In Austin UTMB is participating in the development of the clinical education center that will be housed in the space vacated by the children’s hospital of austin when it moves out on June 30. The entities participating in this endeavor are UTMB, UT Austin, Austin Community College and the Seton Family of Hospitals. The space will house a simulation center and a standardized patient program, as well as classrooms and seminar rooms. A curriculum planning team with representatives from the participating entities is wroking to develop interdisciplinary course offerings. Courses planned to date will include health ethics (to be taught by UTMB faculty member Bill Winslade) and a health care policy elective. We also hope to develop interdisciplinary case simulations and standardized patient experiences.

Briefly describe the purpose of the teams, activities and/or experiences in one paragraph, i.e., what does the team do, how does it function, etc. - Diagnosis, medical or surgical referral, two optional physical therapy paths (referral to PT clinic for supervised PT management or setting up a self-administered PT program at the UTMB field house.)

Please list the members (names and/or titles).
Frank M. Ivey, orthopedic surgeon, Sara Reynolds, PT, Starr Stanich, PT and David Wise, PT.

In hematology-oncology, multidisciplinary teams are the norm. There is a weekly multidisciplinary team meeting for each of the following cancer types: hematologic, head/neck, thoracic, breast, g-i, hepatobiliary, g-u, neurologic. These are all case presentation and discussion. A multidisciplinary plan is developed and that plan is then the one followed. Each such meeting includes at least one faculty member from medical hem-onc, pathology, surgery, radiology, and radiation oncology. The students, house staff, and fellows rotating with the several teams attend and actively participate. The trainees learn two things apart from specific oncology content. They learn how multidisciplinary decisions are made, and they learn how disagreement and uncertainty are resolved professionally.

The ACS (Ambulatory Community Selective) in Internal Medicine includes a required visit to a community healthcare resource (hospice, home health, nursing home, family planning, etc.) as well as a visit to an alternative healthcare provider (acupuncturist, chiropactor, etc.). A brief paper is to be submitted following the visits. I originally thought this requirement would be non-beneficial but subsequently found it to be quite a valuable experience. I learned what various community resources could offer my patients, how they operated, and how they interact with physicians. Visiting the sites gave me a better understanding of what types of patients I might refer in the future and what those patients could expect.

1. Home visit program
Organized by the SOM: Kirk Smith, Susan Gehric, Donna Weaver, Ruthanna Ward and Caroline Jansen. Medical and Physical Therapy students visit multigeneration of diverse back ground in their homes. Each discipline has their own format of reporting paper. PT students also receive credit for it for the Interdisplinary studies at the SAHS.
2. Interdisciplinary studies at the SAHS. Please, contact Dorothy Pearrow. The program includes a multitude of interdisciplinary activities. Students of all SAHS disciplines are required to take a certain number of activities that they select to their liking and receive course credit.
3. Does interdisciplinary research where students participate and are in contact with faculty of various disciplines count for this?

For 9 years, we have staged an interdisciplinary course on SPirituality and Clinical Care which brings together nursing, medical, and allied health students in large and small groups, team based-learning settings to discuss issues related to spiritual issues in health care. This is a rare but excellent chance for these folks to meet each other face to face and experience the others’ perspectives.

Other faculty that have been involved in this effort are Harold Vanderpool(IMH), Kay Sandor (SON), Rodger Marion (SAHS), Susie Gerik (SOM), Elizabeth Gressle (SON), and several others besides me.

We also have had an acupuncturist in several clinics, Family Medicine/Integrative Medicine Green Team, Neurology, and Anesthesia. This adds an interdisciplinary presence and new perspective, particularly for the hard to treat, chronic pain patient.

We were set back last year after a 2 year attempt to bring a chiropractor on board for clinical privileges for an Integrative Back Pain Clinic.  We took all appropriate steps to pursue credentialing and were ultimately unsuccessful at gaining approval from the Executive Committee. Many other hospitals have such alternative practitioners on staff and they add an important transdisciplinary dimension to the integrative care of patients. Since we strive to provide patient centered care, we need to incorporate other professionals such as complementary and alternative provides and also health coaches.

1. UTMB’s Geriatric Housecall Program is staffed by GNPs and MDs, but patient care can not be done without regular, sometime daily, communication from the Home Health Care Companies. Myself and my GNPs are on the phone daily with differing home health companies facilitating the coordination of home health care in the frail home bound elder. As a MD, I am required by medicare to review written communiction from the skilled nurses, social worker, PTs, and OTs atleast every 60 days. Contact person is msyelf.

2. Geriatric Out-Patient Clinic is staffed by MDs, GNPs, RNs, LVNs, and social workers. The clnic uses home health for PT, OT, and RT services. Contact person is myself of Andrea Poindexter, GNP @ 772-3372.

3. Hospice Care Team is a not-for-profit Galveston County based Hospice that has a stellar interdisciplinary team. (nursing, social workers, volunteers, chaplains, bereavement counselors, and PRN other ancillary team members on an as needed basis). They really have the concept of interdisciplainry communication down pat. They is nothing multidisciplinary about this team. Contact person at Hospice Care Team is Debrah Perryman (938-0070).

4. Gulf Healthcare Nursing Center has a strong interdisciplinary team that meets regularly with patient/family meetings to esta2blish both the skilled nursing facilities plan of care and to help the patient and family arrange the discharge plan of care. Regular members of this team are nursing, social worker, PT, OT, ST, dietary, patient, and family!!!! I am the medical director at GHCC, so I guess I would be the first line contact person and then I could hook people up with others there.

Our group is referred to as Children’s Special Services. Our services encompass both inpatient care and multiple outpatient clinics (both on-site and via telemedicine) for those patients who have chronic physical or mental conditions, many of whom are considered medically fragile and are technology-dependent (including children on home ventilators).

Our philosophy is to achieve the highest standard of diagnosis and treatment of complex and chronic medical conditions. We strive to establish an environment in the home and the community to allow the child to reach his/her highest potential possible and to prevent possible complications of the primary condition through education and appropriate treatment modalities using all available resources.

Our team includes allied health professionals, nurses, physicians, social workers, dietitians, chaplains, ethicists, and school teachers who all contribute to a model of interdisciplinary work. We coordinate with specialists in the fields of genetics, surgery, neurosurgery, orthopedics, urology, and otolaryngology. We also work closely with other services including pediatric radiology, pharmacy, specialized lab, orthotics, biotechnology, and off-site informatics to provide a broad-based, approach. Ongoing communication through scheduled team meetings ensures high standards of care.

Our goal is to provide comprehensive care linking the tertiary hospital and the primary care providers to provide the best, most efficient support for these special children in their communities.

The interdisciplinary team on the ACE (Acute Care for the Elderly) Unit on the 10th floor of the Towers consists of doctors, nurses, occupational therapists, physical therapists, case managers and nutritionists. The facilitation of the meeting rotates among the team members, further reinforcing the interdisciplinary team concept. The focus of this interdisciplinary team is to reduce the negative effects of hospitalization on the elderly patients (65 years +) and to determine safe, effective discharge plans for this special population. The team meets DAILY (Monday through Friday)to discuss the current medical plan on EACH patient and to identify discharge needs. The team encourages early identification of discharge needs for this special population and their caregivers. Team members are on the ACE Unit throughout the day and therefore in frequent contact,informing each other of changing medical needs, which may impact discharge plans. For example, the occupational therapist might identify a patient needing more supervision or assistance at home and therefore informs the care manager of this need. The care manager might hear that a family member is concerned about the patient having difficulty walking, and therefore contacts the doctor for a physical therapy consult.
This interdisciplinary team works because all diciplines understand the unique needs of the 65+ population and have a common purpose in serving this population.
Please contact Jean Anne Glass, for more information.

The Great Syndromes Course is a classroom-based educational experience for medical students and physician assistant students at the end of their preclinical training. The students work together in problem-based learning (PBL) groups of 8-10 students plus an MD, PhD and/or PA faculty facilitator.

The school of nursing and the department of family medicine/center for training in international health collaborate in offering a primary healthcare in developing countries elective each summer. Medical, undergraduate and graduate nursing students travel to rural Nicaragua each June to provide primary health care and participate in a research project.

A formal evaluation of the interdisciplinary experience is being conducted by faculty from SAHS, SON and the SOM working collaboratively.

The one that I am most involved in is HEAT which is Hurrican Evacuation Assessment Team and is a student organization and a part of the official Emergency Plan for UTMB. I am the student faculty sponsor. The two students that co-lead the effort are Brian Brendel, fourth year SOM student, and Janis Goulder, SON student and Dorothy Pearow is involved from Allied Health.

The students who belong to this group have volunteered to help with the evacuation of special populations from Galveston via buses going to Austin. There are over 100 medical, nursing and allied health students involved.

You can contact me for more information. Thanks. Barbara Thompson

I have seen probably the most outstanding interdisplinary team when I was on burn surgery at Shriner’s. Their rounds consist of everyone from the MD’s,residents and include nutritionists, respirtatory ,play therapist….so outstanding that you should tape the interdisplinary rounds especially when Dr. Herndon is doing rounds. He makes a point to include and ask microbiology, resp, ther., play, dieticians/nutritionist……it is like his book says how many it takes to treat a burn patient completely………………the far second is the ACE unit under Dr. Loera’s direction…..he does not round with other disciplines but is constantly stressing the importance of the interelationship with PT/OT-nutrition, nursing, wound care, techs, talking and coordinating with the PCP’s in community, F/U with consults and all the time, keep talking to other physicians. Other than Dr. Herndon’s burn surgery and Dr’ Loera’s ACE, I really haven’t seen good interreleationships. Surgery does surgery, peds does peds, and medicine is medicine.

The extreme specialization of medicine is such that I have no idea why phlebotomist draws blood and when nurse’s do…how do PT’s and OT’s differ……when we should involve pharmacy personnel…why do EKG techs do some EKG’s and when do nurses….when is wound care a nursing responsibility and when is it PT? I figure I will learn it as I continue working in the clinical setting.

Many of these roles/contributions and necessities are simply answered by following Dr. Herndon on his Shriner Burn rounds at 7:00AM each morning. Patients benefit from seeing the MD leadership guide the clinical course as well as keeping it unified, delgating to expert opioion and consensus from secondary care providers and then wrapping it all together with what is to be done that day, and a quick one sentence plan for the next few days for that patient and seeing all the various staff involved.

Bill McGrady, MS3

Interdisciplinary Studies

The School of Allied Health Sciences has a one credit, Interdisciplinary Studies course required of all students. Students from different disciplines participate in specific activities to learn how to function as team members and demonstrate the competencies required for practicing in diverse and demanding healthcare environments. The service-learning approach provides opportunities for students to contribute their knowledge, skills sets and experiences to support and enhance the attributes of each discipline in the care of patients. Activities are awarded points based on the time, effort, and learning objectives completed. Each activity includes an experiential and a reflection component which is tracked on-line (www.inds.utmb/). Students have the options of developing their own activities or a Capstone Project with the approval of the course director. The Capstone Project is a community based, interdisciplinary project that provides each member of the team a significant role in planning, implementing, and evaluating the project. An Interdisciplinary Distinction Award is available for students who complete the equivalent points of a second course. The curriculum is overseen by the Interdisciplinary Studies Board of Directors made up of the Chairpersons of each Department, faculty-mentors, and student representatives. For more information about the program or a list of current Interdisciplinary Activities, contact Dorothy Pearrow at dapearro@utmb.edu or Henry Cavazos at hcavazos@utmb.edu.

The Stark Diabetes Center routinely uses an interprofessional approach in helping patients manage their diabetes. Physicians, diabetes nurses, laboratory technicians, and a dietitian work collaboratively in applying their specialized skills and knowledge to help patients. In the past, physician assistants, ophthalmologists, and podiatrists have also contributed to regular diabetes care.

The St. Vincent’s Clinic integrates medical students and PA students. It is a student run clinic in which PA and medical students, supervised by faculty M.D.’s interview, examine, and treat underfunded patients in the Galveston community.

The student directors include MS IV, one MD/PhD student in the medical humanities (myself), and PA students. They are Margaret Wardlaw, Adam Richter, Hava Haisher, Viet Pham, Jamie Lopez, Cindy Lyou, Erin Geordi, and Lauren Reynolds.

The PA and medical students work together and with the faculty to teach each other medical skills, treat patients, and handle administrative aspects of the clinic that include patient funding.

1. The Program: Maternal-Child HIV Program is a multidisciplinary effort between the Departments of Pediatrics, Obstetrics and Gynecology, and Internal Medicine. The pediatric HIV specialists of the program consult with all HIV-infected pregnant women at least once during pregnancy for proper counseling, psychosocial evaluation, initiation of preventive antiviral treatment and coordination of services. Comprehensive diagnostic and therapeutic services are provided to HIV+ pregnant women and HIV-infected and –exposed children at the Maternal-Child HIV Clinic twice weekly: Monday and Thursday
All patients are screened by the program social worker for counseling and ascertaining the need for any special services- financial, transportation, medication assistance. The Maternal-Child HIV Program also maintains a Community Advisory Board to seek input from our patients and families.

2. Population Served: The program serves HIV-infected pregnant women and HIV-affected or –infected children. In 2006, 110 patients were served. The main purpose of this program is to provide medical care in order to prevent perinatal HIV transmission, to diagnose HIV infection in the perinatally-exposed children, and to manage HIV-infected children. The program primarily serves a network of clinics in the Regional Maternal Child Health Program (RMCHP) administered by UTMB in 20 Texas counties. Thirty-four counties also have official contracts with UTMB to provide specialized tertiary care for their residents. In addition, the Texas Department of Criminal Justice (TDCJ) has contracted with UTMB to provide care for HIV as well as other medical, obstetric, dental, and psychiatric conditions. All HIV+ pregnant women deliver at UTMB/Galveston.
COMMUNITY LINKAGES
a. Community-Based HIV Service Organizations: The HIV programs at UTMB interact with several community-based service organizations to coordinate local care and improve access to UTMB-based specialized HIV preventive and therapeutic care for adults and children. Three primary organizations that have collaborative services with UTMB are: (I) AIDS Coalition of Coastal Texas, Inc, based in Galveston, serving Galveston, Brazoria and south Harris counties; (ii) Triangle AIDS Network Inc, based in Beamont, serving Jefferson, Orange, Chambers and Hardin counties; (iii) Health Horizon of East Texas, formerly known as East Texas AIDS Project, based in Nacogdoches, serving Angelina, Houston, Nacogdoches, Polk, Sabine, San Augustine, San Jacinto, Shelby, Tyler, Trinity, Jasper and Newton counties.
These agencies provide a variety of services: case management, emergency financial assistance, transportation, workshops, grief counseling, HIV testing, food pantry, prescription assistance, etc. These organizations have been the key allies of the UTMB HIV programs.
b. Other agencies: The program interacts with AIDS Alliance of the Bay Area, Valley AIDS Council, Gulf Coast Recovery Program, Alternate Resources, Galveston County Hospice and Port Arthur Hospice. Furthermore, coordination of home services is handled through many home health agencies. Referrals are also made to the Family Services Centers’ Rural Outreach and Case Management Programs, and Children’s Protective Services.

OUTCOME: Due to the multidisciplinary and community-based management, the rate of perinatal HIV-transmission in the population served by the program is less than 1% and is one of the best managed programs in the country.

“Hurricane Preparedness for Vulnerable Citizens” is an interprofessional project funded through a President’s Cabinet Award. To date pairs of students representing different professions have interviewed and/or conducted home visits with 343 citizens in Galveston who require assistance to leave the island in the event of an evacuation. Lindsey Scott, a medical student, and
Ginny Meche, an occupational therapy student serve as coordinators supervised by Gretchen Stone, Director of OT, SAHS

At UTMB Galveston, Dr. Kirk Smith is really inclusive of all health professionals being involved with his project for women’s health at Frontera de Salud clinic in Brownsville. Once a month a group of medical, nursing, physician assistant students and faculty volunteer their weekend to go over to provide health care for women and children. I teach the students before they go how to perform sensitive and woman centered well-woman examinations. They are very appreciative. Dr. Smith loves having the interdisciplinary involvement and we have had discussions about future projects between the Schools of Nursing and Medicine. There is a mingling of students and faculty to the benefit of the women patients in Brownsville.

“Case Studies in Pulmonary Functions” This activity was initially developed as joint project between the Department of Respiratory Care-SAHS and the Pulmonary Division of Internal Medicine, and is now offered as part of the SAHS Inter-Professional Activities Curriculum. The program has been offered over a ten year period to students from a variety of different health professions; initially offered to second and third year medical students, but now includes students from the professions of: Physician Assistants, Physical Therapy, Respiratory Care and Clinical Laboratory Sciences.

The learning experience (approximately 2 hrs in a pulmonary function lab and a 2 hour homework assignment) introduces students to basic pulmonary function screening. During the session students learn how to perform spirometry as a screening test to detect the presence or absence of lung dysfunction. Each student is given the opportunity to perform their own spirometry test and interpret sample class data. The session begins with a review of the different spirometry measurement technologies and the identification of lung volumes; this is followed by a discussion about volume/time and flow-volume loops; basic parameters measured by spirometry, development of predicted values and recognition of abnormal values. Students are assigned several cases studies to practice their evaluation skills as well as reviewing case studies in class.

Camp RAD is a one-week summer day camp for children ages 7-14 with moderate to severe asthma. Counselors for the camp come from several different professions including medicine, nursing, respiratory care, and physician assistants. Student Counselors are required to attend a two day training workshop in preparation for the camp. The educational materials were initially developed under a grant, however, continued sponsorship has been a joint effort between UTMB, the John Sealy Hospital and several teaching programs including the Respiratory Care Program (SAHS)

For the children, the camp is designed to provide physical and social experiences that are fun while increasing the child’s understanding of their asthma. The children participate in a number of different activities and learning sessions. Topics include asthma triggers, medications and disease management. Participants are guided to manage their asthma so that they can fully enjoy all camp activities. The goal is for the children and their families to develop a better understanding of asthma management that will last well beyond the camp experience.

Students Improving Global Health Together (SIGHT) is a student organization at UTMB focused on health and medicine for the underserved, both locally and internationally.

The mission of SIGHT is to address the medical needs of the global community by creating awareness of health disparities in underserved populations, by supporting the development of solutions for health issues facing society, and by promoting clinical and research opportunities to students concerned with the development of health care on a local, national, and international level.

Officers and contact information can be found at www.utmb.edu/sight.

I want to join Vic Sierpina in his comments about our unique interprofessional Spriritualy and Clinical Care course. Students learn about the importance of spirituality in the lives of their patients and at the same time they learn about the importance of a team in developing a plan of care to meet those needs.

There is also another important interprofessional team in Galveston County. The Galveston County Medical Reserve Corps at the Galveston County Health Department has formed to respond to natural and manmade disasters. Doctors, nurses, lay chaplains, mental heath professionals, social workers, and others volunteer to prepare and participate if/when needed.

1. The Galveston Island Community Research Advisory Committee is composed of community residents who are very interested in the health of African American Galveston Citizens. The Advisory Committee is actively collaborating with researchers, faculty, and students at UTMB to conduct community-based participatory research. The current projects the GICRAC are involved in concern reducing childhood obesity, providing transition from incarceration to home, and addressing mental health concerns.
2. Frontera de Salud is a wonderful organization that is staffed by students (medical, nursing, respiratory therapy on the latest trip) as well as licensed health care professionals. On the latest trip in April 07, we saw indigent patients during morning clinic, made home visits in the afternoon, staffed a health screening time after church servcies, and provided learning activities for children focusing on asthma treatment and prevention. Sr. Phylis Peters, a NP/Community health nurse, keeps the program all together.

As NEETF Children’s Environmental Health Faculty Champions, Dr. Kokab Saeed and Shelly Leitch RN, MSN, CPNP have collaborated on several projects to increase awareness and recognition of children’s environmental health issues. (See examples below)
1. Jointly presented Children and Environmental Health: What School Nurses Need to Know at the UTMB 30th Annual School Health Conference on Emotionally Based Health Problems in School Aged Children:Overt Crisis and Hidden Suffering this past February 3, 2007.

2. Jointly presented the topic “Lead Poisoning Prevention” to the UTMB Pediatric Residents on March 5, 2007.

In June 2007, the Neonatal Nurse Practioner students and the undergraduate pediatric BSN students participated in a clinical lab experience using SimBaby and VitaSim Child. The primary objectives of this activity were to provide the advanced practice students an opportunity to take a lead role in a pediatric emergency situation and the undergraduate nursing students to take a role as a team member in an acute situation. These life-like situations gave the students an opportunity to provide interventions in a less threatening environment without causing any harm. This learning opportunity was coordinated by Linda L. Rath, PhD, RNC, NNP and Bonnie K. Webster MS, RN, BC assistant professors at the School of Nursing

During clinical rotations, nursing students are exposed to many types of patient situations including patient deaths. During the pediatric end of life lecture, the use of simulation with student role-playing was provided. This allowed the students to experience a pediatric death in a safe environment . The activity was repeated in summer semester with the help of Dr. Herrera, Assistant Professor Emergency Medicine, who worked with the students during the code and participated in the question and answer session after the lecture. The SON plans to provide this activity again in the fall . Our hope is to include medical and respiratory therapy students as well, thus, promoting an interprofessional team approach.
This simulation has lead to the development of a pediatric palliative care elective in the SON. And, perhaps most important outcome of this lecture and simulation, is the role the Student Nurse Association is taking, along with Cheryl Day, Amy Carrol and the nursing staff from the pediatric unit at UTMB, to enhance and promote the use of the “Butterfly Room” for pediatric palliative care. There are plans to create a room for each unit. Additionally, there are plans to create “Angel Carts”. Angel carts contain necessary comfort items families may need while caring for their child who is dying. SNA members will develop many skills on this journey including: team work, delegation, and management. They will be allowed to attend committee meetings with staff to work on this project. It is hoped that medical and allied health students will also become involved in this important project.
The SNA steering committee include: Janiece Jung, Lindsey Waldrep, Chanelle Clerc, Jessica Bateman and Julie Lindsay Clinical Instructor UTMB SON.

The SON is offering an interdisciplinary elective, GNRS 6000 330, Ethics and Research after the Holocaust. This course will take advantage of a series of lectures offered by the Holocaust Museum in Houston throughout the fall and early spring semester. World-renowned speakers will explore the ethical issues for health care professionals involved in eugenics, genetics, and other research during the Holocaust. Dialogue through discussion groups will follow throughout the semester.

Information on the lectures can be found at: http://www.nodussolutions.com/MedicalEthics/
Students from all disciplines are invited to attend the lectures–you do not need to be enrolled in the course to attend but you will need to register for the lectures you want to attend in Houston. Some of the lectures will be broadcast to UTMB and other UT schools and will be open to alumni and the community. That information will be provided through the daily announcements.

I coordinate a SOM elective for 4th year students: Primary Care Telemedicine (FAMU-4115) - “Students taking this elective will be able to observe and participate in the delivery of clinical care at-a-distance….” Interprofessional collaboration is experienced by students through working with physicians delivering care at-a-distance (from campus) and with mid-level providers/presenters and patients at off-campus clinics. The telemedicine team is very much dependent on each other’s clinical skills and clear communication for delivery of patient care.

The Office of Student Life works with numerous student groups that engage in interdisciplinary activities some leadership and some community service. The UTMB Student Government Association is a group of student leaders elected by their various schools/classes to represent their voice to administration. This group of 21 meet bimonthly to work together on student issues. SGA has various subcommittee that are also interdisciplinary they include: the Budget committee which administers revenue and expenses for students activities; the Honor Pledge Committee which promotes academic integrity activities; the QUEST committee which coordinates the new student welcome for new students. Additionally there are many registered interdisciplinary student groups: Frontera, SIGHT, Galveston County Health Fair; HEAT Hurricane Evacuation Assistance Team;QQD Que Quiere Decir Spanish club;ST, Vincents’ Free clinic. The Office of Student Life provides not only administrative support but also leadership training (e.g. retreats, risk management workshops) for student groups. Students learn about leadership models, facilitating groups, conflict resolution, and motivating members. For more information please visit http://intranet.utmb.edu/studentlife/