Spencer C. Knox, MD

Internal Medicine Resident Physician, PGY-3

Tag: senior

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.

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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