Inside a Manhattan VA Hospital, a Student Bridges Theory and Practice

Clinicians in training can read all the textbooks and case studies they want, but nothing can take the place of working directly with patients in a hospital.

Marissa Guerrero, 26, is gaining that experience through her externship this semester at the U.S. Department of Veterans Affairs (VA) Manhattan Campus of the VA New York Harbor Healthcare System hospital.

Guerrero, who is from Los Angeles, is studying to be a speech-language pathologist in Adelphi’s Department of Communication Sciences and Disorders graduate program, which prepares students to treat patients with speech, language and hearing disorders. As part of the program, students are required to complete an off-campus externship.

“The externships really help to bridge theory and practice,” says Ashwini Namasivayam-MacDonald, Ph.D., assistant professor of communication science and disorders. “I can teach the students to think critically, but ultimately it’s these experiences that give them exposure and allow them to apply the skills they’ve learned in class.”

At the Manhattan VA hospital, Guerrero works with speech pathologists to assess in-patients who are having difficulty speaking or swallowing, and to draft clinical reports about their conditions. The externship runs from January to May, when Guerrero will graduate. She commutes from Mineola, New York, into the city five days a week to work at the hospital from 6:30 a.m. to 4:00 p.m. She does this in addition to her classes, which are held on Sundays and Wednesday nights.

“It’s a lot, but it’s worth it,” Guerrero says. “You do what you have to do to meet your end goals, and it’s been really fun for me to just be involved in the medical field.”

At the hospital, Guerrero taps into the knowledge she’s gained from her Adelphi classes.

“I’ve used everything that I’ve learned in almost every single class up until now at my externship,” she says. “[The externship] is very all-encompassing.”

Last fall, Guerrero took a course on dysphagia, which is the medical term for difficulty swallowing. During the course, she had to complete an online training program called the Modified Barium Swallow Impairment Profile (MBSImP), which trains students to identify patients with dysphagia. Students are provided with a video X-ray of a person’s oral cavity and throat while swallowing different stimuli. After watching patients swallow liquid or food, they’re asked to judge different components of swallowing.

Now, at Manhattan VA, she helps her supervisor conduct and report on Modified Barium Swallow Studies (MBSS)—the real-world version of the online training.

“The first time I saw an MBSS in real life, I was like, ‘Wow, this is awesome—I actually know what I’m looking at,'” Guerrero says. “I was able to understand if the person was aspirating—if the food or liquid was going into the lungs.”

In the same dysphagia course, students utilized the nursing simulation lab in Adelphi’s Nexus Building, the 100,000-square-foot home of the College of Nursing and Public Health.

Students were asked to conduct a clinical bedside assessment in a simulated hospital room with a manikin that has the ability to blink, talk and simulate breathing. Students interviewed the patient (i.e., the manikin) about their medical history, gave them different consistencies of food and drink, looked for signs of aspiration, and made sure they could clear their throat properly.

Dr. Namasivayam-MacDonald, who taught the course, controlled the manikin from another room, providing responses to the students’ actions.

“We teach them little things, like how to put up the patient’s bed in a room, how to read the monitors,” says Dr. Namasivayam-MacDonald. “And that gives them some real-world experience before they go into the real world.”

This was particularly helpful for Guerrero.

“Now I do three or four of those assessments every day in the hospital,” Guerrero says. “Having that experience at Adelphi really prepared me to know what the steps are for seeing a patient at bedside.”

After graduation in May, Guerrero will complete a yearlong clinical fellowship, which will allow her to be certified as a speech-language pathologist by the American Speech-Language-Hearing Association. Then she hopes to obtain a job in a hospital setting.

“I know [those jobs] are kind of difficult to get,” she says, “but I feel really confident in my past experience and my current knowledge to be successful.”