Silo Buster 1: Small Idea, Big Changes at NYU-Steinhardt Interdepartmental collaboration brings improved taste and presentation of food for patients with dysphagia. Features
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Features  |   June 01, 2013
Silo Buster 1: Small Idea, Big Changes at NYU-Steinhardt
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Swallowing, Dysphagia & Feeding Disorders / Features
Features   |   June 01, 2013
Silo Buster 1: Small Idea, Big Changes at NYU-Steinhardt
The ASHA Leader, June 2013, Vol. 18, 41. doi:10.1044/leader.FTR1sb1.18062013.41
The ASHA Leader, June 2013, Vol. 18, 41. doi:10.1044/leader.FTR1sb1.18062013.41
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?
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June 2013
Volume 18, Issue 6