I feel like I am not progressing (MS3)

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I'm doing peds right now, and maybe it's just because I don't know much about peds compared to adult medicine, but I feel like I'm not progressing to the point of being competent. I'm trying really hard, and I know I'm not dumb (250's step I), but I just can't come up with good, relevant differentials... It's like I know all kinds of random stuff, but I can't put it together to figure out what's actually going on and what tests I want to order...

help!

We've all been there, and honestly I think this is perfectly normal. I don't think this is an issue unless you're deep into your intern year and still having these issues. Until then, I don't feel as you should worry. You need reps with everything, as a third year you're switching from rotation to rotation before you can get comfortable with the types of patients you're seeing, so its difficult to draw on the heuristics your residents draw upon, making them seem so good and generating differentials and orders.

Originally Posted by Chakrabs

We've all been there, and honestly I think this is perfectly normal. I don't think this is an issue unless you're deep into your intern year and still having these issues. Until then, I don't feel as you should worry. You need reps with everything, as a third year you're switching from rotation to rotation before you can get comfortable with the types of patients you're seeing, so its difficult to draw on the heuristics your residents draw upon, making them seem so good and generating differentials and orders.

Thanks... I'm at the end of MS3 and sometimes I'll see a new patient and just think "I don't know what the f--- is going on".

I'm on peds ED right now and it's the worst because the kids come in, are barely sick, and I just want to be like "go home" but there are evidently tests that need to be done, and things to consider that I've never heard about despite being here for 3 years.

It seems like the more I try to learn, the more it becomes apparent that I don't know s--- about managing the majority of things properly. I have ideas, but cannot describe a complete but succinct treatment plan in many cases.

Hopefully it will get better

Most interns don't even seem to know wtf is going on. I don't think you're alone, OP. At least you're aware of it and it makes you want to improve.

Originally Posted by WashMe

Thanks... I'm at the end of MS3 and sometimes I'll see a new patient and just think "I don't know what the f--- is going on".

I'm on peds ED right now and it's the worst because the kids come in, are barely sick, and I just want to be like "go home" but there are evidently tests that need to be done, and things to consider that I've never heard about despite being here for 3 years.

It seems like the more I try to learn, the more it becomes apparent that I don't know s--- about managing the majority of things properly. I have ideas, but cannot describe a complete but succinct treatment plan in many cases.

Hopefully it will get better

That's how a lot of MS3's feel. If a 3rd year tells you that they know everything and nothing is new/novel, they are lying(or failing at being a show-off).

That's one of the things as a student on rotations which may seem frustrating but necessary: Seeing how much there is that you don't know and acquiring as much as you can. Cause, if you knew how to work up a patient on the first try, clinical learning wouldn't be needed! But it takes lots, and lots of practice. And especially with peds, there are lots of infant/toddler/child diseases that are specific to that population which is new to learn about, and even the diseases you've learned in basic sciences, some of the tests/diagnostic methods they use might be new.

Keep trucking!

Originally Posted by WashMe

I'm doing peds right now, and maybe it's just because I don't know much about peds compared to adult medicine, but I feel like I'm not progressing to the point of being competent. I'm trying really hard, and I know I'm not dumb (250's step I), but I just can't come up with good, relevant differentials... It's like I know all kinds of random stuff, but I can't put it together to figure out what's actually going on and what tests I want to order...

help!

i like the diagnosaurus app on iphone if differentials are all you really want.

Sounds like you have the knowledge OP, you just need to run it through the VINDICATE mnemonic to get the gears turning on your differential. It often helps me come up with plenty of DDx ideas when i know the attending is about to ask me what's going on with a patient whose history i am hearing for the first time. Try it.

Vascular
Infectious
Neoplastic
Drugs
Inflammatory
Congenital
Allergic/Autoimmune
Trauma
Endocrine or metabolic

Originally Posted by WashMe

I'm doing peds right now, and maybe it's just because I don't know much about peds compared to adult medicine, but I feel like I'm not progressing to the point of being competent. I'm trying really hard, and I know I'm not dumb (250's step I), but I just can't come up with good, relevant differentials... It's like I know all kinds of random stuff, but I can't put it together to figure out what's actually going on and what tests I want to order...

help!

I think the trick to peds is to think less systematically and more symptomatically. Instead of learning about CV, respiratory, renal etc., its easier to study the broad differentials and workups for fever, wheezing, abdominal pain, MSK pain, newborn in distress, etc. Then I broke it up into the three basic age groups (e.g. vomiting in neonate vs. infant vs. child). There are also a ton of values that you have to memorize or have handy on your phone that don't come up on the Shelf (or ever again in your life if you don't do peds).

Also, you're there to learn. It was frustrating when the senior resident or attending got on me for not being a high-functioning intern, but I just had to remind myself that there was a reason med school wasn't a 2 year degree. And bask in the brief moments of glory when I actually got a pimp question right.

Thanks for the support and suggestions, guys! I feel a bit better now. Of course, I'm no less inept than I was before reading your posts, but I'm getting the sense that it's OK (as long as I keep trying)

It's not your fault. We are all trained for what seems like forever to take multiple choice tests. When you get on the wards and someone asks you to give them a differential for anemia, many of us often stand there with a dumb look on our face. Of course if we were given a test question with a few choices we'd be fine. Unfortunately this isn't how the real world works, and I often question why we are taught in the manner.

Originally Posted by dd128

It's not your fault. We are all trained for what seems like forever to take multiple choice tests. When you get on the wards and someone asks you to give them a differential for anemia, many of us often stand there with a dumb look on our face. Of course if we were given a test question with a few choices we'd be fine. Unfortunately this isn't how the real world works, and I often question why we are taught in the manner.

Much easier to objectively grade with multiple choice. Best for learning? Perhaps not.

you'll feel better after you study for step 2 and do a sub-I and/or second rotation in whatever you are interested in. It takes repetition and many years of practice to get good at some of this stuff and when you are MS3 basically everything is brand new. If you talk to residents candidly they'll probably admit they don't feel ready to go out on their own even after they are about to finish their training.