Transcription:
PAs at CM and Life in ENT

Trisha:    Hi guys. Welcome to the Advanced Practice Perspectives. I'm Trisha Williams.

Tobie: And I'm Tobie O'Brien. This is a podcast created by advanced practice providers for advanced practice providers. We will be highlighting our amazing APPs here at Children's Mercy and do some education along the way.

Trisha: We are so glad that you guys are joining us today. So sit back, tune-in and let's get started.

Tobie: Today, we are super excited to introduce to you, Jan Yardley. Jan is a physician assistant in the ENT clinic. Tricia and I are so fortunate that we get to work with her. So welcome, Jan.

Jan Yardley: Thank you guys. Thank you so much for having me.

Trisha: You are so welcome. We are so excited to talk with you today. So Jan, tell our listeners about your background. I feel like Tobie and I know you pretty exclusively from working with you in the ENT department, but let's tell our listeners about who Jan Yardley is.

Jan Yardley: Oh, okay. I've been a physician assistant for almost 15 years now. The majority of that having been worked in the pediatric field. Um, I attended undergraduate at the Missouri Western University up in St. Joseph, Missouri, and I got my undergraduate degree in biology.

I kind of have an interesting story as far as deciding to go on to become a physician assistant in that, during my undergraduate years, I really was quite interested in being a physical therapist. That had been my goal. And I actually applied and got into a couple of programs. but then decided that that maybe wasn't the right path for me. So I worked a number of odd jobs for several years after undergraduate and kind of tried to sort out-- out to do some additional schooling, but I don't know when and what, I even looked at things like forensic science and microbiology.

I finally came back to remembering a physician assistant that came and spoke to our pre-professional group in undergraduate. And I remembered how amazing her job sounded. Like at the time I was intrigued, but I was thinking physical therapy. Anyways, I went back and started looking at what is a physician assistant exactly. Like I remember they sounded like they were kind of like a doctor, but they didn't go to medical school.

And, yeah, I got really interested in PA and PA schools and I started looking at programs, came across a program at the University of Colorado Health Sciences Center. And they had a pediatric focus, which really piqued my interest and, um, ended up applying to them and getting in and I graduated from their program a few years later.

After that, I went on and worked in general pediatrics in rural Wyoming for a couple of years. And from there, I ended up moving back to the Kansas City area, worked in another general pediatrics office for about a little over five years, and then eventually made my way here to Children's Mercy, where I've been in ENT for about the past five years as well.

Tobie: And we are so glad to have you.

Trisha: I did not realize that the physician assistants’ programs have ped-focused versus adult-focused. How long has that been in fruition and is that throughout all physician assistant programs or just specific ones?

Jan Yardley: Yeah. So that's a really interesting question because there's approximately-- don't quote me on this-- but I want to say close to 300 PA programs in the United States now. And to be honest with you, the only one that I know of that truly specially focuses on pediatrics is the University of Colorado's PA program. So most programs don't, and really my program as well. You get trained from birth to elderly, so complete kind of like family medicine. So you get trained in everything.

But the University of Colorado's program actually in the '60s when they started out, it was called a child health associate. And what was what you got was what you graduated with from that program originally. So they started out strictly focused on pediatrics, but then as time went on, they developed more of their physician assistant program and encompassing, as I say, everything from peds to adult. They are one of the few, if maybe not the only, PA programs that actually kept that focus in pediatrics to keep history there. And it gives you a little extra coursework and clinical rotations in pediatrics.

Trisha: Wow.

Tobie: Well, that's fantastic. So in ENT, as long as I've been there for about 12 years, I have been lucky enough to work with one other PA and now you, and so I have had just such great experience working with PAs. And I wonder, I know that there are not as many of you guys as there are in our little advanced practice provider group, but I think you're one of six. Is that right, Jan? Maybe there's more.

Jan Yardley: Yeah, I think six at this point in time. Sorry.

Tobie: Okay. And I wonder how do you feel like you have been able to support your other colleagues that are PAs within our advanced practice provider group?

Jan Yardley: Yeah. So one thing that I'm hopeful to start doing is that I'm going to be joining a committee here at the hospital that's made up of advanced practice providers. That's going to be looking at how we can incorporate CME credits for a lot of our conferences that are provided for all of us as APPs at Children's. But in the past historically has just primarily had CME credit geared towards nurses, which of course it's different for us as PAs. So I'm interested in trying to expand our opportunities here as physician assistants to also get some CME credit for some of these amazing conferences that are offered for us here.

Tobie: That's great. I think that will be really helpful for the group, for PAs.

Jan Yardley: Absolutely.

Trisha: So Jan, I'm pretty sure that nurse practitioner group or the advanced practice provider group that puts the conferences on and the meetings and things is going to be-- you're going to be a huge asset to that group to be able to help bring CMEs or continuing education credits to your group. So that's really exciting. I'm going to switch gears here a little bit, and I would love for you to share with our listeners kind of what your current role in our ENT department looks like on a daily basis, kind of what you do.

Jan Yardley: Yeah. I feel like all of us has a different track that we take a little bit in the sense of we may work a little more in clinic, whereas we may have some of us that work a little bit more on the inpatient side of things. And so for me, I work in the clinic where pre-COVID, we worked a little bit more side-by-side with our physicians in clinics, helping to see patients with them. After COVID, we've been working a little bit more independently just in our own clinics, which we had done prior to COVID as well, but we're doing a little bit more now with social distancing guidelines and such in place.

And through that, we get to of course see the patients, evaluate whether they may be surgical candidates, and get them signed up for surgeries or sometimes we're doing procedures on them, if we're going to take them and clean their ears out or getting hearing tests on them and interpreting those. So lots of good things that we do in the clinic to help take care of our patients.

Tobie: Jan, what is your favorite part about working in ENT?

Trisha: Besides working with us.

Tobie: Yeah. True. Besides working with us.

Jan Yardley: Of course. Yes. Absolutely. Honestly, that is one of my favorite parts is we really do have a great group of people that we work with. We seriously do. And so that's pretty awesome, because we do have a big department. We have lots of people and lots of moving parts. And so it's pretty amazing. Everybody does such a great job to be able to bring awesome level of care, but have fun doing it in our department.

Like I've said, you know, some of the other things that I enjoy, like super enjoy-- that's why I went into pediatrics, just the interaction with kids, a good day-- Even if you have to do some procedures on kiddos that they may not be, super excited about or that aren't always particularly pleasant, like if you can make that a good experience for them or at least make it better for them, so it's not as scary. I super love those days. Yeah. I love educating. It's always been something throughout my career that any time I have the opportunity to talk to parents or patients alike about their health or explain what's going on with them. I love doing education with families, so I really enjoy that aspect of our job in the clinic as well.

Trisha: I love to do that as well. I love the education. I also love the collaborative effort that we have amongst each other, as well as our physician colleagues. I think that we have a great collaborative practice within our otolaryngology department. ENT is kind of second nature to the three of us because that is our home base. But we like to provide some educational tidbits for our listeners. And so we thought it may be helpful to discuss some indications for a tonsillectomy and adenoidectomy in pediatric patients. And we were hoping that you could kind of give some educational tidbits-- I guess I said that twice-- but tidbits for our listeners.

Jan Yardley: Yeah. Essentially there's a couple of paths that we think about going down when we're evaluating a patient for a tonsillectomy and adenoidectomy or a T&A. And so the first path has to do with getting recurrent tonsillitis. And of course, a lot of times we think about strep throat with that, but sometimes it may not be even necessarily strep positive cases. But if they are getting documented tonsillitis episodes with fever, enlarged lymph nodes, where they have pus or exudate on their tonsils, needing antibiotics to treat it. We have specific criteria, guidelines that we will follow that might indicate they would benefit from getting their tonsils removed.

So they're called the paradise criteria actually. And they're very numbers based. And if a child has had seven, at least seven tonsillitis episodes in the prior year, we would talk with the family about considering getting the tonsils removed. Additionally, there's some other criteria that can be met with those numbers, which include if they've had five episodes of tonsillitis in each of the past two years or three episodes of tonsillitis in the previous three years. So again, very numbers based on that, but if they meet that criteria, then we would certainly be having a conversation with the family where we might want to consider a tonsillectomy and adenoidectomy in that situation.

The other path that we go down involves if kids have enlarged tonsils that may be causing them some obstructive breathing, particularly at night when they're sleeping. If we're finding that a child may have what we call obstructive sleep disordered breathing or otherwise known as they may have true obstructive sleep apnea, which we would classify if they had a sleep study that verified that, we might also be recommending having their tonsils and adenoids removed to try to help with that condition, because it is known that obstructive sleep disordered breathing or sleep apnea can certainly lead to some, not only nighttime symptoms for patients, but daytime symptoms for them as well.

Trisha: And some of those daytime symptoms we know could be hyperactivity, somnolence, things that are "what teachers would consider", like hyperactivity disorder, where a lot of times they're just not getting very good sleep. So I think that with everybody being homeschooled, parents might be seeing that a little bit more than the teachers these days, but...

Jan Yardley: Yeah. But not just that, I mean their growth and development too,

Trisha: Sure. We all tend to forget that the growth hormone is produced at night when we sleep. And if we're not getting good sleep, you know... Lots of reasons why.

Tobie: Yeah. I love talking parents through that whole process. I don't know, because I feel like it is a big decision, really. I mean that surgery in particular, I think, is a big deal. And so I love to kind of talk through the risks of the surgery and just making sure that they're going to benefit enough to undergo the risks. But yeah, I love talking with families about whether or not a T&A would be best for them.

So Trisha and Jan, I believe you two are currently working on a project to improve parent understanding of how to take care of ear tube otorrhea. Tell me about that more and tell our listeners about that a bit more.

Jan Yardley: Yeah. We're very interested in putting together some materials, including a brochure, hopefully, and potentially a video, that would talk to families about how to care for their children when they have ear drainage. So that they know what to expect as well as how best to treat it, which in the end, hopefully will help them get the best results at getting that drainage to go away.

And also, we're hoping to be able to put some of this information out there for providers who aren't, necessarily an ENT, that can make them more aware about what to expect with your drainage, how to treat it, and also be able to help provide that information to families as well. If they, for instance, might be seeing them for a sick visit in their clinic or in an urgent care visit, at those times they could also be providing the best information possible.

Trisha: The education that we're developing, the idea that came from a multi-arm study that we're currently conducting, looking at chronic and persistent ear tube drainage and how to treat it, and what's the best practice, and what we have found so far in our retrospective chart review is that persistent or chronic ear tube drainage or otorrhea is basically due to a lack of good education, good aural hygiene. And that's aural, not oral. Aural, so ear hygiene and how to take care of them. You have to say that correctly, right? So we have found that providing a good, educational document, succinct pictures could potentially improve the numbers of patients that present to clinic with this persistent otorrhea

So we're hoping to get that developed and rolled out probably after the first of the year. So we're excited to move forward with the research study.

Tobie: Great job on that, you guys. I'm excited for that. I think it really will be super helpful. I really do.

Jan, we like to end each episode on a lighter note. So we are hoping that you will share something that is fun of how you have taken on the challenges of 2020. I guess it doesn't have to be fun, but just maybe a way that you've taken on the challenges of 2020.

Jan Yardley: It's funny. You should say that because of course those of us who are guests on here, we started to realize that we are going to be asked this question. So you start thinking about what have I been doing? And, that being said, I took on the challenge of-- anyone who knows me from when I was a child knows I was never athletic. I am a generally a major klutz. I just was never really good at sports. And so that being said, I took on the challenge of saying, "Okay, I can do this. I can be a runner." I had been walking for miles and doing well with that for some time. And I decided, yeah, I can move on. I can be a runner. So I started doing the Couch to 5k thing at some point after COVID started. And, yeah, that's not easy. Being a runner isn't you would think, you're just going to pick your legs up and go a little faster than walking. But really there's a lot more involved in running. And that being said, you have to be a lot more coordinated than you might think. And I'm close. I'm like towards almost the last week of getting to that 5k. I'm feeling pretty accomplished that before long I'm going to make that goal.

Tobie: I love it. I didn't know you were doing that. That's fantastic. Yay!

Trisha: Way to go!

I can't wait to hear how your first 5K will be. Will you do a race or will it be...? What are you thinking? Unless you want people to know what 5k you're going to run.

Jan Yardley: Yeah. The Turkey trot. No.

Trisha: Jan, thank you so much for spending time with us today. We are so grateful to have you in our ENT department. And to have you as a colleague. You are definitely a joy in my day when I get to work with you

Tobie: Yes, me too.

Trisha: Listeners, thanks so much for tuning in today. Our next episode will feature Scotti Brackett.

We are going to chat about her role in the urgent care and also her passion for advocacy.

Tobie: If you have a topic that you would like to hear about or you're interested in being a guest on this podcast, you can email us at tdobrien@cmh.edu or you can email Trisha at twilliams@cmh.edu. Once again, thanks so much for listening to the advance practice perspective podcast.