Spencer C. Knox, MD

Internal Medicine Resident Physician, PGY-3

Tag: training

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!

 

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-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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