Academic

Students who decide to follow this specialty track will, at graduation, possess specialized skills in the assessment of the peripheral and central vestibular system (i.e. vestibulo-ocular reflex, vestibulo-spinal and vestibulo-collic reflexes). Additionally, graduates will understand what rehabilitative options are available to patients with either unilateral or bilateral vestibular system impairments. Coursework will include three (3) formal courses in vestibular sciences. Specialty track students will have priority for practicum experiences in the Balance Disorders Clinic that assesses ~1400 patients/year. It is our intention for Specialty Track students to be offered the opportunity to have a concentrated clinical “Maymester” experience at a clinical site separate from Vanderbilt University. Finally, it will be expected that the Capstone project conducted by the Specialty Track student will be in a vestibular system/balance topic area.

For additional information, contact Dr. Gary Jacobson, (gary.jacobson@vanderbilt.edu) or Dr. Daniel Romero, (daniel.romero@vanderbilt.edu)

Background

The philosophical background behind our desire to develop this Fellowship in the Vestibular Sciences was presented in an editorial by Jacobson and Kileny (“In Support of a Post-Au.D. Fellowship” JAAA 26: pages 530-531, 2015)

The Fellowship

This is a competitive and compensated Fellowship that has been in existence since 2015. The successful applicant will commit to 1 calendar year (e.g. September 1 – August 31) of clinical and research training. The program incorporates both didactic and practical experiences. The Fellow is invited to attend (i.e., audit) any of the 3-course sequence that are completed by our Au.D. Vestibular Science “Specialty Track” students (referred to as Vestibular Sciences 1, 2, and 3). The third course in that sequence is taught by a doctoral-level physical therapist.

The Fellow will work with the clinical supervisors in the Balance Disorders Laboratory (BDL) until it has been agreed upon by the supervisors that the Fellow can work independently. At that point, and only at that point, will the Fellow be assigned a clinical schedule (referred to as
“templates”) in the BDL. Even at that point, the Fellow will be expected to conference over the results of testing and their proposed impressions and recommendations. It is also noted that the Fellow will have some templated time (4 hours) completing audiology diagnostics in the otology clinic.

The successful applicant will also be expected to participate in the clinical research program in the Division of Vestibular Sciences which may include projects completed in our dedicated lab space. This, in most cases, will represent participation in existing protocols but may also include projects initiated by the Fellow. It is our intention for the Fellow to have achieved co-authorship on at least one manuscript published in a peer-reviewed journal by the time they leave Vanderbilt. Lastly, we may invite the Fellow to provide a lecture in our academic program and/or present research at national conferences.

The Fellow will be expected to possess the following clinical and research competencies in the area of Vestibular Sciences at the conclusion of the fellowship.

•Understand the typical/atypical neuroanatomy and neurophysiology of the peripheral and central vestibular system and how the system compensates to accommodate the unilateral or bilateral loss of function
•Understand the typical/atypical function of the ocular motor system
•Conduct a thorough dizziness and balance case history
•Conduct, interpret and understand the meaning of/pertinence of self-report measures
•Conduct and interpret informal “bedside tests” of the vestibular system
•Conduct and interpret horizontal, anterior and posterior canal vHIT tests
•Conduct and interpret tests of ocular motor system
•Conduct and interpret both static positional and dynamic (positioning) tests and manage all types of BPPV
•Conduct and interpret the caloric test
•Conduct and interpret rotary chair tests
•Conduct and interpret the cVEMP test
•Conduct and interpret the oVEMP test
•Conduct and interpret computerized dynamic posturography/functional balance measures
•Demonstrate the capability to adapt instruction and counseling to accommodate patients who have differing educational levels
•Demonstrate the ability to construct a diagnostic report that summarizes test results and provides the referring source with information that can be used to develop a plan of treatment for the patient
•Participate in the conception, development, and design of research projects
•Demonstrate the ability to synthesize published research to develop the introduction and methods of a research proposal
•Demonstrate the ability to work semi-independently in the data collection/organization for a research project
•Demonstrate the ability to work with a team to analyze and accurately interpret data collected from the research project

The BDL is located on the 7th floor in the South Tower of Medical Center East (MCE). The clinic is incorporated in the Odess Clinic for Otolaryngology. The BDL at the Main Campus consists of 3 ENG/VNG laboratories, 2 rotational chairs, 1 Computerized Dynamic Posturography system, 4-5 evoked potential systems (i.e. for VEMP testing) and 2 video head impulse test (vHIT) systems. It is important to note that ENG/VNG, VEMP, vHIT, and rotary chair testing also is available at a community practice in Franklin, Tennessee.

With this instrumentation we conduct assessments on 1200-1300 dizzy patients each year (~ 35 patients per week). It is noteworthy that we are building a caseload of pediatric patients (currently ~3% of the total caseload). There are 8 clinical supervisors (2 with Ph.D.s, 1 with Au.D, Ph.D., and 5 with Au.D.s) who have the BDL as their primary assignment (e.g. Drs. Jacobson, Roberts, Romero, Grantham, Gray, Krolewicz, Bailey, and Darvin) and oversee the training of our 2nd and 3rd year Au.D. students and 4th year externs. Although supervision is continuous and direct for the 2nd and 3rd year students, supervision is less direct for 4th year externs. The physical facilities, instrumentation, and clinical talent make rotations through the BDL a much sought after clinical placement. We feel that the depth and detail in the clinical training make our graduates a cut- above most Au.D. graduates where understanding of normal and abnormal postural stability, eye movement, and vestibular system function is concerned. Many of our graduates and former Fellows now manage balance disorders laboratories in large tertiary care centers across the United States.

Portions of our research projects are completed in the Vestibular Sciences Research laboratory housed on the 10th floor research space of MCE. This dedicated space has 1 Compumedics Neuroscan EEG/ERP system, 1 VNG/ENG system, 1 clinical evoked potential system, 1 vHIT system, and 1 cutting-edge mobile EEG/ERP system that is forthcoming. Our lab aims to understand vestibular physiology across the lifespan as well as its role in the long-term outcomes of individuals with cognitive and memory impairment including traumatic brain injury. In addition, through collaboration with the BDL and other academic research labs, we seek to explore and improve the diagnosis of vestibular disorders through a variety of techniques including electrophysiology, eye-tracking, and objective detection of evoked responses. We combine these approaches to facilitate and improve the functional outcomes of patients with vestibular disorders. Lastly, the lab incorporates portable vestibular testing in the community as part of the Heart of Hearing and Balance Humanitarian Program while bringing together undergraduate and graduate students from diverse backgrounds across the VUMC and VU campuses including the Vanderbilt Brain Institute.

The Vanderbilt University Medical Center (VUMC), located in Nashville, Tennessee serves Tennessee, northern Alabama and southern Kentucky. It is a premier tertiary referral center for patients with dizziness, unsteadiness, and/or vertigo. Three hospitals comprise the Vanderbilt Hospital system: The Vanderbilt University Hospital (adult care), the Monroe Carell Jr.
Children’s Hospital at Vanderbilt and the Vanderbilt Psychiatric Hospital. Annually, the Vanderbilt University Hospitals have approximately 57,000 discharges. VUMC also provides 1.7 million outpatient visits, including 110,000 to the emergency departments of the three hospitals. Vanderbilt University Hospitals provide critical and often unique health care resources to the community and provide broad access to care.

For over 75 years, the VBWC has dedicated its research to assessing and treating patient’s functional, communicative, economic, and social problems that have occurred as a consequence of their auditory and balance system disorders. The Bill Wilkerson Center consists of a multidisciplinary team of clinical audiologists, speech pathologists, auditory rehabilitation researchers, vestibular researchers, physical therapists, occupational therapists, neuroscientists, physicians, and support personnel who focus their efforts toward improving the health care of patients with auditory and balance impairments. Outpatient clinics occur Monday through Friday. Teaching conferences (i.e., Case Conference or Grand Rounds) occur weekly on Wednesday morning from 7:00a-7:50a.

Interested individuals should forward the following to Daniel J. Romero, Au.D., Ph.D. (daniel.romero@vanderbilt.edu) by 5:00 pm CST on May 31, 2024:
 

1.letter of interest detailing your previous clinical and research experiences in the area of vestibular and balance function (dysfunction)
2.updated (current) curriculum vitae
3.copies of any publications and/or samples of your scientific writing
4.two letters of recommendation by current and/or former supervisors that can speak to clinical and research experiences
5.ASHA Certificate of Clinical Competence in Audiology required, as well as eligibility for TN license in audiology which must be in place prior to hire date

It is our objective to begin virtual interviews late Spring and fill this one-year, non- recurring Fellowship by early-Summer.