Spencer C. Knox, MD

Internal Medicine Resident Physician, PGY-3

Tag: intern

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.

PGY-1 “Intern” Year In Review

It’s time for the obligatory “year in review” post, and I couldn’t be more proud.  Intern year is an emotional rollercoaster, marked by episodes of triumph and failure.  The year is almost over, and I am (anxiously) awaiting my second year of residency training.  Finishing intern year (first year) is a huge milestone in my professional medical career.  Many medical students ask me:  “Any advice for my first year of residency?”  My answer:  The learning curve is supremely steep; the first few months – really the entire twelve months – are extraordinarily difficult no matter your rank within your medical school class.  Personally, I worked hard to maintain a top ranking position within my med school class, but still felt the full burden of the many lessons that intern year teaches.

Dr. ________, (you) are responsible for official-record documentation

From Day 1, most specialties require new baby doctors, aka “Interns,” to be responsible for patient History & Physical’s and Progress notes.  These are the real-deal.  Gone are the days that your medial student notes are reviewed by the resident or faculty mentor and then set aside for your next practice H&P/progress note.  Other physicians, residents, and nurses will read your documentation and you will be judged accordingly.

Dr. ________, can patient in room 618 eat?

I was asked this question during my first official pre-rounds on adult wards.  I had no idea if the patient could eat and had to consult with my senior resident.  You as the new intern will be asked this simple, yet important, question.  Answering wrong means the vascular surgeon won’t be able to operate as scheduled.  Your patient could continue to suffer and your consultant surgeon won’t be happy.  Synthesizing pertinent data points is no easy task for a baby doctor, but you will learn quickly.  Trust your seniors to help you early on, and remember your cases.

Patient in ED bed 23 needs something for pain.

Many rising PGY-2’s will probably agree that the first days of intern year are scary in that YOU are now responsible for some of the orders (and likely all of the orders as your PGY-1 year progresses).  Every medication has its therapeutic (good) effects and adverse effects (some potentially deadly!).  I’ll never forget some of the very first few pages I got from floor and ER nurses asking me for medication orders.  For IM, the very long list includes pain control, blood pressure reduction, fast heart rate control.  A ubiquitous order request is for pain control.  Everyone, including the layperson, is aware of some of the deadly effects of opiate pain killers.  Yet, as an internal medicine, surgical, etc. intern, you’ll be asked to evaluate a variety of cases that require high-intensity pain control medications.  This happens month one of residency.  This is another instance where your senior will help guide you, in most cases.  It’s scary yes, but be prepared for it and you’ll get through it too!

Summary

Intern year was amazing.  I love Internal Medicine.  It’s a cerebral specialty – your thinking will either positively, neutrally, or negatively affect your patient’s wellbeing.  That’s powerful.  The learning curve from medical student to intern year (first year of residency) is STEEP.  Just when you feel you know everything about Atrial Fibrillation with Rapid Ventricular Rate, you’ll be presented with a new patient who hosts a complex medical history and be forced to rethink how to care for this particular patient.  Other specialties are not dissimilar; I enjoy talking to everyone about ways they’ve needed to evolve their thinking.

Intern year = baby doctor learning the basics of the basics, lessons required to become an independently practicing doctor.

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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