Interprofessional Event Planning Form
Thank you for your interest in promoting Interprofessional Practice and Education (IPE)! The goal of this form is to provide a framework for helping develop your IPE learning experience to ensure the best possible outcomes for all learners that participate. We look forward to your feedback and are always open to suggestions to improve this process.
Title of Activity
Institution
Central Washington University
Heritage University
Pacific Northwest University
Washington State University
Other
Other Organization/Department
Disciplines Included
Dietetics
DO
EMT-P
Nursing
PA
Pharmacy
Other
Is this activity part of a research project?
Yes
No
Contact Information
Name/Title/Credentials
Phone Number
-
Area Code
Phone Number
E-mail
Proposed Date
-
Month
-
Day
Year
Date Picker Icon
Proposed Date (continued)
One-time
Annual
Other
Proposed Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Proposed Location
Central Washington University
Heritage University
Pacific Northwest University
Washington State University
Other
Other Location
Will this event be partnering with another club and/or sponsorship?
No
Yes
Name of club and/or sponsor?
What is the overall goal/purpose of this activity? What do you hope participants will learn/gain from participating in this event?
Based on the overall goal/purpose provided above, briefly describe the activity in more detail (350 words or less)
0/350
Additional Information
From the list of core competencies below please choose one or more that apply to the curricular focus of your event. Then, for each core competency chosen provide one or more learning objectives and a description of how you will determine that the objective(s)were accomplished (i.e. indicator(s) of success). NOTE: You can choose to pick more than one competency if you feel it applies. The YVIPEC cautions that you keep the outcomes reasonable to your original goal of this learning activity and explain in detail how you plan to accomplish these goals.
Competency 1(Values/Ethics for Interprofessional Practice) Work with individuals of other professions to maintain a climate of mutual respect and shared values.
Demonstrate a patient/population centered focus on providing care.
Demonstrate respect toward all members of the care team including the patient, family, and other professionals.
Maintian a collaborative work enviroment for patient care.
Explain how this activity will meet this objective in 150 words
0/150
Competency 2(Roles/Responsibilities) Use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients and to promote and advance the health of populations.
Define and operate within the professional scope of practice
Understand the roles of other professional members of the patient care team and explain each professional's role to others as necessary
Appropriately Intergrate other professional in to patient care team
Explain how this activity will meet this objective in 150 words
0/150
Competency 3 (Interprofessional Communication) Engage patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports collaboration in the promotion and maintenance of health and maintenance of health and the prevention and treatment of disease.
Demonstrate effective communication skill as an individual
Utilize individual communication skills effectively in a team environment
Explain how this activity will meet this objective in 150 words
0/150
Competency 4 (Teams and Teamwork) Apply relationship-building values and the principles of interprofessional collaborative team dynamics to perform effectively to plan, deliver, and evaluate patient/population-centered care. In a similar manner, develop population health programs and policies that are safe, timely, efficient, effective, and equitable.
Demonstrate effective teamwork in delivering patient/population centered care
Maintain up to date knowledge of effective teamwork
Demonstrate continual improvement of team based practices
Explain how this activity will meet this objective in 150 words
0/150
Budget Breakdown
Supplies
Food
Registration
Other
Explain other budget requirements
TOTAL Budget
How will your learning outcomes be communicated to participants?
0/150
What is the marketing plan or needs?
Thank you again for your interest in collaborating with the YVIPEC to advance interprofessional practice and education in the Yakima Valley and beyond. We look forward to working with you on this event. If you have any questions, feel free to email IPE@pnwu.edu.
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