Creative, Interdisciplinary Collaboration in Clinical Education

1. Creative, Interdisciplinary Collaborationin Clinical Education Jack Pickering, Ph.D., Professorof CSD Provisions, College of Saint Rose October 23, 2012 With thanks to Erin R. Embry, M.S., Associate Director, Graduate Program, New York University

2. Collaboration collaboration  (kəˌlæbəˈreɪʃən) — n  (often foll by on, with, etc ) 1. the act of working with another or others on a joint project 2. something created by working jointly with an other or others World English Dictionary

3. Why interdisciplinary collaborations? • They are becoming the new societal norm in light of advances in technology, global learning and economic challenges • They mirror the real world, in both medical and educational settings • Research in health care suggests they enhance patient care • They broaden students’ understanding and experience • They provide opportunities for interdisciplinary scholarship

4. Mark Ylvisaker writes… Effective assessment and intervention in SLP are: • Contextualized • Functional • Person-centered • Collaborative • Interdisciplinary Ylvisaker, M. & Feeney, T. (1998) Collaborative Brain Injury Intervention: Positive Everyday Routines.

5. On Neurorehabilitation: A Conversation with Mark Ylvisaker, PhD (IBIA, 2007) Exceptional teams: • Learn from one another; share skills • Do not function in a pecking order or a sense of hierarchy. • Understand that many of the critical needs of the people we serve are not discipline-specific • Are willing to blur professional boundaries and respect one another

6. The WHO Framework for Action (2010)

7. The Challenges • Strober (2011): • Higher education tends to reward individual, disciplinary achievement • There tends to be insufficient funding • Talking across disciplines can be difficult • Interdisciplinary collaboration is difficult to evaluate

8. The Challenges • Education in CSD: • Programs are generally organized in silos • Coursework tends to be disorder-specific • Clinical and academic education are separated in the curriculum

9. Enhanced Collaboration

10. Interprofessional Education (IPE) in Health Care • Student-practitioners learning together with intention, mutual respect, and commitment; IPE requires continuous interaction, coordinated effort and sharing of knowledge – “enhanced collaboration”.* • Consistent with Ylvisaker’s characteristics of an exceptional team. *Alberto, J. & Herth, K. (2009, March 31) and ASHA (2008, June)

11. Examples of Interprofessional Education • Nurse Education (Alberto & Herth, 2009) • Physician Education (MMC-Tufts; Harvard Medical School) • In CSD, the Rockcastle Project (Page, 2010; Page & Morris, 2012):

12. Core Competencies (2011) Competency Domains • Values/Ethics for Interprofessional Practice • Roles/Responsibilities • Interprofessional Communication • Teams and Teamwork

13. Our Creative Collaborations

14. Mocktails and Iron Chef • A course that promotes interdisciplinary, collaborative approaches to care • Focus narrowed to swallowing issues and impacts on nutrition • Team approach fostered in classroom, lab and hospital setting • Students are from CSD and Nutrition programs

15. Mocktails and Iron Chef • Small number in class + application process results in a very dynamic, motivated group • Modeled after problem-based learning approach; instructors serve as “facilitators” • Assignments/projects functional, applicable and fun • Diverse backgrounds, one common vision

16. Mocktails and Iron Chef • Exposure to real-world experiences through: • Observation of modified barium swallow studies at NYU Langone Medical Center (supervised by NYUMC speech-language pathologists) • Active participation in a mock "team rounds" with resident and attending physicians at Rusk Institute (Physical Medicine & Rehabilitation) • “Top Chef/Iron Chef” Cooking competition: • Students create a dysphagia meal individualized to their patients’ needs • Judged on appearance, creativity, nutritional and texture appropriateness and taste

17. Mocktails and Iron Chef • Idea supported by students, department, administration and affiliated medical community • This course serves as a model for other developing courses in Steinhardt and the medical school • Open lines of communication related to this course have had direct and positive impacts on patient care services at NYUMC/Rusk

18. Communication and Counseling • A program providing clinical services for individuals in the transgender community • An initial focus on voice was expanded to include communication and counseling • Group supervision promotes active dialogue about the program, not just student performance

19. Communication and Counseling • A team approach is fostered with opportunities for collaborative decision making • An apprenticeship model is applied: supervisors, counselors, and clients serve as coaches, “master craftspeople” • Goals are functional and individualized, even in the group setting • Mindfulness is integrated into the sessions

20. Communication and Counseling • Classroom presentations (Counseling for SLPs and Multicultural Counseling) provide opportunities for practice and client-led instruction • Recent project provided an interdisciplinary focus on counseling skills for SLPs • A student in Multicultural Counseling takes part in the group

21. Communication and Counseling • The program has support from students, faculty, administrators and mental health counselors (our primary referral source) • The program facilitated community engagement with the local LGBTQ community center • The group has become an important recruiting tool

22. Views into the Voice An SLP-ENT collaboration: • Facilitated by a .3 FTE consulting position in an otolaryngology private practice • Two laryngologists and a neurotologist actively support student learning • The SLP roles include laryngeal vidoestroboscopy, voice evaluation and intervention, with a recent addition of dysphagia services to the practice

23. Views into the Voice Multiple learning opportunities: • Collaborative, interdisciplinaryclassroom case presentations • Student observations of videostroboscopy • A one-credit, advanced “rotation” with the ENTs • Research • A nice bonus: One of the ENTs is a member of our CSD Advisory Board

24. Considering Collaboration

25. Cultivating creative interdisciplinary collaboration • Do a careful environmental scan (internal and external) to see what is available • Find a colleague with whom you can work • Identify a shared vision and tap into individual strengths • Consider the Core Competencies document • Plan Carefully

26. Cultivating creative interdisciplinary collaboration • Engage constituents (students, colleagues, professionals, clients) in planning and evaluation • Get administrative support • Seek funding, consider grant opportunities • Share what you are doing: • Internally & externally • Through public relations & scholarship

27. One Final Thought • “…collaborative efforts…, result in a clearer vision of the seamless realities presented daily in our clinical lives and an enhanced capacity to serve whole individuals as they deserve to be served.” Mark Ylvisaker, 1994

28. References Alberto, J. & Herth, K. (2009, March 31). 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/academics/questions/Interprefessional-Education.htm. ASHA’s Research and Scientific Affairs Committee (n.d.). Interdisciplinary collaborations. Retrieved July 2, 2011, from http://www.asha.org/academic/interdis-collab/. Durkin, T. & Vescovich, M. (November, 2011). The SLP: A valued member of the hospice interdisciplinary team.Paper presented at the 2011 Annual ASHA Convention, San Diego, CA. Hagstrom, F. (2010). Establishing Interdisciplinary Collaborations for International Education. SIG 10 Perspectives, 13(1), p. 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.

29. References Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. John-Steiner, V. (2006). Creative Collaboration. New York, NY: Oxford University Press. 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, June). 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/academics/questions/rockcastle-project.htm. Page, J. L. & Morris, D. S. (2012, May 15). Whole Patient, Whole Team. The ASHA Leader. 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 www.asha.org/uploadedFiles/slp/Stemple.pdf.

30. References 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. Published originally in Russian in 1930. Weinstein, D. (2011, February 14). Students prepare for your final class! The Iron Chef challenge: NYU Steinhart News. Retrieved from http://steinhardt.nyu.edu/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. 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.