Hello and welcome back for another episode of the Future Ear Radio podcast!
For this week’s episode, I had the pleasure of speaking with Sarah McAlexander, Au.D. – Pediatric Audiologist at the Texas Hearing Institute.
In this episode, Sarah and I discuss:
– Sarah’s backstory and motivation for pursuing her Audiology doctoral degree through Vanderbilt
– Sarah’s immersion into the world of pediatric audiology and newborn hearing screenings
– Sarah’s research around “loss-to-follow up rates” in newborn screenings that she presented at the Early Hearing Detection & Intervention (EHDI) conference
– Completing to Cochlear Implant Training course and seeking out ways to gain specialty expertise in all different areas of Audiology
– Building rapport and engaging with potential mentors and professional colleagues who you can collaborate with
– The realities of one’s professional journey, moving from one job to another, and garnering a variety of experience along the way
-Thanks for Reading-
Dave
EPISODE TRANSCRIPT
Dave Kemp
All right, everybody and welcome to another episode of the future ear radio podcast. Very excited for today’s chat with Dr. Sarah McAlexander. So Sarah, why don’t you start here by telling us a little bit about who you are and what you do?
Sarah McAlexander, Au.D.
Absolutely. So, like David said, my name is Sarah McAlexander. I’m currently working as a pediatric audiologist with Texas hearing Institute, which is a nonprofit, pediatric clinic as well as preschool. And Houston’s have Texas. Prior to coming to Houston, Texas and working with Texas Hearing Institute, I was in graduate school at Vanderbilt University in Nashville, Tennessee. So I completed my AuD there as well as my undergrad degree and lived in Nashville for about eight years. In terms of audiology, my primary interests are pediatrics cochlear implants, newborn hearing, screening, and really just providing the best care as early as possible for our littles that are diagnosed with hearing loss.
Dave Kemp
Fantastic. Well, thanks for for coming on today. I’m looking forward to this chat for a variety of reasons. But to just kind of set the stage a little bit, you had this really awesome Instagram post where you kind of highlighted, you know, your achievements, or some of the different areas of professional growth that you had over the last year, which I thought a was just really cool for somebody to be like transparent like that and share, you know, not just the good, but also some of the bad. And also just to put yourself out there like that as a podcaster was perfect for me because I was like, Oh, this is like an episode. It’s just been summed up right here. But but, you know, obviously, you outlined a whole lot of really interesting aspects of of what’s going on in your world. So before we dive into that, let’s go back to the start. Why don’t you share how you even got into audiology? What was the motivation for becoming an audiologist?
Sarah McAlexander, Au.D.
Yeah, um, so when I was growing up in New Jersey, which is where I’m from originally, one of my brother’s best friends as a kid had a little sister who was born. Probably when I was about seven years old or so, he was diagnosed with hearing loss related to Goldenhar syndrome and bilateral microtia Trisha, and so she started wearing about hob pretty much from when she was a few months old. Growing up, our families were always really close going on vacations together, I ended up babysitting her a lot once I was old enough to be able to babysit. And so really got used to being around children with hearing loss and talking about hearing loss and working with hearing loss that way. So that’s kind of what started me on the journey to finding audiology. At the time of that I didn’t really know what an audiologist was, of course, my friends, Heather didn’t know what a hearing an audiologist was from having hearing loss herself. But I was more familiar with the teachers involved in her life, the speech language pathologists that were involved with her life. And so I always sort of envisioned going into a career in deaf education, or in speech language pathology, which I think is pretty typical for a lot of stuff on the audiology path. And I didn’t actually go into college as a communication sciences and disorders major, but I did go special education with the idea that I would go into depth education at the end of that time. And then after about I would say, you’re, you’re in a faff of taking all of the special education class classes at my school, I decided that what I really hated was lesson planning. That I absolutely never wanted to teach a child how to do any type of academic skills. I never wanted to write a lesson plan again. And so I was like, Well, I really love this population still. But what else can I do? And my advisor at the time, had been at a few events over at the Vanderbilt audiology department in the past. And so she was like, Well, did you ever consider maybe being an audiologist, I feel like it would be a good fit for you. And that just kind of started me on the trajectory to getting where I am now.
Dave Kemp
That’s so cool. Okay, cool. So you, and why Vanderbilt? Was there any rhyme or reason why you decided to go there other than it being a fantastic ad program?
Sarah McAlexander, Au.D.
Yeah. So like I said, I actually did my undergrad at Vanderbilt as well. Okay. And so it also has a fantastic special education program. And so that was definitely one of the draws. Although I always tell people kind of on the down low. My reason for going to Vanderbilt was that I wanted to live in Nashville. Yeah, she was a massive Taylor Swift Fan is anyone who knows He can say it’s I’ve always dreamed of going there and the fact that they have this great special education program and then great audiology program. It’s just kind of a little bonus. Yeah, that’s,
Dave Kemp
well, that’s actually pretty nice that it just dovetailed like that, that you decided that he wanted to go audiology. I’ve heard nothing but good things about the audiology program at Vanderbilt. It just sounds like it’s a fantastic program. So you obviously this shaped you know, kind of what you wanted to do, particularly with your first hand experience, growing up knowing that there was like this drive toward pediatrics and stuff like that. But when you when you started to immerse yourself in your doctor role and getting the AUD, what stands out in your mind about some of the stuff that you were learning about pediatric audiology? Was there any one particular facet of pediatric audiology that, like newborn screenings or anything like that, that really grabbed your attention?
Sarah McAlexander, Au.D.
I think initially, the newborn hearing screenings was definitely something that grabbed my attention pretty quickly. We had the opportunities to Vanderbilt, they have a specialty track for early identification and management of children with hearing loss. And as part of that specialty track, students are able to volunteer in different organizations and groups that work with children with hearing loss. And so one of the volunteer opportunities was starting out in the newborn nurseries and Nikki’s doing newborn hearing screenings with some of the tacks. And for a lot of this that ended up leading to a job as a tech later on, which is what I ended up doing. And also starting to build some relationships up with the audiologists at Vanderbilt that were doing a lot of the research and newborn hearing screening and putting a lot of their focus on that. And so I think that was something that drew me in initially, when I was talking about my friend before Heather, you know, she was diagnosed early, she got bought house early, she went to a preschool for children with hearing loss and was able to excel academically. And it’s so important that we’re able to give children access to those early opportunities, and that newborn hearing screening is the best way for us to do that. Because otherwise, these kids tend to come in to us at three, four years old, they’re not really talking. They don’t really know why they may be getting other diagnoses for things like autism, because they know that there’s a speech delay, but no one’s ever really looked into the ears. And so that newborn hearing screening is such a important part of pediatric audiology, because it really is what enables us to do everything else that we need to do to make sure that these children have access to sound as well as to the communication that they need to succeed academically, socially, and just in all aspects of life.
Dave Kemp
Yeah, I mean, the I’ve become more familiarized with the pediatric space over the last few years. And when you were doing this work, when you were a tech, and you were actually performing some of the newborn screenings, were you doing OEE tested? Are you doing ABR testing?
Sarah McAlexander, Au.D.
We were doing ABR testing. So we did EDR testing in both our newborn nursery and in our Nikhil,
Dave Kemp
okay, cool. I actually, I have five month old twins. And so my, my little girl landed in the NICU for a little bit. And so she had her newborn screening, she got an ABR test. And I actually got to see it. That was the first time I’ve ever actually seen it done live. And it’s really kind of fascinating to watch. But she passed with flying colors and all that. But it’s it’s fascinating to see. And it seems like it’s one of those things where you go back to Marian downs, when you know, newborn screenings, like first became a thing, at least here in the US. And it seems like now, you know, it’s progressing to not only more sophisticated types of tests, like the ABR type screening, but also graduating into like you kind of said, more like the early intervention for little kids that maybe didn’t get caught initially. It kind of seems like, it’s great that we’ve achieved this almost mandatory level of newborn screenings in most states. And it seems kind of like now it’s graduating into, you know, how do you make sure that you catch kids, even when they’re in early elementary school as well. So it’s almost like moving up the ladder to make sure that these kinds of things are caught early, because it’s so important. As much as I’ve learned, it seems like it’s just critical. The earlier that you can catch them.
Sarah McAlexander, Au.D.
Yeah, absolutely. And it really is important and that education of other health care professionals is definitely a big part of it. You know, we hear all the time as pediatric audiologists and then also when I was doing those newborn hearing screenings, we hear other health care professionals think that oh, it’s just fluid in the ear. or, oh, you know, sometimes the equipment just doesn’t work. And you don’t pass the newborn hearing screening, but it doesn’t mean anything. And sure, sometimes that is the case, we know that sometimes there are going to be babies, such as have fluid in the ear or the equipment just produces a failed result. And it doesn’t necessarily mean that they can’t hear. But that’s not necessarily the main reason for a failed newborn hearing screening. And so improving that follow up is so important to catch these kids, which is really a big thing that we’re working on now. Because that follow up piece is still one of those big pieces that’s missing. And pediatric audiology. Yeah, exactly.
Dave Kemp
That’s that’s kind of like where it seems like a lot of the focus is now is it’s almost like, you know, mission accomplished with making sure that there’s the mandates around the newborn screening, but it’s like the job isn’t finished yet. Now, you can move up into some of those earlier are some of those like later in life stages as well? You know, so when I was referring to this post that you you had in there, you mentioned that you presented at Eddie at the what does it stand for? Is it early hearing?
Sarah McAlexander, Au.D.
What’s Early Hearing, Early Hearing Detection and Intervention? Okay, awesome.
Dave Kemp
So do you want to share a little bit about what you presented on at that conference?
Sarah McAlexander, Au.D.
Yeah. So that’s really similar to what we’ve been talking about. So like I was saying, the last follow up rate is still pretty terrible in the United States as a whole, and in certain states, particularly. So we know that you know, in in Texas in the US, we’re pretty much screening 98% of infants across the board, again, some ranges there, but we’re doing a really good job of screening and thymus in the hospital. But when they fail the screening, the big question is, do they come back? And the answer is not as positive as we would hope it would be. The loss to follow up rate right now for the whole country is about 27%. And unfortunately, for my state of Texas, we’re really failing here. And we’ve got a loss to follow up rate of about 50%. And so 50% of those infants that are failing are not necessarily coming back and doing their newborn hearing screenings. And so a lot of research has been looking into, what can we do to improve this loss to follow up rate? And how can we try to get parents back in the door so that we can figure out if there is hearing loss, and again, treated early if that’s what we’re finding. And so one of the things that we were looking at back in grad school, and then continued on a little bit into my professional career was some aspects of counseling and brochures that may help contribute to that loss to follow up rate. And so the first thing that we were looking at was the understanding of the word refer in the context of newborn hearing screenings. We had this idea that a lot of parents may not really understand what the word refer means. Does it mean that the equipment stopped working doesn’t mean that you need to go see someone else, which technically is what it means, but doesn’t mean that there was not enough data collected to produce the result? It’s a really unclear word. And so if you hear refer verse did not pass or fail, what are your perceptions going to be? And is that perception going to lead to you following up or maybe saying, Yeah, I don’t know if this is as important. And so the first step of that was kind of looking at, okay, do people understand the word refer, compared to words like pass or did not pass. And we found that only 47% of the people surveyed understood the word refer, compared to 88%, understanding the word pass, and 79%, understanding the word did not pass. And so there was definitely some lack of clarity and that terminology there. So that was the first step. The second step was then evaluating the brochures that are out currently, because a lot of times when you get the newborn hearing screening, the parents aren’t in the room, and they end up leaving a brochure or some information about the results of the test, rather than discussing it with the parents directly. And so are those brochures clear? Those brochures even if you do see someone, maybe that’s all you really have to remind you of what happened? And are you able to understand what it’s saying so that you understand the importance of following up. So we evaluated brochures on four different areas, readability brochure, design, pictures, and use of the word refer. We found that 63% of brochures were written above a sixth grade level, which is typically where we want medical information to be written to make sure that all parents of all educational levels are able to understand it. 59% of those brochures were not meeting the criteria for brochure design. So they were including maybe too many words on a phrase, too many letters on a line. I mean, really small margins, no like summary boxes, we found 27% of them were including inappropriate pictures. So maybe pictures of older children or babies with hearing aids on them when that’s not necessarily what’s happening with this test. And then about 30% of those brochures, were still using the word refer instead of did not pass or fail to refer to a failed screening result. Overall, that combined with only 12% of brochures, meeting all of the criteria that we considered to be important to make sure that these brochures were accessible and readable.
Dave Kemp
I just find this to be really interesting. So what’s been the reception that you’ve had from after these presentations and stuff? It seems like a obvious culprit that’s at least contributing somewhat. And it seems like something that could be remediated relatively easily. So what’s been the response to this? You know, suggestion more or less that maybe we could improve? Just the language on the brochures?
Sarah McAlexander, Au.D.
Yeah, I think a lot of people are in agreement with that, you know, most people that I talk to, it’s something that they haven’t even necessarily thought about, is the language that we’re using on these brochures. And whether it’s clear to parents, a lot of the fear for a while is that the word fail is really harsh. And maybe that scares people a little bit. And you know, on the counterpoint of that, maybe maybe it’s okay to be a little bit scared when your child isn’t passing an important medical exam, because maybe having just a little bit of anxiety, and I’m not talking about being, you know, over the moon anxious about the result. But maybe that says, Okay, this appointment is important. I’m gonna go get this follow up screening and see what’s going on. And so I think people are starting to come around to it right around the time we were doing this study, the jch, the Joint Commission on and Senate hearing, released their updated Edie protocols in 2019. And they actually recommended without necessarily the research to back it up. But they also recommended switching over to did not pass or fail, in contrast to refer because of the same concerns for language.
Dave Kemp
What else was included in that 2019? What is Judy Hai,
Desi, ah, so, on Infant Hearing,
Dave Kemp
we did that. Were there any other kind of landmark recommendations or changes.
Sarah McAlexander, Au.D.
So the big one was moving from 136 to 123. So the idea is that we should have screening by one month diagnosis by two months and intervention by three months now, instead of that 136 that we’d been working on more. So I think that’s still been a big shift for a lot of clinics, especially with COVID Kind of getting in the way there for a couple years. But definitely something we’re all working on. aspiring to.
Dave Kemp
Yeah. Okay, cool. So, um, that’s very interesting. About we shift over to the cochlear implant side of your passion. How did this come to be and share about what you’ve been working on in that regard?
Sarah McAlexander, Au.D.
Yeah, um, so I really love working with cochlear implants, specifically with pediatric cochlear implants. And I was lucky enough to go to school at the Enter belt where they’re doing a lot of research and seeing a lot of cochlear implant patients. So I don’t know that it was something that prior to school, I knew exactly where I was going to fall on. But getting in the clinic and being able to do cochlear implants was really exciting. And I knew it was something that I wanted to do in my professional career. I feel like cochlear implants is often one of the area’s that’s a little bit harder for students to get a lot of exposure to in grad school. Again, I was lucky enough to go to a program that has a large cochlear implant program and a lot of cochlear implant patients for students to help with MC. And so I did get a lot of exposure in grad school. But when I was looking for ways to improve my skills post grad, I ended up going ahead and signing up for the Institute of cochlear implant trainings advanced audiology course. And so it’s a online course for a few weeks, I think it’s about 10 to 12 weeks weekly, where we have different lecturers that would come in and talk to us about different aspects of cochlear implant programming. They would give us like little assessments or discussion boards that we would be posting on to kind of better ask questions and communicate with fellow professionals that were also programming cochlear implants. And then that all ended and an in person component with some hands on programming experience out at Cochlear is headquarters, and they switch the location of that in person component every year to a different cochlear implant manufacturer. So this year’s course will be going over to mams bionics out in Valencia, California, but it was a really rare Eat chorus, I highly recommend it for anyone that’s looking at improving their own cochlear implant skills. The instructors are fabulous. They’re all people that have been working with cochlear implants their entire career, they’re at the forefront of cochlear implant research. They work with cochlear implant patients on a daily basis, and they’ve got a lot of knowledge to share. So it really gave me a lot of tips and tricks that have helped me kind of elevate my skills and feel a lot more comfortable when I’m now in the clinic rooms. And in the booths working with cochlear implant patients on a daily basis.
Dave Kemp
This whole thing is so near and dear to my heart, which is just like just constantly finding ways to grow professionally. And I just think that this, like audiology is such a great example of, you kind of come out of your program, maybe you’ve specialized a little bit within, but you kind of start at this like base level. And then you have to like acquire some of the specialty skills. And I feel like it’s kind of a challenge, because there’s not a lot of very clear cut, like, here’s exactly how you do it at night. It’s fascinating doing this podcast, because everybody that I talked to you kind of comes at it a different way. They’ve learned about, you know, the things that they want to do a lot of people like you had preconceived ideas of like, I want to get involved with pediatrics and passionate about cochlear implants. But to actually go in, and this is where I’ve always found it to be very interesting is there’s a big, big difference between learning from a textbook and learning with hands on training. So like, after doing this, obviously, it probably really helped in a lot of ways to build up your confidence, all that but how big of a leap? Has it been from just like this training course and doing it in that? You know, simulating it that way? And then the real world what you’re doing now, where you’re actually now in a clinic, doing a lot of this stuff? Did you feel like it really prepared you? Or is there no real preparation, because you just got to kind of almost do the real thing.
Sarah McAlexander, Au.D.
I mean, I feel like this course wise, really great preparation, in a way because the idea of at least this course, is that everyone who’s in it is already an audiologist, that is programming, cochlear implants, at least on a regular basis. And so that regular basis may vary. There were some people in the course, who pretty much only see cochlear implant patients, there were some people who see a few cochlear implant patients here or there, and a lot of people that were somewhere in the middle. And so I think what was nice about doing a course like this verse kind of something in grad school, where you’re sitting in a classroom every day, and you’re learning about it, and maybe you’re doing a couple labs, but whether or not you’re actually going into the clinic that day and seeing it later on, is variable. The nice thing about this course is that we would learn something and then the next day I would see a patient’s and clinic and I would say okay, what did we talk about last night on the course, let me try to do that today. Let me try to take that strategy that we were talking about where maybe we would talk about a difficult programming case and talk about changing the rate or changing the pulse width or something like that, to help the patient hear about her. And I would think about oh, I have that one patient that might actually really benefit from that. Let me write this down or put a little reminder in their chart so that when they come in, I can say, Okay, let me try this and see if it works. So I think that doing that type of continuing education was really helpful. And something again, that I don’t know, there’s a lot of programs out there that do it. But being able to immediately hear those things, and then put it into practice helped a lot of what they were staying click a little bit more than that when I was reading textbooks in grad school, and trying to make things make sense without me having the hands on component to go along with that.
Dave Kemp
Yeah, yeah, I just that seems to be, you got to get the firsthand experience. And if there are programs that can help to facilitate that. I think that’s so critical. Because I do you know, I think, for young audiologists in particular, or aspiring audiologists. I think that there’s this broad understanding that there’s probably a lot to gain from having specialty expertise. But it’s a matter of how do you actually, like foster that, you know, it’s not as if you can go and just like, you know, Garner that on your own, you’re going to have to have some sort of entity that can administer that on your behalf. But that’s really cool to hear that I didn’t I didn’t even know that like cochlear and some of these different manufacturers helped to facilitate that stuff. So it sounds like it’s been a very positive program for you.
Sarah McAlexander, Au.D.
Yeah, it’s been really helpful. And again, so that’s through the Institute for cochlear implant training in case anyone is interested in it. And then it’s a kind of separate where connotation, but it works with all the different manufacturers, they usually have reps that are on the calls in case specific manufacturer related questions come up. So it really is helpful. And again, for any new grad that’s looking at, okay, how can I specialize, you know, maybe I am interested in pediatrics, or cochlear implants, or Vista, or whatever the case might be. Those are really my recommendations is finding continuing ad that’s meaningful, going to conferences, getting continuing education, that way, there’s always lots of opportunities to add to your tool belt. And then my other recommendation is really to talk to different people in the field. I’m a big networking fan. I love talking to people, I love meeting new people. And building up that met mentor relationship with different audiologists who have that specialty experience already is going to be really helpful, building up that network of your peers and colleagues that you’re going to be able to ask questions about if you have a difficult case, you’re going to be able to reach out and say, Hey, have you seen this before? And how have you managed it is really, really helpful. And so I think for any new grad, building those relationships up finding mentors that you trust, turning to that community of audiologists around you for help when you need it is really, really important.
Dave Kemp
Yeah, well, good segue. Because the next question I was going to ask, or just wanted to kind of dive into is mentorship. This is something that I’ve discussed on the last few episodes. And it just seems like there’s no, it’s another one of these things where you kind of have to just like, figure it out on your own. And it’s variable based upon where you live, what program you went through, and all this. But my question is, how did you sort of cultivate? Where identify mentors? You know, did you seek them out? Were you really proactive about it? I think that’s something I really admire from afar about you is, it seems like you’re very proactive in, you know, pushing your own personal boundaries and forcing yourself to be out of your comfort zone. So I’m sure that some of this maybe just happened. Because you you’ve kind of, you know, manifested it you you you wanted it to be. But like, can you walk me through that a little bit about what what that was like, because it feels like it’s such an important part of this whole process of as a young person coming into this field, like, you can stand to gain so much if you can have some of that wisdom imparted upon you, instead of having to just like fumble around in fail a whole bunch on your own. What was that like for you?
Sarah McAlexander, Au.D.
Yeah, and so I think a lot of my mentor ship relationships formed very organically. And so some of them are going back to grad school, trusted supervisors, or professors that I had the chance to really form close relationships with. And a lot of it started with finding something in common with someone or common interest in audiology that I wanted to learn more about. And so when I think about some of the supervisors that I was able to form, close mentorship relationships, people that I still talk to, and I have questions or concerns today, a lot of it started from being like, you know, I’m really interested in newborn hearing screening. And that’s, that’s what you focus on. So what are your suggestions? How do I get involved? Do you have an opportunity for me to help with some research in this area? Do you have something that you did that helped you learn more about this? And what would you suggest and starting out with out with those questions was really helpful for starting to build up those relationships, and kind of build some rapport with people that I really respected, looked up to admired and wanted to have a closer relationship with. And that goes with colleagues at my current jobs to you, I think there’s always a lot of wisdom to be found with audiologists who’ve been working for a little bit longer than I have, who can help with those questions, especially if they’re at the next desk over, be really helpful to have someone that’s willing to work with you and willing to help build you up. The biggest kind of advice that I have for again, anyone looking to build up those relationships is not to be scared to talk to people and ask questions. You know, if you’re at a conference, I’ve, I’ve told students this before, and you see someone that maybe you really love the work that they’re doing research wise, or clinic wise, or whatever the case is going up to them and saying, hey, you know, I saw your article on XYZ, and I thought it was great. And this is how it’s impacted my clinic. And I would love to talk to you a little bit more about it, exchanged email addresses, exchange, phone numbers, whatever the case might be, and keep in touch with those people say hi to them at every conference that you can or every event that you happen to come in contact with them, ask how they’re doing things like that, and you’ll notice that those relationships start to form very organically. Yeah, 100%
Dave Kemp
I mean, the one of the last episodes I did was with Dr. Rachel McGann In favor, and she was saying very much the same thing. She was like, you know, I made a pact with myself that when I go, you know, I really tried to force myself when I was really getting started to go to these trade shows. And when I would see a presenter, even if I didn’t have anything like specific to tell them, I just give him my business card. And I’d say I loved your talk. And I am a big fan of you more or less. And I think that what we talked about, and like this is just like a total like echoing of that is, that kind of stuff stands out so much in people’s minds, like they actually remember that kind of stuff. And it is scary. It’s uncomfortable to put yourself in a situation like that. But like, those are the kinds of things that you got to put yourself out of your comfort zone. And I know it’s uncomfortable, but it is that it’s so beneficial for your career. The other thing I’ve noticed with you that I think’s really cool is you you seem to be a big proponent of doing speaking, like we talked about with the whole Edie presentation and all that. But can you just give me a sense of like, is your motivation there, along with, you know, providing, you know, being your own, wanting to be a resource to the industry and all that. And your colleagues? Do you feel as if that’s another good way in which you can sort of put yourself out there more or less?
Sarah McAlexander, Au.D.
Yeah, absolutely. I think that there’s this concept that everyone has to work that someone has to know everything before they’re qualified to speak on something or qualified to present at a conference or speak with students, or whatever the case might be, you sort of feel like, okay, well, if I’m not, this person who is working at one of these fabulous universities, has published 50 papers, I haven’t been working for 20 years, I haven’t seen 1000 patients in my life, that I probably am not qualified to speak on much of anything. And I think that’s such a misconception, and audiology and in other fields as a whole, you know, we’re a very small profession, there’s, there’s only a few 1000 audiologists in the entire country. And every single person has something to share, everyone has a different interest, everyone’s career looks a little bit different. And I think there’s a lot of value in sharing that with other people and being open about what your career has looked like. Even if it hasn’t always looked pretty, you know, I think sometimes it’s even sharing the hard parts or the patients that have gone wrong. Or the times that maybe you didn’t feel so short during an appointment, or during a job interview, or whatever the case was, because all of that helps educate the next generation coming forward so that they’re able to do this job even better than we are able to do it today. And that starts with sharing knowledge without gatekeeping any of that information that we have with sharing interesting patients or cases or whatever the subject might be, in whatever way possible. And sometimes that is at a conference. Sometimes it’s just in your local kind of circles or your local network. Maybe with even just the people sitting around you at work, but I really do think it’s important to get that knowledge out there and to not discount yourself, because you’re missing whatever accolade or experience that you think you need. Because those people with all those accolades and experience and published papers, were ones also sitting there a year out of grad school, without as much experience or research or whatever it might be, to their name to,
Dave Kemp
I could not agree more with this whole thing. And it touches on, you know, imposter syndrome or imposter phenomenon, whatever you want to call it. But I think that you couldn’t be more on on the nose with that with everybody that you admire started somewhere. So to think that you’re not qualified, I think I couldn’t agree more that it’s a misconception in the best, the best remedy is just to start. And I think that’s what’s really cool about the nature of how the actual tradeshow side of this industry works is you don’t have to necessarily like maybe go and speak at AAA at the national show, start with developing a talk and go in presented on at a stage show where a regional show or do something on audiology online or figure out something that is appropriate for a podcast or something like that. I mean, you can develop your own brand identity, if you will, and a lot of it is just your own internal confidence that you can just build on it’s like okay, because you’re gonna want to have like an introduction when you have a talk and, you know, so you can start to use these things as credentials more or less in and of themselves. So I just think that they’re especially as young People, it can feel very intimidating, that you’re not qualified for this and you don’t have the, you know, you’re not like eligible for the speaking opportunities. And I just think that the biggest the biggest roadblock is your own inner mentality. You know, it’s like, well, whatever you’re telling yourself.
Sarah McAlexander, Au.D.
Yeah, no, I agree. I always I tell people all the time, you know, sometimes things are going to scare you. And that doesn’t mean that you shouldn’t do it. I think that you have to say, Okay, this scares me. But I know that I can do it, I’ve got four years of education under my belt, I’ve got this much clinical experience under my belt, I’ve got something interesting to share. And I’m gonna go for it anyway. Because honestly, the worst thing that happens is, you apply for an opportunity to speak, and you don’t get accepted. And that doesn’t put you in any worse of the position than you are if you didn’t apply in the first place. Or you go speak and maybe it doesn’t go perfect, but it probably still goes pretty well. And you learn something from that. And other people learn from that, and you develop a better talk for the next time. And so all of that matters, all of those experiences matter. I don’t think failing is failing. I think failing is just learning more and trying again, totally.
Dave Kemp
So the big, the big life change, I guess, that you had, on top of all of these different things that you’ve you’ve achieved over the last year, was joining the Texas year Institute. So tell me about that. I mean, when did you when did you get your AUD? It was recently, right?
Sarah McAlexander, Au.D.
Yes, yeah. So I graduated from Vanderbilt in May of 2021, and moved to Houston about three months after that. And I was initially working at another clinic in Houston, UT physicians, which is more of a en t University Hospital tightness. So a mixture of adults pediatrics, the stib, cochlear implants, hearing aids, you name it, we did it. And so I worked there for about 13 months before just recently, about three months ago, signing on with Texas hearing Institute, which is another clinic in Houston. So still staying in Texas for the time being. And I think that was you know, we’ve been talking about kind of putting yourself outside of your comfort zone, doing things that scare you. Looking at changes, not as failure, but as a chance to kind of start over and do something new. And I think that was a lot of the way that I felt getting into my first job. And then realizing that maybe I didn’t want to be at my first job anymore. I think no new grad necessarily signs on for a job and thinks, Okay, I’m only going to be here for a year. And then I’ve never, you know, I think there’s this idea sort of when you’re graduating that you’re like, I’m gonna find my dream job. And I’m going to be there for 510 years, and it’s going to be fabulous, and great. And I’m going to love it. And I just don’t know that that’s ways realistic, right. But, you know, that’s, that’s definitely the thought process I had going into it. And I think even starting to kind of feel like I needed a change in my career. So early started to feel a little bit like sailing. Like, well, maybe I should have taken a different job. Or maybe I should have waited a little bit longer for the right opportunity to come along. Or maybe the reason that this job isn’t working right now is me and something that I don’t have, instead of that it’s not the right fit for me. And so I finally got to kind of a point after, again, about a year there was like, Alright, I’m just gonna put myself out there, I don’t know if it’s going to work. I only have this year of experience under my belt. I don’t know if people are going to love that. But we’re just going to try it and see because I really want to be working with pediatrics full time. I love my adult audiologists working with adults is just not really for me doing vestibular testing, I will refer them to my friends who love it any day of the week. But it is just not in my wheelhouse. And so those were kind of the big things that I was like, I just don’t love part of my job, and I want to love what I’m doing. And so I sent out my resume to a couple places in Houston, kind of on a whim. And by the end of two weeks, I had a job offer that was with an organization that I loved that I was excited to be working with. That was excited to have me and it was such a important thing I think for me to see that succeed because I feel like I felt like I was applying because I had failed. And so instead to realize that I was a great applicant for this role and I was a great fit for this was kind of reminding myself that just because I’m not a good fit for something doesn’t mean that I’m not a good fit for Audiology or I’m not a good fit for everything. And I think that it’s okay to look at your career and make those changes. But I don’t know that new grads always feel empowered to do that. I think there’s this idea that you have to stay for three years, four years, five years, and then it’s acceptable to leave and try something new.
Dave Kemp
Yeah, totally. I think that’s something that all, not all, but a lot of young people will have to go through is that first step, first job that you need to part ways with for whatever reason, usually, you want to make sure that you do it amicably. But, but I think that’s a really good point is like, it’s not really necessarily a testament to you, or, you know, all that, I mean, to your point, you can almost become paralyzed when you’re just starting out of trying to find the perfect thing, you know, and so there’s, you, there’s like a balance there, where it’s like, you know, on one hand, you’re right, you want to make sure you find something that’s a good fit. But you also don’t want to like delay and delay and delay looking for the perfect thing, when in reality, kind of, as you’re saying is, you can start somewhere, see, if you like it, get your feet underneath you. And then there’s always an opportunity to move around. And I think what you learn as you, you grow, and you you, you, like exist in the workplace for a little longer is, this is it’s actually extremely normal to do that. Like, I think that when you’re first starting out, you are so fearful of like, am I, you know, is like the fact that I’m already having to throw in the towel and say that I want to do something different. It feels like a failure. But I think that that’s really the reality of it is you just don’t really know how normal that really is, you know?
Sarah McAlexander, Au.D.
Yeah, yeah. And I think one of the things, you know, that I’ve thought about a lot with this kind of big transition, because it was a big change, it was a hard decision. It was a scary decision, for sure, is how, what the job process looks like for new grads for students coming out of their audiology program, and what it ends up being in reality, and I remember, you know, I started applying for jobs, and I had this idea that it was going to be the dream job, probably sent out like 3040 applications to different jobs, and honestly expected to get a lot of interviews, I had a lot of confidence in my resume and the connections that I had built up. And I felt confident that I was gonna get interviews I was gonna get offers, I was gonna have my pick of where I wanted to go, and it was gonna be great. And in reality, that’s not what happened. And it’s not really what happened for any of my friends that were graduating. You know, we had a few people that maybe, you know, they applied one, they got that job or got hired on straight out of externship. But for a lot of us, it took a lot more effort, it took a lot more time than we had been anticipating. And I think that sometimes felt a little bit demoralizing. But we all ended up in jobs. Some of us loved our jobs immediately. Some of us didn’t feel quite as Sure. But it all worked out in the end. And then when I also think about my time back at UT physicians, and some people have also asked me, you know, like, was it all bad? Do you regret it? Do you wish you had waited and tried something else. And in retrospect, like I don’t regret it at all, I think that it was the right opportunity for me at that time, I think that I grew a lot of skills. Again, I’m not an adult person. I’m not a vestibular person. But I now know how to work with adults. And I know how to do vestibular testing. And if one of my pediatric patients needs vestibular testing, I know where to refer. And I know what to look for. All my pediatric patients become adults. And so it’s important to know what that looks like when that happens. And so I still gained a lot I made great friends, great connections, I’ve got several people that I trust and love that still work there or who have also moved on to other things that I would reach out to in a heartbeat if I have a question about a patient that maybe is unfamiliar to me. And so even those things that maybe didn’t work out exactly like I wanted them to have grown me into the audiologists that I am, made me a better candidate for the job that I have now and have made me a better audiologist. And so even those experiences that maybe didn’t quite fit into my you know, picture of what I wanted, from the start of applying for jobs are still an important part of the skills that I have now. And so I would always encourage people to also say, you know, if you’ve got an opportunity, and it’s not meeting every checkbox, but it’s meeting some of them, go for it, you’re going to learn something and if you decide after a year that it’s not working for you try something else. Okay, it’s okay to not know everything right when you graduate.
Dave Kemp
That’s some real talk. I really appreciate you like being real candid and transparent like that because I think that, that has to resonate for some people that are listening to this, that I just think it’s, that’s just like, how it really is, you know, you don’t need to stress so much over finding the perfect thing. And I, to your point, I think that like, maybe the right way to look at it is, I’m gonna gain experience, I’m going to, I’m going to be able to walk away from this thing that like, I might not feel like it’s a perfect fit a year or two years from now, whatever it might be, knowing that like that was worth my time that it was valuable. I mean, don’t get into a situation where you’re going to have a toxic employer or something like that. But if it’s just more around, like, you haven’t been able to find that dream thing that you really want to do. This is the kind of stuff where I just think that you, you got to have a starting point. And that is ultimately going to benefit you in some way. Like you’re going to be able to take those skills with you in to the next thing as well. So with your current job, it sounds like you love it. What what what is it about this new gig that that that you love so much? Do you feel like you’re kind of finally fulfilling the vision that you’ve had for a long time of like how you’ve seen yourself as an audiologist?
Sarah McAlexander, Au.D.
Yeah, I definitely do. I think what I love, love about where I’m working right now is how varied my day is. And really focused again on pediatrics. And even a lot of the pediatric jobs that I was looking at, tended to be kind of one aspect of pediatric so you would be doing just pediatric hearing aids, or just pediatric cochlear implants, or just ADRs. And I love all of those things. And so I love that at my new job, I’m kind of wearing multiple hats, and I’m able to do all of that. We’re a very interdisciplinary clinic. So we have audiology, we have speech language, pathology on site. And then like I said, we also have a preschool for children with hearing loss on site as well. And so it’s really nice to be able to collaborate with those people. If I have a concern about how a child is progressing, I can walk down to their speech language pathologist in the next office and ask that question. If I have a student at the school that I need to get some extra testing on, I can go pull them out real quick, and do that testing during the school day. And so having that extra kind of collaboration between individuals has been really, really fun. We also work closely with all of the EMTs in the area. So we don’t have an e and t on staff at my clinic. But we do work closely with Texas Children’s Hospital, actually, with UT physicians, which does have several of the Egan’s, he’s in the area. So I’m keeping those connections strong.
Dave Kemp
Exactly thing.
Sarah McAlexander, Au.D.
And several other EMTs in the Houston area, which has also been really fun to get to collaborate with some new people and make some new connections across Houston. But also maybe not have the stress of working in an EMT clinic and having to prioritize those patients over my own. So I’ve I’ve really loved it. My coworkers are wonderful. It’s a great place to work and we are hiring. So if anyone’s interested, feel free to shoot me an email or check out Texas hearing Institute.
Dave Kemp
So cool. So as we come to the close here, this has just been really interesting. And I’ve really enjoyed this. What does the remainder of 2023 look like for ceramic Alexander?
Sarah McAlexander, Au.D.
Yeah, so I don’t I’m not even entirely sure what it looks like some of the things that I ended up doing ended up being a little spur of the moment for me, but I will be at the AAA conference coming up in April. So I’m very excited to see anyone who’s there in Seattle. Oh, yeah. Awesome. So I will see anyone who’s there hoping to make it to the Texas Academy of Audiology conference as well this fall. And then in general, trying to get some new research projects off the ground and continuing to grow and my cochlear implant skills and just general pediatric audiology skills however I can
Dave Kemp
and maybe fit a T swift show in there.
Sarah McAlexander, Au.D.
Oh, I’ve already got that. But it’s my birthday in Dallas. So if you’re ready to go April 1, come say hi.
Dave Kemp
That’s hilarious. How do you like Houston?
Sarah McAlexander, Au.D.
I love Houston. I wasn’t sure about it. I keep telling people I have this kind of a move in moving on South for a few years now and I don’t know that I knew what to expect from Houston when I moved down here back in 2021. But we we really like it here. The weather is great. The summers are a little bit warm, but I’m finding that I like the warmth better than the cold so I’m okay with that. So it’s fantastic.
Dave Kemp
I hear it’s a low key like foodie city. It’s like it is really city.
Sarah McAlexander, Au.D.
The food is like crazy. I mean I’ve never had better queso then after Texas. It makes everyone else’s queso not hold it. So
Dave Kemp
jerseys queso does it doesn’t hold a candle not at all.
Sarah McAlexander, Au.D.
Not at all. And like, there are foods that like Houston can’t stand up to Jersey with like my jersey nagels are always gonna be like, That Houston’s queso is is pretty great.
Dave Kemp
That’s awesome. Well, I’m very much looking forward to seeing you at AAA. Keep on keeping on with what you’re doing. It sounds like you’re really just like seizing the moment here and pushing yourself to just kind of like grow as much as you possibly can. So I think it’s really neat. And it sounds like you’re just getting started with what you’re doing.
Sarah McAlexander, Au.D.
Yeah, absolutely. I’m excited to see where everything goes. Absolutely. Well.
Dave Kemp
Very cool. Thank you so much for coming on today. And thanks for everybody who tuned in here to the end. We’ll chat with you next time. Cheers.
