Spencer C. Knox, MD

Internal Medicine Resident Physician, PGY-3

Category: PGY-2

A Thoughtful Gift!

Medical residency training is an amazing opportunity, filled with a lot of stressful scenarios that test your knowledge and grit.  I have had the pleasure of working with some excellent Fellows in the various subspecialty fields, including one in particular from the Critical Care Medicine department.  Knowing that I am pursuing a Gastroenterology fellowship position, he went through the effort to give me this textbook just a couple weeks ago.  Completely unexpected, and very thoughtful!  I’ll always remember this!

Graduating this June, one of my favorite Critical Care Medicine fellows gifted me this book.

The Maturation of a Physician

The Kilauea Lighthouse on Kauai, Hawaii. Copyright original photography Spencer C. Knox, MD

With the new year fast approaching, I felt that the weekly “New Horizon” photo challenge was apropos. Internal Medicine residency is a perpetual cerebral challenge, involving new and interesting medical cases and an abundance of clinical situations where knowledge is not only pushed to the limit, but expanded.  I love what I do, and the opportunity to train with many amazing physicians, as well as learn from helpful registered nurses.

Looking at the remaining fifteen days in the year 2016, I am reminded of the career decisions that await me.  Physicians in internal medicine residency training programs, like me, either graduate and work in primary care or as a hospitalist, or sub-specialize.

On December 31, 2016, I have set a firm deadline to decide whether or not I will pursue fellowship training.  A commitment is relevant now because my actions during the second-half of my PGY-2 (second year) will affect the next step in my professional maturation.  Will I go immediately from internal medicine residency to a fellowship training program?  Will I be able to find sufficient research opportunities early 2017?  There are many uncertainties that I must begin to answer in the next month or two in order to gain clearer insight into my chances of obtaining fellowship training.

 

ACLS Protocols

As a senior internal medicine resident on night float and overnight call, I’m responsible for running to codes and rapid responses.  Rapid responses at my institution are critical patient situations that require urgent bedside attention for things like symptomatic supraventricular tachycardia, new typical chest pain, hemodynamic instability, etc.  Today after work, I wanted to brush up on my ACLS protocol knowledge.  I reviewed the American Heart Association’s protocols, and have attached them here for fellow physicians to reference.

PGY-2 Life And Decisions

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In front of the North Tower on my last day of intern year!

It’ll take some time to shake the feeling of being the “Intern” after twelve months with that role.  One of my primary goals for intern year (first year) was to learn the fundamentals of real-world medical practice.  If I had to choose a few from a long-list, some fundamentals would include:  recognize life-threatening and other urgent but common conditions, treatment, and speaking to patients and families about their diseases, treatment, and prognosis.

It does feel good to officially be a PGY-2, or “senior” resident. Good and a little scary, to be honest.  I’m sincerely looking forward to the challenges that’ll come with being a senior resident on wards teams, ICU, and all of my elective rotations this academic year.  To help keep me focused on some of my top priorities, I’ve listed some areas I’d like to emphasize…

 

Research projects

  • Get going early this academic year, and aim to publish 2-3 different papers/works.
  • Work with a variety of mentors to gain insight/exposure.

Confidence

  • Make decisions confidently, knowing that I’ve (hopefully) had time to pre-read on the disease process/treatment/prognosis.

Keep an open mind

  • Continuously reassess my strengths and weaknesses; read & study daily whether that is UpToDate/MKSAP during spare time in the hospital and (for bonus study points) a few important sections daily at home.
  • Allow each new elective rotation to shape my future practice of medicine and career choices (e.g. fellowship options).

Ultimate goals

  • I do not know whether I want to end up in general medicine or sub-specialize just yet, but am leaning towards the latter.  Although I know in my heart the areas within Internal Medicine I enjoy most – Cardiology, Gastroenterology, and Musculoskeletal systems – I must decide on my ultimate career path no later than September 2016.
  • Sticking to a self-imposed deadline will allow my nearly daily struggle to decide on a possible fellowship path to come to a conclusion.  If I end up going the fellowship route post-IM residency, I really intend on going straight from residency to fellowship to maintain formal education continuity.

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