Spencer C. Knox, MD

Internal Medicine Resident Physician, PGY-3

Tag: medicine

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.

Goals for 2018

This weekend has been really relaxing and re-energizing.  Weekends are rare during residency, and are exceedingly sparse during the first and second years.  This year, my third and final of residency, has ushered in more weekends.  It’s been awesome for organizing and cleaning at home.  Today, I’ve been able to vacuum, clean the kitchen, and am in the process now of organizing my desk.

Goals for 2018

In taking a new approach to the prototypical “New Year’s Resolutions,” I decided to rename it “goals” for the year 2018.  Earlier today, while jamming out to music on my Bose Mini Soundlink, I did some thinking about my goals for this year.  I’ll share my big three.

#1 Studying with a fresh perspective

   I will study with a new purpose, as if I have a patient sitting right in front of me

Sounds strange just writing this, but I recently sat in on a lecture that drove this very point home.  I’ve been fortunate to have success on many exams utilizing the “study [x, y, z] material for the exam” approach.  I want to extend and improve on my success with a more diverse and more detailed working knowledge of medicine.  Also, I want even better exam scores.  How I plan on doing this will involve approaching reading and answering practice questions differently.  Starting in 2018, I pledge that I will study with a new purpose, as if I have a patient sitting right in front of me.  This will impart relevance to the study topic at hand.

Note to self when answering practice questions:  you may very well see a patient with the same presentation and be faced with the same problem.  Learn from it.

#2 Improve my communication

The hope is to improve on two fronts:  answering my text messages promptly and reaching out to family and friends more often.  Time seems to be accelerating the deeper I get in residency/training; I need to take pause and appreciate others in my life with a simple “Hi, how are you doing?”  Time constraints are often an impeding factor, but I plan on using breaks in the day to reach out more often to develop quality relationships.

#3 A focus on my well-being

Super complex and relating to a myriad of areas of my life, this is the year to enhance my health.  Despite eye-popping reports of physician burnout, I remain very happy with my choice of practicing medicine as a doctor.  Training takes a toll on everyone in residency, but I plan to stay ahead on the wellness curve.

Exercise, something I frequently recommend to patients and seldom do myself, is first and most important on this list.  I’m happy with weight lifting, elliptical/stationary bicycle/treadmill, or a walk outside even if for only 30 minutes, if that’s what I can do in a day.

Diet, another key element in my life, has suffered as of late.  Instead of reaching for pizza/fries/Lo Mein, my 2018 diet will consist of less carbohydrates and more protein.  When possible, I’ll make fruit smoothies with fiber and protein sources.  Lastly, looking forward to the future is super invigorating.  I will begin training in a GI fellowship, aka my dream career.  To be the best physician possible, it has to include personal improvement all of the aforementioned categories.

Let’s do this!

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.

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