Spencer C. Knox, MD

Internal Medicine Resident Physician, PGY-3

Tag: education

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.

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.

Millennial Doctors and Social Media

I’m part of the “Millennials” class of physicians.  Depending on the source you read, it’s generally characterized as people born between the years 1982-2004, give or take a couple years on either end of that date range.  We’re learning a great deal from our senior medical professionals, also known as Attendings.  These are our predecessors – the mentors we look up to, to learn the bread and butter techniques as well as secrets of the trade.  Like many other resident doctors, I still rely heavily on traditional methods of learning, including textbooks and question banks, but there is another movement afoot.

That movement – albeit a slow movement – is physicians learning and discussing healthcare topics online (examples on Twitter:  #meded, #hcsm, #FOAM).  Hashtag it whatever you want, it’s essentially anyone in healthcare who spends time disseminating information about the trade – online.  Physicians play a key role in healthcare, however I still feel (anecdotally speaking) that we are lagging behind a bit.  There are but just a few active residents and fellows on Twitter.  This leaves a large void in the social media world.

Prominent online physician presences like KevinMD illustrate why it’s important for doctors to at least establish a footprint online, and I agree.  It’s the norm; people look to our social media profile(s) for more about us.  The articles, comments, photos, and videos we post today may influence a patient to come see us in hospital A or clinic Z; a high school student to consider pre-medicine; a premed student to continue on the grueling path and get accepted into medical school; a medical student to choose a specialty and strive for the residency program of choice; and a resident to learn more about a sub-specialty field.  The opportunities to influence are numerous and far too many for me to account in one simple blog post.

I actively search and link to other young physicians on Twitter.  I enjoy reading posts in my spare time, whether those are micro-updates on Twitter to full-length articles and blog posts on reputable websites.  It keeps me updated on things that are happening within my profession across the U.S. and World in real-time.  The beauty of the modern world is that we have so many efficient ways to talk to one another; it is unprecedented.  So, let’s use this powerful technology to help other people.  It can be other doctors, PAs, NPs, registered nurses, or the general public – physicians should feel comfortable in their own professional online presence to educate and assist.

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