Silo Buster One
Take a snapshot look at what health sciences faculty at three institutions—New York University, the College of Saint Rose and the Medical College of South Carolina—are doing to bring together students across specialties.
Small Idea, Big Changes at NYU-Steinhardt
An interprofessional nutrition and speech-language pathology class at NYU-Steinhardt proved valuable not only for students, but also for patients with swallowing difficulties—who now have tastier and more varied food choices.
Recognizing the need for educational and clinical training that more closely mirrors real experiences, Communicative Sciences and Disorders and Nutrition were the first departments at NYU-Steinhardt to offer an interprofessional course promoting collaborative approaches to care. Given that the keys to effective interprofessional case management are understanding and valuing the contribution of each discipline, the primary focus of the course was to foster a comprehensive, evidence-based and person-centered team approach to care for individuals with swallowing disorders.
We conceived the course as including multiple disciplines as part of the learning experience. However, the logistical barriers of creating a first-time course with so many key players proved too overwhelming, so we narrowed the focus to swallowing issues and their impact on nutrition. Primary learning methods include the use of problem-based learning—including complex individual case studies (based on real patients)—student-led discussions, and exercises to apply the information taught in class.
As with a real case, information related to the "patient" unfolds over time. CSD students are responsible for interpreting and explaining information from the clinical and objective swallowing evaluations. In turn, nutrition students discuss methods for determining and analyzing nutrition lab values and non-oral feedings. Collectively, students review and critique evidence-based treatment and management practices, discipline-specific standards of care, and problem-solving approaches to ethical decision-making and case management. From these interactive learning opportunities, students identify intersecting aspects of the assessment and treatment process that may affect several aspects of their interactions with patients—their individualized approaches, written and verbal communication, and clinical recommendations—and that may lead to a more comprehensive, efficient and effective plan of care.
More recently we added simulated real-world opportunities to the course. At NYU Langone Medical Center and Beth Israel Medical Center, speech-language pathologists allow students to be part of the collaborative process by observing videofluoroscopic swallow studies. Physicians from Rusk Institute of Rehabilitation Medicine also participate by leading our students in simulated team rounds specific to their cases. The culminating experience includes a "Quick Fire" mocktail and "Iron Chef" dysphagia cooking competition, in which student groups select and prepare a beverage and a meal specific to each patient's swallowing and nutritional needs. Guest judges rate each group's creations based on taste, appearance, appropriateness, rationale and best use of a secret ingredient.
Students, department faculty, administration and the affiliated medical community support the idea of creating an interprofessional course with a common vision. Students generally are surprised and impressed by sharing discipline-specific knowledge and responsibilities, and refer to this unique learning opportunity as one of the highlights of their academic career.
As a result of this course, NYU Langone Medical Center modified its dysphagia menus last year. It now offers patients chef-inspired meals and uses food molds to improve the taste, consistency and presentation of food. In addition, students in the hospital's culinary academy will soon learn how to enhance textured foods for people with swallowing disorders. What began as a collaborative, team-based learning experience became a source of significant change at a major medical center.
This course, its impact on the community and what it represents for clinical education and training programs on a larger scale are more than my collaborator and I ever could have imagined. It has inspired us to challenge conventional ideas about learning in ways that benefit students, educators, organizations, health care providers and, most important, the patients we serve. Each year the course continues to evolve and we are having fun exploring where it goes. Maybe a show on the Food Network is next?
Silo Buster Two
Transforming Support at the College of Saint Rose
Speech-language pathology and counseling students join in a voice modification program for people who are transgender.
Five years ago, I received a call from a local mental health counselor about services for two transgender women interested in modifying their voices. With the help of these clients, The College of Saint Rose established a voice and communication program for people in the transgender community. Initially the program focused on voice, but expanded to include nonverbal communication, language and articulation.
Collaboration has been an integral part of this program from the start. Each semester, graduate student clinicians in speech-language pathology provide services to five to 10 transgender clients using an apprenticeship model in which supervisors and clients serve as "master craftspeople" supporting the students. A team-based approach fosters collaborative decision-making between clinicians and clients. Participants discuss the collaborative partnership during weekly group supervisory meetings.
A lynchpin of the program is collaboration with counseling, as mental health counselors play an integral role in gender transition. Counselors support people as they work through a significant and often stressful life change and connect them with providers who address primary health care, hormone therapy, surgery and other aspects of transition. We encourage students to explore their role as clinician-counselors. And we include activities that allow student clinicians and clients to experience interprofessional collaboration between speech-language pathology and counseling. These include:
CLASSROOM PRESENTATIONS. Clients and student clinicians visit counseling and communication science and disorders classes to practice communication skills, evaluate communication in a functional context and teach others about the transgender experience [PDF]. In two graduate classes, "Counseling for SLPs" and "Multicultural Counseling," faculty and students also use the visits to practice counseling skills (such as active listening and facilitating the client's story), creating a dynamic collaboration between the two disciplines.
MISSION AND MINDFULNESS. Two years ago, a counselor specializing in transgender health came to the group to discuss ways of creating a more positive culture. The counselor helped us craft a mission statement and determine principles of effective communication. The counselor also provided guidance on using mindfulness to enhance the group experience. Feedback from clients and student clinicians, who provide mindfulness activities, indicates that this is an important component of the program.
A LEARNING MODULE IN COUNSELING SKILLS. With a small grant from the college, two communication sciences and disorders faculty members, a mental health counselor, CSD students, and program clients collaborated to create a video designed to teach CSD students about counseling for individuals in the transgender community. The video focuses on gender transition, the role of the mental health counselor, group therapy and the speech-language pathologist's role as clinician-counselor.
STUDENT PROJECTS IN MULTICULTURAL COUNSELING. Two students in multicultural counseling have completed projects on counseling people who are transgender. Part of their project research involved engaging in the group's activities and interviewing clients.
VISITING MENTAL HEALTH COUNSELOR. During the past semester, a mental health counselor from a large community-based counseling center came to the group, observing activities and providing support. She also presented to the student clinicians about gender change and the emotional aspects of transition. This arrangement will continue in an effort to foster more regular interprofessional collaboration between our program and the counseling center.
The transgender voice and communication program at Saint Rose has received considerable support from students, faculty, administrators and our primary referral source—mental health counselors. The program has a relationship with the local lesbian, gay, bisexual and transgender community center, which extends our reach beyond the campus. Continued collaboration with mental health counselors and students studying counseling will ensure that our services meet the needs of people undergoing an extraordinarily life-changing physical and social transformation.
Silo Buster Three
The New Face(s) of Training at MUSC
The Medical University of South Carolina is a leader in providing interprofessional education and training. Here's a snapshot of its IPE program.
At the Medical University of South Carolina, we've required students to participate in interprofessional education since 2007—when we focused on IPE as part of university-wide reaccreditation. All first- and second- year students participate in an Interprofessional Day, where they learn more about the necessity and value of interprofessional collaboration.
First-year students learn more about one another's professions through an interactive small-group exercise. The second-year experience builds on that experience through discussion of cases designed to showcase the value of collaboration. Students also complete an interprofessional course, in which they learn about the complexities of the health care system—including cultural and ethical issues—and work in small interprofessional groups to analyze a fictional sentinel event. The intent is that they apply teamwork skills when working together.
Because problems can emerge when bringing together different professionals and personalities, we incorporate training on effective teamwork behaviors when encountering challenges: respect for others, listening to different perspectives, clear communication, encouraging others to participate, negotiating differences to be inclusive, and resolving conflict productively. Interprofessional challenges typically relate to respect issues, a need to break down the traditional hierarchy in medicine, and confidence in reaching out to other professions—a trait that is often not role-modeled by faculty or preceptors. We sensitize our students to all of this.
As students progress to clinical rotations, each program requires them to purposefully interact with other professions to improve a patient's care—not simply stand side by side during patient rounds and never interact. Our goal is for students to apply teamwork skills and their knowledge of others' professions in multiple learning and practice settings before they graduate. Students report confidence in seeking help from other professionals during patient care. Ensuring that students can collaborate and truly understand what different professions contribute to health care is the new direction in health professions education.
Amy Blue, PhD, assistant provost for education and professor of family medicine, Medical University of South Carolina.
Alberto, J., & Herth, K. (2009). Interprofessional collaboration within faculty roles: Teaching, service and research. OJIN: The Online Journal of Issues in Nursing, 14(2).
ASHA (2008, June). Why is greater emphasis being placed on interprofessional education in health care? Access Academics and Research. Retrieved July 20, 2011, from http://www.asha.org/academic/questions/Interprofessional-Education.
Durkin, T,. & Vescovich, M. (2011, November). The SLP: A valued member of the hospice interdisciplinary team. Paper presented at the 2011 Annual ASHA Convention, San Diego, CA.
Embry, E., & Pickering, J. (2012, November). Cultivating creative, interdisciplinary collaboration in academic & clinical education. Paper presented at the 2012 ASHA Annual Convention, Atlanta, GA.
Embry, E., & Pickering, J. (2012, April). Cultivating creative, interdisciplinary collaboration: Perspectives from two institutions. 2012 Council of Academic Programs in Communication Sciences and Disorders Annual Convention, Newport Beach, CA.
Hagstrom, F. (2010). Establishing interdisciplinary collaborations for international education. SIG 10 Perspectives, 13(1), 13–17.
Harvard Medical School (n.d.). Academics: Cambridge Integrated Clerkship. Cambridge Health Alliance. Retrieved on July 19, 2011, from http://www.challiance.org/academics/integrated_clerkship.shtml.
Huff, E. G. (2009, November). Incorporating Medical Setting Interdisciplinary Experiences into a Graduate SLP Program. Paper presented at 2009 Annual ASHA Convention, New Orleans LA.
International Brain Injury Association. (2007). On neurorehabilitation: A conversation with Mark Ylvisaker, PhD. Retrieved June 16, 2011, from http://www.internationalbrain.org/?q=node/71.
Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Available at http://www.aacn.nche.edu/education-resources/ipecreport.pdf.
John-Steiner, V. (2006). Creative collaboration. New York: Oxford University Press.
Kirch, D. G. (2011). Higher education and health care at a crossroads. Trusteeship, 2(19), 1–7.
MMC/Tufts Medical School (n.d.). Milestone: About us. Maine Medical Center/Maine Health. Retrieved July 19, 2011, from http://www.mmc.org/mmc_milestone.cfm?id=6239.
Page, J. L. (2010). The Rockcastle Project: A model for interprofessional clinical education in a rural medical center. Access Academics and Research. Retrieved July 20, 2011, from http://www.asha.org/Academic/questions/rockcastle-project.
Page, J. L., & Morris, D. S. (2012). Whole patient, whole team. The ASHA Leader , 17(6).
Perry, C., Hall, B., & Tiongco, C. (November, 2011). Interdisciplinary teamwork: Making IT work. Paper presented at the 2011 Annual ASHA Convention, San Diego, CA.
Pickering, J., Bloom, C., Luna, A., & Selmon, S. (November, 2011). The clinician-counselor with transgender clients: An instructional video. 2011 ASHA Annual Convention, San Diego, CA.
Stemple, J. C. (2006). Personnel shortages in speech language pathology: Doctoral Collaborations. Retrieved June 16, 2011, from http://www.asha.org/uploadedFiles/slp/Stemple.pdf [PDF].
Strober, M. H. (2011, January 2). Communicating across the academic divide. The Chronicle of Higher Education. Retrieved June 16, 2011, from http://chronicle.com/article/Communicating-Across-the/125769/.
Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press.
Weinstein, D. (2011, February 14). Students prepare for your final class! The Iron Chef challenge: NYU Steinhart News. Retrieved from http://steinhardt.nyu.edu/site/ataglance/2011/02/students_prepare_for_your_fina.html.
Wertheimer, J., Constantinidou, F., Raymer, A., Turkstra, L., & Paul, D. (2008, November). Promoting effective interdisciplinary collaboration. Paper presented at the 2008 Annual ASHA Convention, Chicago, IL.
Williams, L., Marks, L., Barnhart, R., & Epps, S. (2011, November). ICF-CY: Basis for a conceptual model for interprofessional education. Paper presented at the 2011 Annual ASHA Convention, San Diego, CA.
World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice. Geneva, Switzerland: World Health Organization Press. Available at http://www.who.int/hrh/resources/framework_action/en/index.html.
Ylvisaker, M. (1994). Collaboration in assessment and intervention after TBI. Topics in Language Disorders, 15(1).
Ylvisaker, M., & Feeney, T. (1998). Collaborative brain injury intervention: Positive everyday routines. San Diego: Singular Publishing, Inc.