Spencer C. Knox, MD

Internal Medicine Resident Physician, PGY-3

My Last Month of Wards as a Resident: Reminiscing

With only one week remaining in my final month of Wards (adult inpatient medicine), I’m finding the moment bittersweet.  Undoubtedly, there’s a sense of nostalgia.  I remember my first day of Wards, not knowing the answer when an RN asked me, “Can the patient in room [632] eat breakfast?”  I remember hours spent answering the onslaught of pages from the floor pager when on-call.  I remember the metamorphosis when my title changed from “intern” to “senior,” and all of the new expectations that came with the new position.

Internal Medicine residency is rigorous, but it’s something I am so incredibly thankful for.  Wards is considered one of the more rigorous rotations, since it includes working six days/week and 24+ hour calls.  The remarkable amount of information I have learned throughout 12 months of Wards, over the past two and a half years of residency, has molded me into the young physician I am today.

Time Management:  According to Each Year of Residency

Since beginning residency, “efficiency” has signified different things.  Intern year, solid time management equaled seeing all of my patients and writing all of my notes before the unwritten deadline (e.g. when our attending liked signing them).  Slowly but surely, I ultimately learned to formulate my own medical treatment plan independent of my senior.

Second year marked another keystone moment in my training when suddenly I had to manage a list of 20 patients, two interns, and a medical student.  Time management at this stage meant staying on top of admission orders, completing admission med reconciliations, updating medication/treatment orders, and answering “upper level” management questions that were filtered via the interns.

Now in my third year, I am working on fine-tuning my practice of medicine and deeper learning.  It’s expected that I know how to treat common illnesses, but third year residents also need to expand on our relatively small knowledge base so as to better care for patients.  Increasing efficiency when admitting patients, prioritizing sick patients, and identifying who may soon become very sick is consequential.  Finally, learning how to coordinate with the RN and even radiology technicians can have a management-altering impact!

What I Hope to Take With Me

  • Remember the lessons learned from both positive and negative patient outcomes – be mindful of improvements to patient care.
  • Each attending has something amazing to contribute – take a few positive elements from each one and formulate my own ideal way to practice medicine.
  • Always approach each new intern/resident with respect.  Also understand that I may teach them something valuable, even if it seems mundane to me.  Conversely, I need to keep an open mind and realize that a junior may know something I don’t!
  • Prioritizing and time management is imperative!  It can help enhance medical care, and even save lives.

Learning During Residency – How to spot an effective teacher/mentor

I love Internal Medicine residency training.  I am blessed to be at a fantastic program.  For the past several years, my medical practice – and career – has been molded by attending physicians.  I often sought out the “best” teachers/mentors to help.  Here’s my guide to pinpointing an invaluable teacher-mentor during inpatient and outpatient clinical rotations.  This applies to anyone training in clinical medicine – from nurses to medical students, residents, and beyond.

1.)  Approachability

Friendly and easy to talk to should be keystone elements in a mentor.  Renowned mentor leaders in academic medicine should and – most importantly – can be approachable.  A lot of brilliant people in academic medicine are fantastic physicians, but intimidate students and residents.  Some people argue that to be respected, one must behave in an authoritarian way.  Anecdotally, this is unequivocally false.  Residents prefer to work with attendings who treat them with respect and encourage learning.  This translates into better patient care.  We physicians are here to treat patients.

The average resident does not need to be coddled, but does need a mentor who is easily accessible and responsive.  Approachable means the student or resident can discuss face-to-face/call/text any clinical scenarios and pose questions at will.  This greatly augments real-world learning for the student and resident.  Honestly, it is the #1 most underrated attribute in an attending physician.

2.)  Knowledge

Self-explanatory.  The student or resident physician expects that their mentor be an expert in their field.  Adult wards attending doctors need to impart clinical expertise on their team.  This includes the art of medicine.  There are innumerable instances where a clinical guideline (that any resident can read in a textbook) doesn’t exist or is published on “expert opinion.”  A true mentor will provide timely medical decision making advice to help the student and resident learn.  Finally, when a procedure is indicated, the true mentor will give the resident hands-on experience under a watchful eye.

3.)  Networking

To a certain extent, once you’ve begun residency, your career path will be influenced more so based on who your mentor knows.  Yes, you are expected to be a competent doctor and know how to treat patients.  However, an excellent mentor will help guide his/her student/resident/fellow in a number of ways.  This includes suggesting relevant conferences and events to attend.  One of my mentors helped me attend the ACG/WCOG conference here in Orlando.  Intimidating at first, it turned out to be a really nice experience.  Networking provides a way to help others in medicine become familiar with you, exchange ideas, and advance your career.  I have a tendency towards the introverted side when it comes to professional networking, but am rapidly learning that meeting other like-minded professionals is extraordinarily fulfilling.

4.)  Research Guidance

Although my primary focus as a physician is to care for patients, attention to publishing journal articles is also crucial.  I wouldn’t be in the position I am now without it.  Publishing in print/online journals shows peers you seek relevance in academia and want to expand mankind’s knowledge.  A quality mentor will proactively assist with editing and submitting manuscripts — or find a colleague who will get things done.


  1. Approachability
  2. Knowledge
  3. Networking
  4. Research guidance

The four key items listed above need not be in a single mentor.  One of the most important things I have learned since starting residency is that combining two or three mentors can get one started on the best path to the career of choice.  The rest is up to you.

Keep the faith, and seek out the people who embody the ideals you desire in yourself.

Endoscopy Simulator

Thought I’d share a photo of my residency program’s GI endoscopy simulator!  Earlier today, I had fun testing out some of the EGD and Colonoscopy scenarios on this machine.  Once a month, our program allows for “Simulation (sim) Lab.”  Essentially, it’s an hour-long block wherein residents practice code blue 90’s, rapid responses, central line insertions, and even practice with the simulator.

Interestingly, not only does this simulator attempt to recreate life-like images while you manipulate the endoscope, but it also includes a fully-functional biopsy/intervention channel.  This allows the user to position biopsy forceps, epinephrine injection needles, and more.  Really cool technology!

GI endoscopy simulator

Simulator is ready-to-go for the next clinical scenario!

Origin of ‘Doctor,’ a Resident’s Perspective

It’s extremely helpful and interesting to know the origin of words.  People working in medicine are delineated, in part, by their title.  It assists patients and professional colleagues in knowing who to trust when information is needed.  A key member of the medical team is the doctor, also known as physician.

Where does ‘Doctor’ come from?

A quick query in the dictionary yields the origin of ‘doctor,’ docere (translation:  to teach).  First coined in De Oratore (55 BC) by Cicero, the famous Roman politician and lawyer, the word has solidified its place in our lexicon.  It defines an individual who is expected to know relevant facts, be able to apply those facts in a logistically feasible fashion, and efficiently communicate that information to the patient and/or staff.

Of note, the role of a resident doctor/physician is humbling in a number of ways.  Perpetually learning myself, I find that the more I know, the more I realize I don’t know.  Translation:  there is always something new to learn.

As part of an academic program, residency gives us residents the opportunity to impart our knowledge on medical students.  I love to teach what I know.  It’s especially enjoyable to see the reaction on a student’s face when your explanation results in a “lightbulb”-type moment.  No matter the level of training, the role of the doctor is to teach; the list includes medical students, nurses, medical assistants, and non-medical staff.

Origin of ‘Physician’

Doctor and physician are synonymous.  I find it important to remind myself that physicians are expected to provide a trusted source of information in the treatment of living beings – people.  We are also looked upon to prove that our teachings – recommendations – translate to a healthier life.  I hope to improve my knowledge and wellbeing a little everyday, so that I can one day show a new med student, resident, anyone that anything is possible.

Definition source:  New Oxford American Dictionary

Goals for 2018

This weekend has been really relaxing and re-energizing.  Weekends are rare during residency, and are exceedingly sparse during the first and second years.  This year, my third and final of residency, has ushered in more weekends.  It’s been awesome for organizing and cleaning at home.  Today, I’ve been able to vacuum, clean the kitchen, and am in the process now of organizing my desk.

Goals for 2018

In taking a new approach to the prototypical “New Year’s Resolutions,” I decided to rename it “goals” for the year 2018.  Earlier today, while jamming out to music on my Bose Mini Soundlink, I did some thinking about my goals for this year.  I’ll share my big three.

#1 Studying with a fresh perspective

   I will study with a new purpose, as if I have a patient sitting right in front of me

Sounds strange just writing this, but I recently sat in on a lecture that drove this very point home.  I’ve been fortunate to have success on many exams utilizing the “study [x, y, z] material for the exam” approach.  I want to extend and improve on my success with a more diverse and more detailed working knowledge of medicine.  Also, I want even better exam scores.  How I plan on doing this will involve approaching reading and answering practice questions differently.  Starting in 2018, I pledge that I will study with a new purpose, as if I have a patient sitting right in front of me.  This will impart relevance to the study topic at hand.

Note to self when answering practice questions:  you may very well see a patient with the same presentation and be faced with the same problem.  Learn from it.

#2 Improve my communication

The hope is to improve on two fronts:  answering my text messages promptly and reaching out to family and friends more often.  Time seems to be accelerating the deeper I get in residency/training; I need to take pause and appreciate others in my life with a simple “Hi, how are you doing?”  Time constraints are often an impeding factor, but I plan on using breaks in the day to reach out more often to develop quality relationships.

#3 A focus on my well-being

Super complex and relating to a myriad of areas of my life, this is the year to enhance my health.  Despite eye-popping reports of physician burnout, I remain very happy with my choice of practicing medicine as a doctor.  Training takes a toll on everyone in residency, but I plan to stay ahead on the wellness curve.

Exercise, something I frequently recommend to patients and seldom do myself, is first and most important on this list.  I’m happy with weight lifting, elliptical/stationary bicycle/treadmill, or a walk outside even if for only 30 minutes, if that’s what I can do in a day.

Diet, another key element in my life, has suffered as of late.  Instead of reaching for pizza/fries/Lo Mein, my 2018 diet will consist of less carbohydrates and more protein.  When possible, I’ll make fruit smoothies with fiber and protein sources.  Lastly, looking forward to the future is super invigorating.  I will begin training in a GI fellowship, aka my dream career.  To be the best physician possible, it has to include personal improvement all of the aforementioned categories.

Let’s do this!

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