IPE Special Event Proposals

Principal contact *

Email *

IPE Lead Faculty *

Event Date(s) *

Event Title *

Purpose of Event/Activity *

Description of Activity: *

Anticipated # of students needed *

1) Are there at least 2 professions participating in the event? This is a requirement for IPE events. *

Other

3) Is there involvement of other faculty/students from other programs in the planning of the activity/event, to ensure relevance and accessibility to all students (timing, location, outcomes)? *

4) List names and email addresses of activity/event planners: *

5) If volunteers are needed, please create a digital group sign-up sheet, Be sure to list the description and quantity needed of each volunteer role. Students from different disciplines are working together working to learn about, from, and with each other. List the sign-up document’s link here: *

6) What IPEC Competencies will be addressed? It is not necessary to address all four competencies. The competencies are: *

Competency 1 – Values/Ethics for Interprofessional Practice: Work with individuals of other professions to maintain a climate of mutual respect and shared values

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

Competency 3 – Interprofessional Communication: Communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease

Competency 4 – Teams and Teamwork: Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable

a) How will the above competencies be assessed? *

Please email ipe@ulm.edu to access IPE assessment tools currently in use at ULM.

7) At what level will students be involved in this activity? *

Exposure/Content – These activities are primarily knowledge based. Examples include: Shadowing experiences, Journal clubs, Special event seminars, “lunch and learn”, Interprofessional Education Student Organization approved activities

Immersion/Application – These activities are typically of longer duration than exposure activities and require higher levels of interaction between the health professional students. Students will be required to collaborate with other health professional students, make decisions and solve problems together. Examples include: Tutorial Courses, E-based Learning Activities, Special Projects, Special Events, Communication Skills Lab, Clinical Initiatives

Competence – This is the most complex and integrative group of activities. Students will integrate their IP knowledge and skills in a team environment. Typically, this will be of longer duration. Students will build relationships in a team environment and be actively engaged in team decision making around patient care. Mastery activities are primarily clinical education experiences

8) How will your IPE activity/event prepare the students for collaborative practice? *

9) Target Audience and maximum number of participants: *

10) Activity Duration: *

11) Timeline of Activity: *

12) Pre-Event Assignment (if any):

13) Do you need assistance from the IPE Co-College Committee? If so, please let us know how we can help below.

14) Please email any promotional materials produced for this event ipe@ulm.edu. This committee does not approve promotional materials. It is your responsibility to ensure all materials have been approved by Graphic Services prior to distribution. For approval, go to ulm.edu/opiservices. Login to OMC Services and click on “Graphic Design” to submit for review. If you have any questions, please contact OMC at 342-5152.

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