@gmail.com.

DOI: 10.1097/NNE.0000000000000107

Nurse Educator Volume 40 & Number 1 & January/February 2015 15

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.