IPE Learning Activity Registry

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Your name Your name * First Last
Email address *
Phone Phone * - ### - ### ####
Select the component you have your primary appointment.

Select the component you have your primary appointment. COD COM CON COP SPH Other Other
Second faculty member name working with you on this event. Second faculty member name working with you on this event. First Last
Second Faculty Information: Select the component that is the primary appointment.

Second Faculty Information: Select the component that is the primary appointment. COD COM CON COP SPH Other Other
Third faculty member name working with you on this event. Third faculty member name working with you on this event. First Last
Third Faculty Information: Select the component that is the primary appointment.

Third Faculty Information: Select the component that is the primary appointment. COD COM CON COP SPH Other Other
Fourth faculty member name working with you on this event. Fourth faculty member name working with you on this event. First Last
Fourth Faculty Information: Select the component that is the primary appointment.

Fourth Faculty Information: Select the component that is the primary appointment. COD COM CON COP SPH Other Other
Fifth faculty member name working with you on this event. Fifth faculty member name working with you on this event. First Last
Fifth faculty Information: Select the component that is the primary appointment.

Fifth faculty Information: Select the component that is the primary appointment. COD COM CON COP SPH Other Other
Title for this interprofessional education activity *
Event Start Date (if known) Event Start Date (if known) / MM / DD YYYY
Event End Date(if known) Event End Date(if known) / MM / DD YYYY
Role of faculty/staff in learning activity
(Check all that apply) *

Role of faculty/staff in learning activity
(Check all that apply) Instructor/Professor Facilitator Mentor Planning Committee Other Other
Requirements for registering for this activity
(Check all that apply) *

Requirements for registering for this activity
(Check all that apply) Involvement of two or more professions Significant interactivity between participants Opportunities to learn about, from, and with one another Interprofessional teaching/learning is intentionally targeted, discussed, addressed, reviewed, and/or assessed Alignment with IPE Core Competencies
Type of learning activity
(Check all that apply) *

Type of learning activity
(Check all that apply) Case-based and/or problem-based learning Clinical observation learning Collaborative research project Competition or contest Controversy discussions and/or mock debates learning Didactic learning Experiential and/or clinical learning International/global health experience Interprofessional journal club Pilot program or project Service learning and/or community engagement project Simulation learning Team-building activity TeamSTEPPS training within an interprofessional environment Workshop, interactive demo, or small group activity Other Other
Detailed description and purpose of learning activity. Include how the students will learn with, about, and from each other in this section. *
Level of interprofessional education and collaborative practice integration
(Check all that apply) *

Level of interprofessional education and collaborative practice integration
(Check all that apply) Exposure Level: Consists of introductory learning activities that provide learners with the opportunity to interact and learn from professionals and peers from disciplines beyond their own. The desired outcome for activities offered at the exposure level is that learners will gain a deeper understanding of their own profession while gaining an appreciation for the perspective roles of other professions. Immersion Level: Consists of development learning activities that provide learners with the opportunity to learn about, with, and from other professional learners in an active learning situation where they are applying learning during the activity. The desired outcome for activities offered at the immersion level is that the learners will develop critical thinking skills as part of an interprofessional view that incorporates multiple perspectives, and acknowledges and enourages diversity in providing quality health and human services. Competence Level: Consists of practice-ready learning activities where learners will integrate their interprofessional education and collaborative knowledge and skills in an authentic team-based environment. These activities will have learners actively engaged in team-decision making around patient, family, and/or community care. The desired outcome for activities offered at the competence level is development of competent practice-ready health care providers. Other Other
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