Spencer C. Knox, MD

Internal Medicine Resident Physician, PGY-3

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2017 In Review

Writing my 2017 year-end article as a third year resident (PGY-3) is truly something.  I find myself reflecting on a myriad of things; vying to be a competent physician, enjoying my first wedding anniversary with my wife Claudia, bringing home our Cavalier King Charles puppy, and finding my niche within the ever-changing landscape of healthcare.  I’ll explain a particular highlight of 2017, relating to personal professional development.

Residency Trains the Human to Be A Doctor

As of today, I have completed 30 months of a 36-month program.  With the passage of time comes (limited) experience in the clinical medicine world.  This year, more than others, I have noticed that the practice of medicine is just that.  It is adaptable, and largely dependent on knowledge plus experience.  Guidelines and standard-of-care are two cornerstones of modern medical care.  Evidence-based and peer-reviewed literature is the precise mechanism underlying the success of western medicine.

Oddly enough, the more knowledge I gain, the less I feel I know.

Residency is the formal time period wherein academic hospitalists, sub-specialists, and experienced nurses teach people — my co-residents and I — how to be a doctor.  Accomplishing this intricate task in a mere three years is sort of mind-boggling.  Personalities transmogrify.  Knowledge expands.  Oddly enough, the more knowledge I gain, the less I feel I know.

How Personalities Change During Residency

Medical training is arduous.  Hours are long.  Rounds are often both mentally stimulating and exhaustive.  It is all necessary to mold the best clinical physicians.  A side-effect of the process is a change in personality.  Whether or not we realize it, residents’ personalities adapt.  Usually for the better, people emerge from training an evolved version of themselves.  A key area I am trying to improve is to more efficiently condense lots of patient data.  Keeping the best bedside manner is also pivotal.  The overarching message, though, is to always bear in mind that people are seeking a doctor’s expertise.  I am honored to have the opportunity to treat, and sometimes cure, both routine and complex ailments.

Becoming a Gastroenterology Fellow

I am so proud to be a part of GI medicine.

I discussed the pure joy of matching into a Gastroenterology (GI) fellowship in a previous post, but to properly review 2017, I would be remiss if I didn’t talk about the Match.  I am so proud to be a part of GI medicine.  It is by far the most interesting subspecialty for a multitude of reasons, some more personal than others.  I’ve said to many colleagues and friends that gastrointestinal medicine is the #1 most enjoyable topic I study.  Coupled with a family history of Celiac disease, matching into a GI fellowship is a dream come true.

As an aside:  statistically, GI is the most competitive Internal Medicine subspecialty.  The NRMP compiled interesting data to back this claim.  GI programs as a whole received 1.5 applicants per available training position in the 2017 cycle.  By contrast, Cardiology, historically the most competitive field, had a ratio of 1.3 applicants:position.

2017 In Summary

  • I am incredibly happy at my residency program, and have experienced a positive metamorphosis as a person and professional.
  • My wife and I had our first wedding anniversary!  🙂
  • I matched into my dream subspecialty field, Gastroenterology and Hepatology.

Here’s to an even more AMAZING 2018!

I Matched into GI Fellowship!

Matching into a three-year clinical Gastroenterology fellowship program is a dream come true.  Match Day was December 6th, 2017.  I remember anxiously driving home to meet my wife Claudia and puppy Chloe so that everyone was there to hear the news as soon as I pulled up the NRMP 2017 Medical Specialties results online.

Sitting down at my desk, I opened Chrome and started to type the NRMP’s website address.  My web browser filled in the rest.  I scrolled down to the results area, and was stunned to see I matched!! 🙂

NRMP Fellowship Results

We shared a celebratory toast, thanking God, our family, and my new GI program for… the opportunity.

Hugging Claudia, we both instantly knew our lives would change.  “I’m going to be a GI doctor!” I exclaimed to my wife.  We shared a celebratory toast, thanking God, our family, and my new GI program for allowing me the opportunity to train in the art and science-based medicine of Gastroenterology.

Suddenly, the text messages and Facebook posts came in.  I recall thinking, I feel so blessed to have family and friends in my life who are so supportive and genuinely happy for me.

In the hours and days after the shock gradually wore off and reality set in, my mind began running through all of the things that need to happen before starting day one.  Licensure in Massachusetts, finding a suitable home for the next three years, the unknown of who our new Massachusetts friends might be, and so much more.  It’s such an exciting time!

 

Fellowship Candidacy

Life in residency is always busy.  Time flies by.  I am nearly three months into my third and final year of residency (PGY-3).  I was scrolling through social media earlier today, and noticed a familiar big announcement:

The start of a brand new cycle of residency applications is a momentous event.  For MS4’s, it marks the official beginning of what will be a life-altering season.  Interviews will be sent out to deserving applicants, and both the programs and applicants work towards a match.  I can’t help but remember the feeling of pure joy at the sight of each invitation email.  It’s been over two full years since I went through the process.

Right now, as I enter the fourth month of my last year of residency, I can say that I am so very honored and happy at my current residency program.   I like my co-residents, and call many of them friends.  Attendings have been extremely supportive.

Now, I am a candidate for a fellowship in Gastroenterology (GI).  I recently went on my first interview for a 2018 position, and felt very, very honored to be in the presence of so many professionals who are making GI their life’s work.  Meeting current GI fellows and attendings is extraordinarily invigorating.  I can see myself diagnosing and treating patients with disorders of the small intestinal including Celiac Disease and malabsorption.  I want to make it my career to protect and prevent complications of Barrett Esophagus, IBD, colon cancer, and various other downstream problems of the gastrointestinal system.  A Gastroenterology fellowship would mean the world to me!

Consolidating Social Media Accounts

I recently came across a terrifically intriguing TEDx talk regarding social media.  The title?  “Quit Social Media,” by a self-proclaimed “Millennial, computer scientist, book author” from Georgetown University.  A short 13-minute video with over 1.5 million views (as of May 31, 2017), with that title, instantaneously piqued my curiosity.  I watched.  He also wrote an article for the NY Times on the same topic.

Transformative content on the internet is just that – potentially life-changing.  Think of educational YouTube videos (like TEDx), or other videos that teach specialized skills to allow the busy professional to hone skills for a beloved hobby.  Also easily obtainable online is a construct commonly known as “social media.”  Everyone and everything (e.g. dogs, businesses, etc.) have a social media presence nowadays.  Viral videos are commonplace.  Flashy color schemes and “sophisticated” new features including new platforms like SnapChat and Periscope (and countless others) seem to populate an ever-crowded space.

Professional success is hard, but it’s not complicated. The foundation to achievement and fulfillment, almost without exception, requires that you hone a useful craft and then apply it to things that people care about.
– Dr. Cal Newport

I recall the first Facebook days, around the time I was in senior year in high school; the primitive network was “semi-exclusive,” allowing only those with .edu email addresses to log in.  Today, Facebook remains a routinely visited website on my home laptop after a busy day at work.  I truly enjoy “catching up” with family and friends, mainly via photo sharing.

However, I noticed an unsettling trend amongst my social media practices – something I’ll call “social media bouncing.”  I define this as leaping across a multitude of networks, from Facebook to Instagram to SnapChat to Twitter to LinkedIn while aimlessly browsing news feeds.  I know I’m not alone.  A 2014 Pew Research Center poll showed that approximately 50% of people use at least two or more social media services (I suspect more people participate in multiple social media services in 2017).

 

In a capitalist economy, the market rewards things that are rare and valuable. Social media use is decidedly not rare or valuable.

 

I love this quote from Dr. Newport’s article and TEDx talk.  I find that some people look to social media as a way to attract attention, thereby bolstering their own personal brand.  The endpoint?  Perhaps the thrill of attention; however, I posit that the same people feel it will further their career or in some way generate money/fame.

Considering my own social media involvement, I decided to free up more time to learn new skills, become a better physician, and enjoy more leisure time.  To do this, I deleted some of my accounts.  The only accounts that remain are Facebook, Twitter, and LinkedIn.

Even more fascinating was the multi-step process required to delete a social media account.  In May 2017, I began deleting my social media accounts.  I’m technologically adept, yet I could not find the page to delete my account.  I enlisted the help of Google to point me to the page/form needed to actually delete (not “suspend” or “deactivate”) my account.  The services are so concerned with keeping their valued customers (“friends”) that they ensure you give them more data entry points before you leave.  I reminded myself that every single data entry point on social media is a source of revenue for these companies.  This only hastened my desire to leave Instagram and SnapChat.

 

I want to be the very best physician possible.  However, I desire leisure time just as much as the next human.  Filling this leisure time is made exceedingly more useful by watching top-rated movies, learning new skills via online videos, reading textbooks, traveling, and spending time with friends/family.  I needed to be reminded of how social media is not as useful as I once thought it was.

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.

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