Transcription:
Adolescent Medicine and Pediatric Clinical Pharmacology with Stephani Stancil

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

Tobie O'Brien: 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 Williams: We are so glad that you're joining us today. So sit back, tune in and let's get started.

Tobie O'Brien: Today, we have with us Dr. Stephani Stancil. She is a family nurse practitioner who also has a post-doctoral fellowship in Pediatric Clinical Pharmacology and her PhD in pharmacology and pharmaceuticals science. She's also on faculty at the University of Missouri, Kansas City School of Medicine. Wow, that was quite a mouthful. Welcome, Stephani. We are so glad that you are here joining us today. Thank you for your time.

Dr. Stephani Stancil: Thank you so much for having me. I'm excited to chat with you guys.

Trisha Williams: We are so excited to have you, Stephani. I have known you for quite some time and your dedication to your field and what you have accomplished is huge and so impressive. So let's share with our listeners a little bit about who Stephani is, what your background is, and let's talk about you.

Dr. Stephani Stancil: Trisha, it is great to chat with you and Tobie as well. You're right, we have known each other for a very long time back from when we were both staff nurses in the pediatric intensive care unit. And I am happy to chat today and to really just share my journey to hopefully inspire or encourage others to pursue their passions. Otherwise, it makes me uncomfortable to chat about myself, but I'll kind of frame it in that other way and hopefully encourage others to think down those lines as well.

Okay. So Trisha and I were both staff nurses in the PICU. And I knew kind of early on that I wanted to become a nurse practitioner. In fact, I knew that when I was in nursing school as an undergraduate, because I wanted to be able to take care of patients, to diagnose, to treat them and to kind of follow them along that path. And so I did, I got my master's as a family nurse practitioner. Back in those days, that's really all there was available. There weren't DNP programs as there are now.

And my first job as a family nurse practitioner was in Adolescent Medicine here at Children's Mercy. And I chose Adolescent Medicine because I really loved that kind of middle ground that adolescents kind of hold. They're not, you know, the babies or infants kind of the bread and butter of pediatrics, if you will, but they're also not adults. They're kind of in this in between this dynamic stage. And so that was really interesting to me to be able to kind of connect with them and help them learn and grow from kind of being a younger child to developing into an adult.

And so, as soon as I started, I knew that I really wanted to be able to get to know my patients at the individual level. And at the time, there was this kind of hubbub about personalized medicine and really what that means is knowing as much as you can about your individual patient to be able to design a treatment plan specially for them.

And a part of that personalized medicine at the time, this was over a decade ago, was pharmacogenomics, which is using genetic variation in each individual to help inform care. And I hadn't really learned a lot about that in my training thus far, but knew I wanted to learn more and then be able to contribute some knowledge to the field as well. And that's what led me to get my PhD in pharmacology.

We are lucky enough here at Children's Mercy to have one of the most well-known and productive pediatric clinical pharmacology and pharmacogenomics groups, not only nationally, but that some would argue globally. And so I was able to kind of hitch a ride on that train, if you will, and was lucky enough to connect with great mentors here, Dr. Steve Leeder and Dr. Sue Rahman, to help kind of shape my journey during my PhD. Also he's not here anymore, but Dr. Greg Kearns was instrumental in allowing me to kind of do that and learn and grow as well.

So that process took a very long time to get my PhD. I was still working as a nurse practitioner. My clinical time kind of reduced as I got farther along in my program and more focused on my research. And then I finally finished in 2018. And at that point, I applied for the post-doctoral clinical pharmacology fellowship here at Children's Mercy, which again we were lucky enough to have, I didn't have to travel cross country or anything, and finished that about eight months ago. And here I am, now I'm past that.

Trisha Williams: I think if you remember back, when I was in grad school, you were my preceptor. And so we kind of came full circle, like with mentor and mentee and kind of flipped roles and things like that. I mean, I think you're just starting your PhD program at that time. So I remember kind of the start of that journey for you.

I have so many questions about what you just said. First, I would really kind of like for you to just give a brief description about what pharmacogenetics is for our listeners, just to kind of, I don't know, give a little succinct synopsis of what it is.

Dr. Stephani Stancil: So pharmacogenetics or genomics, and kind of, you can get into the weeds on when to use which, but, you know, a brief summary of the pharmacogenomics as it's called is to really use genetic variation that exists within your patient to be able to inform treatment. So that might mean that you look at a genetic variation in a particular gene of interest that could impact the dose that you would select on a particular drug or even the drug itself.

Trisha Williams: Thank you for that description. And then my followup question is, can you tell us a little bit about what the doctoral fellowship in Pediatric Clinical Pharmacology is and what that looks like?

Dr. Stephani Stancil: Yeah. So again, we are lucky enough to have one here at Children's Mercy. It is a post-doctoral Pediatric Clinical Pharmacology fellowship. And it is funded by the NIH through a T32 mechanism. And all that kind of means, the alphabet soup, means that the NIH has granted Children's Mercy support for this program. And through that support, there are connections, not only with the NIH, so additional kind of training options, but also with the other T32 clinical pharmacology fellowships across the country. And there are only five, I believe, at this time that are funded in that way. And so it's kind of a really great group of opportunities and the connection in that way. And I'm incredibly thankful to be accepted into that program.

Tobie O'Brien: Yeah, impressive. I had researched that a bit and saw that there were only, like you said, five in the country. So how great that we have one here and that you just finished it. So Stephani, will you tell us more about what your role looks like today at Children's Mercy, and if that includes also our new fancy Children's Mercy Research Institute? It's so pretty, by the way.

Dr. Stephani Stancil: It really is. Yeah. So my role now is technically an assistant professor with the University of Missouri, Kansas City School of Medicine. And also on faculty with the Division of Adolescent Medicine here in Clinical Pharmacology. I am able to have this mix of activities where I'm still able to see patients clinically, which is incredibly important to me. I don't ever want to lose that connection, because I want to make sure that the questions I'm asking from a research perspective come from the patients, and then the answers that we find can be translated back.

But the majority of my time is dedicated to research and, you know, just like with each one of those buckets, clinical or research, they spill over, right? They don't stay within the hours or the confines of time that we think they will. And research always takes a lot longer and more kind of daily effort than imagined. So the majority of my time is for research, but again I still have a portion for clinical.

I'm also beginning to take call for our clinical pharmacology in-patient service, which is a really unique service that not very many pediatric academic hospitals actually have. But just to speak a little bit about what that is, that's, you know, if you have a patient in the hospital who has an adverse drug reaction or maybe isn't responding to a drug like the clinicians think that they should, they can consult Pediatric Clinical Pharmacology and our team would come and evaluate the patient, get a really detailed drug history and medical history and then help make recommendations about would pharmacogenetic testing be useful? What other things might be considered? Do we think this is a drug-related adverse reaction or is it potentially something else? And so that is really interesting to me and I'm glad to be able to be a part of that.

Trisha Williams: That is a fantastic service that we can offer our patients and what an honor it has to be for you to be a part of this program, to be able to take care of our patients.

Dr. Stephani Stancil: It really is. It is certainly my privilege to be able to be a part, to learn from the wonderful folks that have been doing it a long time, but also now be able to kind of contribute in that way and continue to learn. That's the great thing about being at an academic medical center is there's learning every day.

Trisha Williams: Every day. I totally agree. You know, you're talking about your research and about how long research takes, and it really does take a long time. But Tobie and I would love to hear, and probably our listeners as well, like what are some of your research activity that you're doing or some of your research accomplishments?

Dr. Stephani Stancil: So, you know, the focus of my research at this point, kind of transitioning into that faculty role falls under kind of reducing risk and improving the health of adolescents. And then there are different buckets that I kind of think about. The primary bucket is precision therapeutics. I mentioned that personalized medicine before, and that word has morphed over the years as hot button kind of terms do.

And so now that the generally accepted term is precision therapeutics, which means, again, we're going to be precise about how we're going to choose therapy for our patients and what makes us precise is knowing as much as we can about that individual. And that could be the pharmacogenomic variants that patient may have. It could be some other personal or medical history related conditions that would impact among other things.

And so my work under that precision therapeutics or within that precision therapeutics bucket focuses on adolescent mental health. And right now, I'm studying a drug called naltrexone that is used to treat binge eating and purging that is a part of eating disorders in teens. We are trying to figure out why some patients respond to that drug and other patients don't. We have some thoughts and some hypotheses, if you will, that we're beginning to test out and challenge.

The other buckets that my work focuses on has to do with reproductive health for adolescents and community health. I have a clinic on the campus of Synergy Services, which is a shelter for youth experiencing homelessness in the community. And that is one of my favorite things about the clinical care we're able to provide and to connect with those teens and be able to address questions and improve access to care for those youth. And we do that by answering questions from a research perspective to be able to understand how we can do things better.

Trisha Williams: I love how you can incorporate your clinical care with your pharmacogenetic research and put them together to create this position that you have and be able to do the work that you can do. And I feel like Synergy is a fantastic place for you to be. Synergy is something that I know that Children's Mercy is affiliated with, but a lot of people may not know what it is. And so would you be able to kind of shed some light on what Synergy is?

Dr. Stephani Stancil: Absolutely. I'm happy to give a shout out to Synergy. So Synergy Services is this large nonprofit organization primarily in the Northland, so across the river, which to me feels like a completely different city, but I know it's not really. And so Synergy has a youth campus where they have a drop-in center for youth, as well as a shelter for youth experiencing homelessness and a few other programs there.

And then they also have a domestic violence center and a children's center. And so families, women, children in crisis can go to Synergy and get a safe place to stay, get additional resources to help with mental health, therapy, among other things. Children's Mercy partnered with Synergy 11 years ago, I think. They came to us. At the time, it was Dr. Daryl Lynch who was leading our division and said, "Hey, we want to have a medical clinic on our youth campus because we want to provide a medical home for these teens." And they actually received some benevolent grant funding to fund that. And we got that established. And we've been working, you know, at it and providing that medical care to those teens through this last decade.

And the services have expanded over time. So not only do we have Children's Mercy nurse practitioners who are out there and our wonderful nurses, they also partner with Miles of Smiles, which provides free dental care. And they have an optometrist that comes out and does eye exams and eye care. And so for these youth who may not have consistent access to healthcare, to be able to connect with Synergy and get those wraparound services, it's really amazing.

The other nurse practitioner that's there, she and I split time out there, her name's Deb Jaklevic, and we both just feel that we are so lucky to be able to do this work and we both feel strongly that if we weren't able to anymore, we would still volunteer there. We would still do that, be there in that capacity or in some capacity.

Tobie O'Brien: Sure. I head towards Synergy, just looking for a volunteer opportunity and was amazed. First of all, it really is a beautiful place to be. It's so creative and I feel like it's a great place for these teens to come to feel like home, at least home away from something or to be able to get away. And I was really surprised by all of the services that they offered. When I went, at the time, of course this was before COVID, they even had cooking classes and a place for them to experience like yoga or other sorts of just self-care sort of stuff. And I thought it was cool. I saw the Children's Mercy nurse practitioner office, and I thought, "Oh my gosh, how awesome. I would love to do that." So I saw that and thought, "Wow, this is super cool." So I'm so glad that you get to be there as well.

Dr. Stephani Stancil: Thank you. Yeah, it is an incredibly neat space and you're right, super creative. They took an old building. It used to be, I think, like a radiation oncology building. So it's got white brick and then they added kind of a modern space on to that white brick building. But on the, you know, exposed white brick, they have used to do kind of creative graffiti and reclaim that space in a positive way, which is really neat. Before Synergy kind of bought it and took it over, it was not inhabited for a period of time. And so even though it was this old medical building and then it wasn't anything for a period of time, and so there was graffiti that would be kind of painted on just, you know, from folks in the community. And so when Synergy kind of took it over and kind of reclaimed that for a positive service for youth, it's kind of a really neat turnaround

Tobie O'Brien: Okay. Stephani, will you tell us a little bit more? There's a lot of research going on within precision therapeutics, but is it active clinically yet in practice? And if so, what patients is that used for?

Dr. Stephani Stancil: Yeah. Great question. So precision therapeutics is one of the main goal areas or focus areas for our Children's Mercy Research Institute. And that's led by Dr. Steve Leeder. And so those of us who get to be a part of that program, each kind of develop our own niche or focus and mine is adolescent mental health, and so that's kind of the research focus.

But to your question about, is it ready for prime time clinical care yet? Kind of. We can use certain tools available to us in the clinical setting. And one of those is pharmacogenomic testing. You know, I do that in my clinical practice for a subset of patients that I think it might be beneficial. That inpatient clin-pharm consult service, also might recommend that to you know, again, a subset of patients who it might be beneficial. And so there are some ways that we can begin to incorporate precision therapeutics at the bedside.

And then there are wonderful researchers here who are working tirelessly to come up with tools to bring it to the bedside as quickly as we can. Dr. Sue Rahman is one of those who creates kind of decision support systems. She has worked with our hematologists and oncologists on some of the drugs with a narrow therapeutic index. So, you know, those drugs that you really have to get that dose and the exposure correct for that patient to be as healthy as they can be.

And so being able to kind of plug in information numbers about your patient and then it kind of spits out a recommended dose for a particular exposure. That's pretty cool. It seems kind of space age to me and I love that and I love that that's where we're going. And we want to do that for as many kinds of conditions and drugs as we can.

Trisha Williams: Right. So it sounds like it's replacing the old Lexicomp where you go and you look at your drug and every patient gets this dosage and it's all the same. So it's like we can really tailor therapeutics for each individual patient. And you're right, it sounds so space age and freakin' cool, for lack of better words.

Dr. Stephani Stancil: Right? It is. It is freakin' cool. It is. And you know, like our kind of tagline and it's so true, so even though it sounds maybe kind of canned, it's we really believe this, that we want to find that right drug for the right person at the right dose the first time. You know, kind of take away that trial and error.

Trisha Williams: And it's freakin' cool. It's amazing.

Dr. Stephani Stancil: Yeah. And man, who wouldn't want that, right?

Tobie O'Brien: Right. I mean especially with our children and being able to minimize the amount of medications if possible or like the minimal amount of dosing that we have to use. I think there's even a role within that.

Dr. Stephani Stancil: Absolutely. No, absolutely, right? So rather than kind of starting with this dose that everybody gets, there might be folks who need to start at half that dose. There might be folks that need to start at twice that dose. And man, if we knew that ahead of time, that would really help kind of save, you know, heartache and also reduce the time that they're able to-- or I guess, make it quicker for them to get that response, right? To feel better. I want them to feel better quickly. So we're working hard to try to make that happen.

Tobie O'Brien: Well, thank you for all the work that you have put in. I am curious, when you were a nurse practitioner in the teen clinic when you had first graduated, how did you ever think that or did you think that you would get to this point? Had you had that in your head that was something you wanted to do? And maybe you touched on it a little bit in the beginning, but you have-- I mean, it took you years to get here and I didn't know if you had already known that you wanted to go this far.

Dr. Stephani Stancil: Yeah, another great question. And I think for me, I knew I wanted to contribute in a kind of more impactful way for this kind of tailored therapeutics, precision therapeutics. And so, to me, it seems that a PhD, because I knew that had the research focus and I could get a PhD in pharmacology, was the right, you know, path to do that, even though it didn't necessarily make sense or kind of be what most people do who have an NP and want to go on and do research And, you know, for example, choosing a PhD in nursing versus a PhD in pharmacology.

But I knew that I wanted to contribute in that way. And so I talked with my boss at the time, Daryl Lynch, and he basically said, "Yeah, you should do this. And I'll support you as much as I can." And because of that support, I kind of went forward. I kind of jokingly say, "I had one eye open and one eye closed." Like I knew this is what I wanted to do. I had this passion to learn more about pharmacology and precision therapeutics as it became. But I could not see the end. It would be impossible to me at the time, because there were just so many potential barriers along the way that I knew I might run into.

And so I just thought, "You know what? I'm just going to keep going until I cannot go anymore." And every time I would kind of reach a barrier or kind of come up to a potential stopping point, I was able to find folks who supported me and helped continue to open doors to allow me to continue.

And so I couldn't have done it without a ton of support from my mentors, from administration here at Children's Mercy and elsewhere, administration at UMKC for that matter. And so again, just kind of keep going, one eye open, one eye closed, even if you're not exactly sure what that finish line is going to look like. You kind of put one foot in front of the other.

Tobie O'Brien: One eye open, one eye closed. I love that.

Dr. Stephani Stancil: Yeah. It's funny because that's not at all how I lived my life up until that point, right? Like I'm a planner. I want to know, like the beginning, middle and end. You know, I'd have plans for, you know, decades down the road. And so to kind of do this, whereas one eye open, one eye closed, it was a bit uncomfortable for me, but I knew I was pursuing my passion. And so that was something that was important to me and it ended up working out. Thank goodness.

Tobie O'Brien: And you did mention that the support of Dr. Lynch was sort of instrumental. And I do think that is worth just saying, I think that our collaborative physicians that really support us and encourage us is so important. I mean, I feel like I wouldn't have taken some steps that I've taken without having my doctor colleagues encourage me to do so. And I do think that has been super helpful.

Dr. Stephani Stancil: I completely agree. Yeah, when you find those individuals that you can go to and say, "Here's this crazy idea. Here's what I hope I can do with it." And they say, "Yeah, how can I support you?" That's amazing. And we are super lucky to have this great colleagues here at Children's Mercy.

Trisha Williams: So Stephani, your plate is extremely full with all of your different buckets on this big old plate. Is there anybody in this unique type role that you have that you share with? Like, are there other people like you in our hospital or you it?

Tobie O'Brien: Good question.

Dr. Stephani Stancil: So there definitely are other nurses who are doing research for sure. I think I look a little bit different in the sense that my research focuses kind of in this precision therapeutics and my training looks different. I am not aware of any other kind of nurse practitioner who has that kind of similar level of or I guess similar path in pharmacology and continues to practice as an NP in the country, really.

Although I have been introduced to someone named Catherine Sherwin. She was a nurse who was actually trained in Australia and came over to the states many years ago and ended up getting a PhD in pharmacology and doing a post-doc. And she now is an associate dean, I believe, for research in a university in Ohio. But she no longer practices as an RN, but that's certainly how she was trained. And so we've connected at a national meeting. And just to kind of, you know, when you meet another nurse, there's a lot of things that are unspoken that can go between you, those connections, and that was really wonderful to connect in that way.

But I would love for there to be others. I would love for me not to be the last. And so, if there is something that is of interest or passion for you and it feels a little different than the average bear, I would say pursue it until you can't anymore.

Tobie O'Brien: That's right, listeners. You guys call up Stephani and tell her how you can get started. Really quick, you said it was a long time. How long did it take you to get the PhD? I am curious.

Dr. Stephani Stancil: It took me six and a half years. But again, I was working during that time.

Trisha Williams: Raising babies too, right?

Dr. Stephani Stancil: Same stuff that we get to do as women. Yeah. So, again, it took that long. I had a ton of support. It would have looked a lot different had I not had the support of Children's Mercy, honestly, to kind of continue to say, "We will protect your time for research as you go because we're making an investment in you." And so I was able to continue working and seeing patients over that time and devote a lot of my time to research when I needed to for those last several years.

But you know, in the moment there were so many times I felt like I'm not sure if I'm ever going to reach this finish line. I don't know if it's going to happen. But it did. And now that it has, that six and a half years kind of feels like a blink of an eye, not a hundred percent, but, just like with everything else, right? We look back at these experiences we have, and it doesn't seem as long in retrospect.

And you know, I hope I have a lot of working years ahead of me. And so that six and a half years will kind of be a drop in the bucket to what I hope to be able to do going forward. So yeah, do it. Go for it if you can. If you need support, you know, seek out support, say what you need, ask for it. And then, you know, be innovative in how it can happen. That's what I would say anyway.

Trisha Williams: I think it's amazing advice. You are definitely a shining star within our profession and very inspiring. So listeners, like Tobie said, blaze the trail, reach out to Stephani, figure out how to do your passion. It's important.

Dr. Stephani Stancil: And I think we have, you know, as we think about this precision therapeutics, right? Figuring out the most about our patients, the way nurses think, the way nurses were trained, I think, are really well kind of placed to be able to do that. You know, we think about the patient as a whole person. That's just how we do, right? And we can begin to integrate, you know, the various elements of science, whether it's pharmacogenomics, metabolomics, there's all these -omics. You can, you know, Google and find tons of them. But that begins to help us define who our patients are through that already kind of holistic framework. So I say, go for it.

Tobie O'Brien: That is awesome. You know, I was wondering, will they be able to do this also with oncology patients like they do for adult oncology patients too?

Dr. Stephani Stancil: As far as kind of using precision therapeutics at the bedside?

Tobie O'Brien: Yeah.

Dr. Stephani Stancil: Absolutely. And I would say oncology is one of the areas that is, you know, kind of leading the trail or blazing the trail, leading the pack with precision therapeutics, because you can get a sample of the tumor, for example, and then begin to genotype that tumor and look for variants within that tumor that you could potentially target with a specific drug. And so, those types of efforts in oncology have been great opportunities for the field to learn from. And there are folks doing it here already as well.

Trisha Williams: Well, Stephani, it has been an absolute pleasure and honor to speak with you today. And thank you so much for spending time with us and sharing your story.

Dr. Stephani Stancil: Absolutely. Thank you so much for giving me the opportunity. And I appreciate speaking with you guys. It's been a great time and good luck with all your future endeavors.

Trisha Williams: Yeah. Thank you. Really quick. We like to kind of end each episode on a fun and light question and kind of the same question for this year. If you could go back to your new nurse practitioner self one year out of school, what advice would you give yourself knowing what you know now? Would it be the one eye open, one eye closed or would it be something different?

Dr. Stephani Stancil: You know, I think it would, I think it would just be to trust that gut instinct that what you are interested in or passionate about should be focused on. And so, yeah, go forward, one eye open one eye closed, use the resources available to you, seek out new ones and just keep going. Just keep going until you get to the place that you want to be. And along the way, we can lift each other up and bring others along so that they can also reach their goals and passions.

Trisha Williams: Love it.

Tobie O'Brien: Thank you so much. Yes, it has just been such a joy hearing about your journey. So thank you for joining us. I really appreciate it.

Dr. Stephani Stancil: Thank you for having me. It's been a lot of fun.

Tobie O'Brien: Listeners, thank you for tuning in today. Our next episode will feature Diane Petrie and we are going to be discussing pediatric HIV awareness.

Trisha Williams: If you have a topic that you would like to hear about or you're interested in being a guest on our podcast, you can send us an email at tdobrien@cmh.edu or twilliams@cmh.edu. Once again, thanks so much for listening to the Advanced Practice Perspectives podcast.