Spencer C. Knox, MD

Internal Medicine Resident Physician, PGY-3

Tag: fellowship

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!

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.

 

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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