This document describes a theory-based continuing interprofessional education (CIPE) program designed to improve sepsis care through enhanced healthcare team collaboration. The program involved three activities over six months that applied social identity theory, reflective and experiential learning theory, and communities of practice theory. Evaluation results found the program positively changed provider perceptions of team-based care and increased commitment to collaborative behaviors. Participants demonstrated a greater appreciation of other roles in sepsis care.

1. 2014
http://informahealthcare.com/jic
ISSN: 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 continuing
interprofessional education program to improve sepsis care by
enhancing healthcare team collaboration
John A. Owen1,2,3
, Valentina L. Brashers2
, Keith E. Littlewood3
, Elisabeth Wright3
, Reba Moyer Childress2
and
Shannon Thomas2
1
Office of Continuing Medical Education, 2
School of Nursing, and 3
School 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. Applying
theories to underpin the development, implementation, and evaluation of CIPE activities
informs educational design, encourages reflection, and enhances our understanding of CIPE
and 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 related
to CIPE and workplace learning. A description of an effective theory-based program delivered
to faculty and clinicians to enhance healthcare team collaboration is provided. Results
demonstrated 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 by
indicating that more responsibility for implementing the Surviving Sepsis guideline should be
given to nurses and respiratory therapists and less to physicians. Furthermore, a majority (86%)
of the participants made commitments to demonstrate specific collaborative behaviors in their
own practice. The article concludes with a discussion of our enhanced understanding of CIPE
and a reinterpretation of the learning process which has implications for future CIPE workplace
learning activities.
Keywords
Collaboration, continuing interprofessional
education, interprofessional learning,
interprofessional practice, theory,
workplace learning
History
Received 28 January 2013
Revised 19 December 2013
Accepted 29 January 2014
Published online 4 March 2014
Introduction
Traditional continuing education (CE) is primarily focused on the
transfer of clinical knowledge delivered from experts to those less
knowledgeable and often is provided in settings removed from the
point of care. Continuing interprofessional education (CIPE)
differs both in the learning process and the content, therefore
requiring that different theories and new approaches be used in
designing and implementing CIPE activities (Sargeant, 2009).
In addition, learning transfer is improved by providing a strong
relationship between what is taught and the learners’ work roles
within the workplace environment (Merriam & Leahy, 2005).
Workplace learning, defined as ‘‘the physical location, shared
meanings, ideas, behaviors, and attitudes that determine the
working environment and relationships’’ (AACN/AAMC
Lifelong Learning, 2010), is a logical approach to match what
is taught to the leaners’ work roles. Educators have utilized
workplace leaning in many ways such as by creating simulated
IPE workplace scenarios to reflect the workplace environment
(AACN/AAMC Lifelong Learning, 2010). To maximize the
effectiveness of CIPE, it is essential to underpin the development,
delivery, and evaluation of CIPE activities with a sound
theoretical 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-based
sepsis care, targeted for physicians, nurses, advanced practice
nurses, and respiratory therapists who care for patients with sepsis,
was recently developed using a theoretical framework for CIPE in
a simulated workplace setting. Recognizing that effective work-
place learning occurs when the goals and interests of the
workplace and those of individuals who participate in it
are shared (Eraut, 2004), this program reflected the UVA
Health System priority to implement the 2004 Surviving Sepsis
evidence-based clinical guidelines. The guideline consists of
multiple emergent steps for the resuscitation and management
of patients with severe sepsis, and teamwork is essential for
optimal implementation of these complex and time-dependent
interventions. The CIPE program was developed to enhance
healthcare team collaboration within the workplace setting where
sepsis care is delivered. The purpose of this article is to describe
this program and the process of its design, implementation, and
evaluation through the application of explicit theories related
to CIPE and workplace learning.
Correspondence: John A. Owen, Office of Continuing Medical
Education, University of Virginia, McKim Hall, Charlottesville, VA
22908, USA. Tel: +14 349245318. Fax: +14 349821415. E-mail:
jao2b@virginia.edu

2. Background
There is substantial evidence that patient outcomes improve by
enhancing professional healthcare team collaboration (Frenk
et al., 2010; Josiah Macy, Jr. Foundation, 2012). In the Institute
of Medicine (IOM) report, Redesigning Continuing Education in
the Health Professions, one of the numerous recommendations
focused upon the vital role of CIPE: ‘‘Continuing education
efforts should bring health professionals from various disciplines
together in carefully tailored learning environments. As team-
based healthcare delivery becomes increasingly important, such
interprofessional efforts will enable participants to learn both
individually and as collaborative members of a team, with a
common goal of improving patient outcomes’’ (IOM, 2010).
Workplace learning, which is situated within the context of
complex systems of practice (AACN/AAMC Lifelong Learning,
2010; Sargeant, 2009), is emerging as an important consideration
for CE educators and researchers (Newton, Billett, & Ockerby,
2009). Its importance is underscored because workplace learning
serves as a ‘‘process of reasoned learning towards desirable
outcomes for the individual and the organization. These outcomes
should foster the sustained development of both the individual
and the organization, within the present and future context of
organizational goals and individual career development’’
(Matthews, 1999). CIPE in the workplace involves explicit
interactive learning (e.g. group reflection, opportunities to
practice behaviors) where various health professions and others
participating 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 provides
numerous benefits: (1) Theory is integrated into educational
practice by informing the development and delivery of inter-
professional programs, (2) Reflection is encouraged through a
systematic, disciplined and critical approach to thinking about
these activities; and (3) Rationale is provided for making
decisions and testing propositions (Barr, Koppel, Reeves,
Hammick, & Freeth, 2005; Clark, 2009). It is important to
recognize that theories applicable to CIPE are not mutually
exclusive and that selecting a single theory is insufficient for the
complexities of interprofessional education (Hean et al., 2009).
Recent publications have described many relevant theories and
selecting the appropriate theories relevant to the educational
context and content of CIPE workplace activities can be
confusing. 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 the
understanding that interprofessional education is both product and
process-oriented (Sargeant, 2009). This selection process can be
simplified by following a recently published guide (Hean et al.,
2009). Three theories that are foundational to CIPE program
development 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 theories
underpinned the design and implementation of the learning
objectives, learning activities, and outcome measures.
Social identity theory
Social identity theory is the recognition that the identities of
people are developed through membership in social groups whose
members have shared knowledge and values (Ellemers, Spears, &
Doose, 1999). These socially derived identities influence how
individuals perceive and relate to others, and provide individuals
with positive feelings and self-esteem from their estimation of
being part of a distinct ‘‘in-group’’ (Sargeant, 2009). Working
in collaborative teams can pose a threat to social identity, and
can mean having to give up some of this identity (Sargeant,
2009); by implication, CIPE must develop methods to counter
the influence of traditional professional group identity and to
encourage cooperation and collaboration with professionals
of other groups (Clark, 2006).
Reflective and experiential learning
Self-reflection is a learning strategy that entails learning from
experience (Clark, 2009), and is particularly effective when
professionals are faced with unique experiences not easily
understood from established practice patterns. Scho¨n (1987)
approach for educating the ‘‘reflective practitioner’’ accounts
for health professionals’ need to be well prepared both in the
science of their profession as well as in the ‘‘gray’’ areas
where uncertainty and value conflicts are likely to occur.
Interprofessional practice often encompasses gray and value-
laden areas, and developing the ability to learn by reflecting
on one’s own experiences and interactions with other health
professions is an important attribute (Clark, 2006).
The major tenant of experiential learning is that learning is a
continuous process emanating from experience, and is not simply
a product or an outcome (Clark, 2006). Experiential learning
entails both individual and group reflection on the process, and
requires that health professionals learning to work as interprofes-
sional teams have opportunities to engage collaboratively in real
clinical situations, or in CIPE settings that use realist case studies
and 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 occurs
through social activity within a specific context (situated
learning), 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) learning
occurs through interaction or ‘‘co-participation’’. Both elements
have 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 and
work are inseparable in this context (Wenger, McDermott, &
Snyder, 2002). Learning is not a discrete activity separate from
work 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 CE
activities, can be improved by understanding how communities of
practice work and learn together (Sargeant, Hill, & Breau, 2010).
Education activities
At the University of Virginia, a CIPE program was developed for
enhancing teamwork during implementation of the Surviving
Sepsis Guidelines (http://www.survivingsepsis.org). The learning
objectives were as follows: (1) Describe the differences between
IPE 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 involved
three days of faculty/clinician training. The second and third
DOI: 10.3109/13561820.2014.890581 Designing and evaluating a theory-based CIPE program 213

3. activities, which focused on the healthcare professionals’ roles
and responsibilities related to effective sepsis care, began
2 months following the first activity and extended for a total of
4 months. These activities were designed as work-based CIPE
through the utilization of a high-fidelity IPE sepsis simulation
case which linked the program content to the learners’ work roles
and workplace environment.
Thirty-two people (9 MDs, 19 RNs and 4 PhDs) participated
in the first activity. Applying social identity theory to counter
the influence of traditional professional group identity and to
encourage team cooperation, facilitators assigned participants to
stable 5–6 member interprofessional groups to enable participants
to experience and reflect on their own dynamic interprofessional
group process and apply what they were learning about these
topics throughout the course. Reflective and experiential learning
was applied by encouraging participants to interact actively with
the facilitators and with the members of their interprofessional
group, and to engage in reflective journaling that stimulated
reflection on what was happening in the experiential learning
process, and to assess the effectiveness of their collaboration
skills. The overall goal of this training, entitled ‘‘Educating
Health Professionals for Interprofessional Care’’ (ehpicÔ), was
‘‘to engage professionals in learning how to work together
by providing the knowledge, skills, and attitudes required to
effectively collaborate’’ (Oandasan & Reeves, 2005). Learning
activities included icebreakers, didactic lectures, small group case
study work and discussions.
Eleven people (3 MDs, 8 RNs) participated in the second and
third activities. Learning in communities of practice was applied
in designing the second activity. Clinical simulation that demon-
strates a collaborative practice approach is a powerful educational
method to prepare healthcare providers for interprofessional
practice (Morton, 1999). Participants were asked to code each
step in the Surviving Sepsis Guideline as the responsibility/role
of a physician, nurse, advanced practice nurse, and/or respiratory
therapist. They then viewed a videotape in which four participants
assumed the roles of a physician, nurse, advanced practice nurse,
and respiratory therapist engaging in a high-fidelity simulation of
a sepsis management case. They were asked to repeat the
responsibility/role coding of the guideline steps after viewing the
video recording. One, two, three, or all four of the healthcare
professionals could be assigned the responsibility for each step of
the guidelines. By having participants watch the simulation via
the videotape and identify ways to improve care by working more
effectively together, individual learning was shifted to situated,
team-based learning.
Reflective and experiential learning was applied in designing
the third activity. Participants were presented a list of 10
interprofessional practice behaviors and asked to respond to the
following question: ‘‘Drawing on your expertise in collaborative
care, which of the following behaviors are most important
for ensuring optimal care of patients with sepsis?’’ The six
behaviors most frequently identified were used to create a sepsis
‘‘Collaborative Care Best Practice Model’’ (Owen, Brashers,
Peterson, Blackhall, & Erickson, 2012). Participants were then
presented the same ten interprofessional practice behaviors and
asked to reflect on the question, ‘‘Which of the following
collaborative behaviors are you willing to make a personal
commitment to demonstrate and promote in your practice?’’
Methods
For the first activity, it was recognized through social identity
theory that participants likely would encounter some internal
resistance 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 this
theory, the Readiness for Interprofessional Learning Scale
(RIPLS) Questionnaire (Parsell & Bligh, 1999) was used to
assess readiness related to interprofessional learning as this
learning pertained to the roles of other healthcare professionals
and their scope of practice. The RIPLS consists of 19 items using
a 5-point Likert scale (1 ¼ strong disagree to 5 ¼ strongly agree).
RIPLS data were collected ‘‘pre and post’’ activity one.
Reflective and experiential learning created the basis for the
evaluation form in which participants were asked to explore
their experiences working in teams in two ways: improving their
knowledge of teamwork for implementing the sepsis guidelines
and improving the CIPE learning experience itself. The evalu-
ation, which consisted of open-ended questions and 12 statements
measured by a 5-point Likert scale, was given at the end of each
of the 3 days of the program so that daily as well as cumulative
responses could be assessed.
Social identity theory was applied in the evaluation of
outcomes for the second activity. Effective collaborative team
behavior can threaten social identities especially if certain
responsibilities comprising a health professional’s identity are
relinquished. Based on this theory, it was hypothesized that
certain responsibilities in the implementation of the sepsis
guidelines would be viewed by participants as the exclusive
domain 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 of
responsibilities and practice behaviors necessary to implement the
sepsis practice guidelines would change after viewing the
interprofessional teamwork demonstrated in the sepsis simulation
video recording.
Reflective and experiential learning, as well as communities
of practice learning, guided the development and evaluation of
outcomes for the third activity. In communities of practice
individuals create experiential knowledge as they work together.
By identifying and committing to collaborative behaviors after
having participated in the communities of practice CIPE experi-
ence with colleagues from other professions, it was anticipated
that participants would have more incentive to implement
new practice behaviors and to learn from that experience.
The ‘‘Commitment to Change’’ strategy of asking participants
to identify specific behaviors that they planned to promote in
their practice has been demonstrated to predict actual changes
in practice behavior (Wakefield, 2004).
Results
For the first activity, the means of the pre/post scores in the
RIPLS survey did not change significantly (73.5 pre faculty
development and 72.9 post faculty development; n ¼ 17), thus
indicating that attitudes related to interprofessional learning
remained basically unchanged. Program evaluation data varied
over the 3 days, with a drop in positive responses on Day 2.
Noting these changes in quantitative data following Day 2 and
in response to participant suggestions to modify the material, the
originally planned content and delivery was modified for Day 3.
Evaluations improved and participants’ increased interest and
enthusiasm on Day 3 was palpable. Averaged over the 3 days, 92%
of the participants agreed or strongly agreed that the material
was relevant to their work, 86% agreed or strongly agreed that
it encouraged them to change their practice, and 87% agreed
or strongly agreed that overall the workshop had met their
expectations.
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

4. data. However, pre/post changes in the assignment of responsi-
bilities for the roles of physician, nurse and respiratory therapist
were noted, most often with less assignment of responsibility
being given to physicians and more assignment of responsibility
being given to nurses and respiratory therapists after having
viewed the video. By way of illustration, data for three of the
guidelines steps are presented in Table I.
These same 11 people participated in the third activity and
identified behaviors needed to provide optimal sepsis care
collaboratively. They then made commitments to demonstrate
and promote specific collaborative behaviors in their practice
(Table II).
Discussion
Foundational to the design of this CIPE workplace program
was the assumption that ‘‘there is nothing so practical as a good
theory’’ (Lewin, 1951), and that underpinning the design with
explicit theories would enhance our understanding of CIPE and
collaborative practice (Reeves, 2013). The application of theories
to the various aspects of this CIPE program encouraged system-
atic, methodical, and analytical thinking (Barr et al., 2005), and
supported 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 happening
in the learning process. As participants obtained new knowledge
and skills, they desired to adjust the content and delivery of the
CIPE experience to better meet their needs while learning was
still in progress. This observation illuminated our understanding
of CIPE, and revealed that using continuous feedback from the
learners to adjust the content and delivery of instruction enhanced
the learning process.
The observation that the means of the pre/post scores in the
RIPLS survey differed only slightly was at first surprising.
However, on further reflection, we realized that the participants
were likely already to be positively biased towards interprofes-
sional learning based on their self-selection for this intensive
workshop. This realization raises the possibility that CIPE may
not change the attitudes of participants already favorable towards
interprofessional learning. This conclusion was supported by
a previous study which revealed that students with high self-
reported IPE exposure had more positive attitudes towards
IPE than those students who reported no IPE exposure (Lie,
Fung, Trial, & Lohenry, 2013).
Although interpretation of results for the second activity
is limited by the small number of participants, the changes in
the assignment of responsibilities for the physician, nurse and
respiratory therapist relative to the sepsis practice guidelines
suggest a change in knowledge pertaining to collaborative
team practice and a better understanding of the responsibilities
and practice behaviors necessary to implement the sepsis practice
guidelines interprofessionally. Findings from a previous study
revealed that difficulties in team collaboration occurred
Table II. Importance of and commitments to demonstrate collaborative behaviors.
‘‘Drawing on your expertise
in collaborative care, which
of the following behaviors are
most important for ensuring optimal
care of patients with sepsis?’’
‘‘Which of the following
collaborative behaviors are
you willing to make a personal
commitment to demonstrate and
promote in your practice?’’
Behavior % Response (n ¼ 11) % Response (n ¼ 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 the
professions.
91% 100%
Effectively exchange knowledge and ideas with other
professions.
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 and
benefits.
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 the
patient/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 inhibitor
91% (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

5. ‘‘when team members acted towards one another as representa-
tives of their professions’’ (Kvarnstro¨m, 2008). Noting these
changes in the assignment of responsibilities enhanced our
understanding that CIPE has the potential to minimize the
threat to peoples’ professional identities that naturally occurs
when healthcare professionals work together collaboratively.
For the third activity, it was interesting to note that the
percentage ranking of the list of behaviors necessary to provide
optimal care of patients with sepsis compared to the list of
behaviors participants were willing to demonstrate and promote
differed. For example, 73% (8) of the 11 participants listed
‘‘define individual responsibility for implementing joint decision
and follow-up’’ as one of the behaviors most important for
optimal care of sepsis, yet only 18% (2) of the 11 participants
identified this as a behavior to demonstrate and promote in
their practice. A possible explanation for this change in priority
could be that a collaborative behavior needed for optimal care
of sepsis already was being practiced due to a supportive
workplace environment, thus making it unnecessary to list that
behavior as one to demonstrate or promote. This explanation
furthered our understanding that effective CIPE and learning
within communities of practice must recognize that learning is
strongly influenced by the unique aspects of each workplace
and the associated collaborative behaviors required of those who
participate in it.
Evaluation of the results of this study is limited by the small
number of participants who completed the second and third
activities. Clearly, the well-recognized barriers of limited time
and complicated scheduling apply to CIPE activities as well as
CE. Finally, participants were overwhelmingly physicians and
nurses; very few professionals from other disciplines were able to
attend. Future programs will explore additional ways of retaining
participants and recruiting a broader range of professionals.
Concluding comments
Knowledge of theoretical foundations for learning enhanced our
understanding of factors that influence the effectiveness of CIPE
and workplace learning, and the application of explicit theories
supported the design, implementation, and evaluation of this
innovative CIPE program. In addition, this enhanced understand-
ing enabled us to reinterpret various aspects of the learning
process linked to theory, which in turn suggested a new learning
strategy to employ in future CIPE workplace learning programs.
Results suggest that positive changes in provider perceptions of
and commitment to team-based care can be achieved with well-
designed CIPE programs.
Acknowledgements
The authors would like to thank Mandy Lowe, MSc, BScOT, Ivy
Oandasan, MD, CCFP, MHSc, FCFP, and Belinda Vilhena, MEd, BSc
who served as the University of Toronto, Centre for IPE, facilitators for
the faculty development program entitled ‘‘Educating Health
Professionals for Interprofessional Care’’ (ehpicÔ) and who provided
feedback on this manuscript.
Declaration of interest
The authors report no conflict of interest. The authors alone are
responsible for the writing and content of this paper. This Program was
funded by Pfizer, Inc. Grant ID: 030608.
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