An Interprofessional Approach to Managing the Dizzy Patient

These days, finding balance is especially important, on all levels. But addressing dizziness is particularly important to prevent falling and serious injury. Funded by a PIPE Interprofessional Clinical Opportunities grant, Rosanne Krauter, BSN, MSN, NP led a pilot rotation on managing dizzy patients in a two-week intensive; other participating educators included audiologist Lauren Pasquesi, AuD, Erica Pitsch, DPT, and Jeff Sharon, MD.

(l-r) Syeda Burkhari (nursing student), Eliza “Ellie” Winter (physical therapy student), Natalie Sienko (audiology student), and Roseanne Krauter, BSN, MSN, NP

The idea for the rotation came from Krauter and Sharon, both vestibular specialists who noticed gaps in the medical and nursing curriculum for students around dizziness.

“There's this very interprofessional practice around caring for these patients. We get input from our physical therapists for treatment and from our audiologists on testing these dizzy patients. At times, we work with neurology, and certainly lots of imaging,” said Krauter.

Every other month Krauter and colleagues held vestibular rounds, where they would present cases and different professionals would attend, so she felt that would be a good fit for interprofessional education.

For this pilot, three learners participated—one in nursing, one in physical therapy, and an audiology extern. Students spent time in audiology, physical therapy, and otology clinic. They also spent a day learning vestibular exam and one day practicing mock cases.

“The students really loved when we came together for the mock cases. A lot of the learners were reporting that was one of their favorite parts of the rotation. For upcoming rotations, we might give them more opportunities for them to apply their knowledge,” said Krauter.

She shares how the learners quickly acclimated to the environment and asked each other questions. “Sometimes it can be a little intimidating when you're new to the field. I think the learners found quick camaraderie in each other being at the same starting point,” said Krauter.

Coming from the University of the Pacific as a student in audiology, Natalie Sienko started at UCSF in July 2021 for an externship clinical experience as her final year. She came to the rotation after completing her academic coursework and had worked closely with ENT practices and physical therapy for balance, rehabilitation, and training. Sienko said, “What we don't get to do is really study what happens in the other practices and follow up with these cases and what happens to them, so this was a great opportunity to kind of see the other side of management of these patients.”

“Within the field of audiology, we focus a lot on hearing, but also our inner ear houses our balance organ as well. We work a lot with both of those because sometimes different pathologies or problems are related to dizziness and also hearing loss. Something that really drew me to a particular fascination with the balanced portion of audiology is the anatomy of the inner ear. It’s very complex and just very interesting to study,” said Sienko.

Over two weeks, Sienko had the opportunity to conduct many balance assessments for dizzy patients and focus on their management.

(l-r) Brooke Warren (medical student), Melissa Im-Giuffrida (nursing student), and Lauren Jacobs (audiology student)

“In audiology, we do a lot of diagnosing and new referrals out. The interdisciplinary program allowed me to have a greater depth and understanding of the management of these patients and focus on providing me with a lot more background and information to provide to my patients in the future about what's going to happen at ENT and at PT,” said Sienko.

One of the high points of the rotation for Sienko was seeing how other providers had a depth of knowledge in audiology, and to see the team of providers come together.

Krauter praises the learners: “Whenever I'm done with these rotations, I'm always very proud of UCSF because they select such bright learners who I know are going to contribute to their fields.”