Spencer C. Knox, MD

Internal Medicine Resident Physician, PGY-3

Tag: career

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.

Conclusion

  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.

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!

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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