Supported by a PIPE Interprofessional Clinical Opportunities grant, co-course creators Roseanne Krauter, BSN, MSN, FNP, and Nina Zhao, MD, MAEd, piloted the Interprofessional Voice, Airway, Swallowing elective in fall 2020.

To develop the elective, Krauter, a nurse practitioner in the Department of Otolaryngology – Head and Neck Surgery, and Zhao, an otolaryngologist, collaborated with colleagues Matthew Russell, MD, and Regina Gould, MMSc, MPH, PA-C, to create an interprofessional elective at Parnassus that highlighted how health professionals from different backgrounds collaborated on caring for hospitalized patients with voice, airway, and swallowing issues.

Much of the care provided at the campus site is complex airway for patients who have tracheostomies and are on ventilators. The elective was an immersive and engaging one, involving the rapid response team, nursing practitioners, physician assistants, physicians, residents, attendings, respiratory therapists, and speech-language pathologists, who are all uniquely involved in a patient’s care. Second-year nurse practitioner students were paired with third-year medical students in a one-to-two-week rotation where they shadowed the different professions. Their learning included the head and neck exam, how to do a flexible laryngoscopy, and collaboratively writing patient care consult notes.

“We developed this rotation to provide students with an authentic, on-the-ground experience for what interprofessional patient care looks like,” said Zhao. “Even though we are specialized in these conditions as otolaryngolgists, we still require the expertise of other professionals. This is interprofessional teamwork in action.”

Krauter said, “I was encouraged and inspired to see how the students were primed for observing and identifying interprofessional interactions.”

Interprofessional Appeal

Most electives are department-based and lack an interprofessional emphasis, which made this elective stand out for medical student Joseph Kidane. He was paired with nurse practitioner student Sara Lezin.

Lezin said, “I've personally suffered from idiopathic hearing loss, which has enhanced my interest in the anatomical complexity and teamwork involved in otolaryngology.”

Both were enthusiastic about the elective’s design. “Sara and I witnessed firsthand how intentional Dr. Zhao and Rosie were in creating this elective,” said Kidane. “They made sure that we were a part of interprofessional trach rounds and exposed us to the interprofessional care that goes into the voice, airway, and swallowing. Seeing how the team members were so respectful towards each other and knowledgeable in each other’s roles and duties in taking care of the airways was extremely beneficial and created a strong learning environment.”

Lezin agreed, “It was enlightening to work with each of these providers and learn how their specialized training distinctly contributes to the comprehensive care received by patients. As students, we are narrowly focused on our own academic agenda, but learn little about other specialties and their unique training and expertise. This experience has broadened my understanding and appreciation for the team effort in patient care - I aspire to work in a setting that is as equally collegial as UCSF otolaryngology!”

The elective was also a great bonding opportunity. “This was the first time where students work alongside other students from a different school. I came to learn and understand the different subtleties of our training and how it becomes important in a range of scenarios,” said Kidane. He noted that he was able to contribute a more meticulous knowledge of anatomy and physiology and familiarity with the operating rooms. In turn, Kidane learned from Lezin’s inpatient care skills in communicating with patients and their families and being detail-oriented in working with ventilators and looking at a patient’s O2 sat monitor. Compared to medical students, many nursing students have prior clinical experience. Prior to UCSF, Lezin previously served as a nurse at the Jaycee Burn Center at University of North Carolina Medical Center in Chapel Hill and the Bothin Burn Center at St. Francis Hospital in San Francisco. 

Maintaining Safety

Given that the airway is the main site of COVID transmission, there was a heightened awareness of safety for everyone.

“The ENT inpatient team frequently performs aerosol-generating procedures, so with the initiation of this rotation during the COVID-19 pandemic we needed to ensure learner’s understanding of appropriate PPE protocol,” said Krauter.

It’s UCSF practice to test all patients for COVID before they are admitted, after they are moved to a different ward, and prior to certain procedures. The learners had to undergo PPE training and there was an adequate supply of PPE to keep everyone safe.

The elective’s impact was immediate for Kidane in his subsequent rotations in internal medicine and neurology. “For patients who just had strokes, their airway function is often compromised,” said Kidane. “When I was on internal medicine, whenever a patient had a tracheostomy, I was empowered having knowledge about the trach tube and complications that can arise. This isn’t something that’s taught in pre-clinical curriculum and I was able to bring that knowledge to my team, which is unique.” 

Krauter and Zhao are making a few tweaks to the elective based on feedback and are already enrolling for next year. They plan to make the rotation longer and incorporate a day of outpatient work. Krauter encourages others to follow their lead and become involved with PIPE to develop new rotations.

“Our PIPE colleagues were incredibly supportive, every step of the way, from the inception of the idea to execution,” she said. “Creating a rotation is accessible, even if you don’t have an extensive background in education.”