Intern Struggles

[Backpack234]

So I'm a couple months into my intern year at program X now. I'm coming to the end of my first dedicated ER month before joining the realm of off-service, but I can't help but feel that as this month has gone on, I've actually gotten stupider and worse at managing patients. The expectation for patient management as an intern is pretty low, 0.5-1 per hour, and on some cases I do really well from start to finish. But the last few days I find myself either giving poor presentations, prescribing antibiotics for the wrong course despite looking it up, forgetting to directly treat pain, having no idea what medicine is ok to treat pain, missing LPs, forgetting how long until my face/leg/finger lac has to follow-up, asking my upper levels and attending before doing anything, and just overall feeling like I forgot everything I learned in medical school, and then forgot it all again but now I'm trying to apply it.

My upper levels assure me that this is how they all felt when they were at my stage, but I'm not quite sold on that. Is there some magical spell that get cast on us when we transition from pgy-1 to pgy-2 or pgy-2 to pgy-3? Is this how anyone else felt at this stage? The only way to go from here is forwards, and I'm looking forward to the challenge, but damn if some commiseration wouldn't be nice.

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[namethatsmell]

Your seniors are correct...we were all there during intern year. It will get better and better as time rolls on though rest assured you'll keep eating humble pie throughout residency (like we all do). It's not a bad thing, it's what helps EM kids grow up to be super strong.

If you don't believe me my spell involves a bottle of Laphroaig and a single cube. And it works every time.

 

[gutonc]

So I'm a couple months into my intern year at program X now. I'm coming to the end of my first dedicated ER month before joining the realm of off-service, but I can't help but feel that as this month has gone on, I've actually gotten stupider and worse at managing patients.

This part right here proves that you're doing it right. And this is true of every specialty.

It's not that you're doing things worse now than 4 weeks ago, but that you're realize how much better you can (need to, and will) get at doing it. Your knowledge and skills have increased (somewhat) but your expectations have increased dramatically. This is how you get better...at everything.

 

[dotcb]

There is no substitute for lots of experience. That's why residency is a few years. Med school is the start, but the doctoring game has just begun for you...

 

[Crayola227]

Sounds normal.

BtW I love the EMRA's top clinical problems pocket book, it helped me stay organized

 

[Zebra Hunter]

Right there with ya, intern buddy. I can assure you, you are not alone in your struggles.

I have a solid group of intern friends at my program, and we get together frequently for drinks and talk about all the stupid stuff we did. Its great de-stressing and lets you know that you aren't alone in your feelings of incompetence. You should give it a try.

 

[engineeredout]

As a third year resident I have days where I walk out thinking that my presentations were crap, my assessments and treatment plans were stupid, and I kept forgetting to do things. Welcome to residency

 

[da8s0859q]

Normal, and agree that this is what is going to make you a solid resident.

I'm in my last year and still critique myself all the time. Can be a healthy thing.

 

[dav86]

Just wait until you first year as staff....

New system, new consultants, solo coverage during some shifts....

I love being done with residency but the transition is tough. You have another three or four years left. Don't sweat it. See how you feel in a year. It will get a lot better. Get used to be slightly uncomfortable. That is part of the speciality. I am always a little nervous heading into a shift. Usually see something I have never seen every shift, but you will figure it out and succeed. Just keep your head down, keep reading, and enjoy it.

 

[Birdstrike]

All normal stuff. This is why residency is 3 years, not three months. In a few short months there will be a whole new crop of interns, with you in your second year, that will be feeling infinitely more this way, than you. Don't worry about it. You're getting paid to do this (albeit not much as you'd like) but certainly more than the $0 you made last year. Also, there's a crew of 2nd years who's job it is to make sure you don't mess up, and 3rd years to make sure they don't mess up and attendings to make sure they don't mess up. Don't worry about it.

Diagnosis: Normal.

 

[TheBlueBlazer]

I remember being told that there are 3 times when the learning curve is steepest, your first year of medical school, your intern year, and your first year as an attending. This has held quite true. Welcome to the jungle. I remember having the same feelings you had, and I wouldn't expect them to go away. Many of your classmates are having these feelings too. I'm worried about the ones that aren't. All interns suck, and the ones that are less introspective, less humble, or actively in denial are the ones that are going to end up hurting people by being too precocious. You should talk about it with your co-interns over a couple beers - these are the times when you let your guard down that you can really start getting to know people.

 

[Birdstrike]

Is there some magical spell that get cast on us when we transition from pgy-1 to pgy-2 or pgy-2 to pgy-3?

Yes, you're damn right there's a "magic spell" cast when you transition to PGY 2. It's cast by a crew of underclassman who know a helluva lot less than you. You have no idea that magical effects of being surrounded by a whole team of people that know way less than you. In 10 months you'll benefit from that magic spell. It happens overnight.

This is all normal stuff. This is why residency is 3 years, not three months. Don't worry about it. You're getting paid to do this (albeit not much as you'd like) but certainly more than the $0 you made last year. Also, there's a crew of 2nd-years who's job it is to make sure you don't mess up, and 3rd-years to make sure they don't mess up and attendings to make sure they don't mess up. Don't worry about it.

Diagnosis: Normal.

 

[filhodeinferno]

As a third year resident I have days where I walk out thinking that my presentations were crap, my assessments and treatment plans were stupid, and I kept forgetting to do things. Welcome to residency

Amen, as a PGY-2 this still happens to me on a regular basis. When does the feeling stupid all the time go away?

 

[Vandalia]

You acquire knowledge much faster than you acquire the ability to manage that knowledge.

Assume that your sibling called you when you were a pre-med student and said, "I went to McDonalds for a McRib, and now I feel terrible and am vomiting like crazy." You would have responded, "You have food poisoning. You will be fine."

Now the same thing happens as a PGY-1, and the entire spectrum of possible diagnoses flashes before your eyes and you are paralyzed, going "uh, uh, uh... what if this is the presentation of a leaking cerebral aneurysm... or a small bowel obstruction?"

Don't worry, as your mind is able to prioritize and categorize all the raw data you have picked up, and as you pick up the ability to recognize the subtle clues that signify "badness", in about 12 months you will be back to "You have food poisoning." (Until you are an attending, and the same paralysis pops up. Although that usually passes much more quickly.)

EDIT: This is also the "fools gold" of medicine. Often the expert and the amateur will diagnose and treat things exactly the same way. However, there is a lot more being considered in the physician's brain - things that become critical when the obvious diagnosis is not the correct diagnosis.

 

[GeneralVeers]

7 years out, I still feel stupid walking away from shifts. I still miss stuff, give poor presentations (to consultants), and miss procedures. None of these things go away completely, but hopefully your moments of stupidity get less and less as time goes on.

 

[Birdstrike]

7 years out, I still feel stupid walking away from shifts. I still miss stuff, give poor presentations (to consultants), and miss procedures. None of these things go away completely, but hopefully your moments of stupidity get less and less as time goes on.

I think it does go away completely, when you've finished your last shift, the day before retirement.

 

[deleted547339]

You're on the struggle bus....it usually picks up every July 1st. From time to time you'll hop back on. It's the preferred mode of transportation in residency.

 

[Daiphon]

I think it does go away completely, when you've finished your last shift, the day before retirement.

Nope. 18y later when the statute of limitations expires. d=)

 

[normtheniner]

I feel the same. I just finished my first ED month. 90% of my shifts I feel dumb. No matter how hard I try I barely see 1 patient per hour. I feel like the dumbest person in my intern class most of the time... I'm studying most days for 20-30 minutes... just feel like I'm always behind.

 

[b-real]

Agree w/ everything above. I'm a new attending and I still feel dumb from time to time. Good to know even those who are wiser and more experienced than me feel the same! And it is so true that even after residency you'll still be learning. Residency is nowhere near enough time to master the entire specialty. I will say though that you'll feel way more comfortable in second year and even more so in third year. Remember, you matched for a reason, and the administration/faculty of your program knows you have what it takes.

 

[deleted547339]

Seriously. This is normal. Don't freak out. You invested way to much to give up now.

 

[Birdstrike]

I feel ya. I just started intern year as well and I feel so dumb every shift. Making stupid mistakes. Being completely exhausted after a shift managing only 10% of the patient load my seniors are managing. I started residency with so much motivation and now I find myself actively questioning whether or not medicine was even right for me. It also doesn't help with the burnout when you look at all your friends who have weekends off and can hang out whenever they feel like it.

Everything would be a little more tolerable if I just the least bit more confident, but my lack of knowledge makes work such a grind.

Have faith in the training process. It's designed to take you (and the rest of us) from this normal, to confident attending. It will.

 

[Backpack234]

I feel ya. I just started intern year as well and I feel so dumb every shift. Making stupid mistakes. Being completely exhausted after a shift managing only 10% of the patient load my seniors are managing. I started residency with so much motivation and now I find myself actively questioning whether or not medicine was even right for me. It also doesn't help with the burnout when you look at all your friends who have weekends off and can hang out whenever they feel like it.

Everything would be a little more tolerable if I just the least bit more confident, but my lack of knowledge makes work such a grind.

OP here. Man this is pretty close to where I'm at, but the feeling comes and goes. When I posted this initially I had come off of a shift where I mismanaged at least one thing on every patient that shift, and felt like I really dropped the ball on one case in particular (lack of knowledge, stretched myself too thin on 10% of the patient load of my seniors, mental errors, etc). Obviously felt bad enough to post on here. After reflecting though, now I'm starting to believe what everyone around me and on here is saying...it'll come with time. Last night I felt really cocky at the beginning of my shift when I had 3 patients under my name on the board while my 3rd year only had 1....until I remembered they took sign out....and they had 12 patients to my 2 on the board at the end of the shift. But at least I felt like I managed my few patients really...mostly well! Humble pie every day.

 

[shoal]

New attending here. It unforunately happens again when you're done with Residency. Its tough making decisions without telling someone, talking out your ideas. Im getting more comfortable slowly, but still go home after a shift and wondering if I sent someone home I shouldn't have. Tough job. Good luck

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[EskimoFriend13]

I'm an intern too. I've noticed that some my colleagues are more stressed than I am, but it's certainly not because I'm performing better. I make the same silly mistakes as everyone. I have brain farts at the worst possible times. I think it helps that I had talked to upper level residents about what to expect and that I can vent to all my new intern buddies. It's like people have said: you are definitely not alone. And just because a fellow intern doesn't seem overwhelmed does not mean they aren't going through the same thing. I just try to remind myself that this is my time to make mistakes and learn from them so I can kick a$$ later.

 

[emememem]

I want to cosign what all my other intern homies are saying - I feel like an idiot, I feel like I am not improving as fast as I should be, I'm missing hard stuff AND easy stuff, and my whole workflow can get derailed by even the tiniest things. On top of that, I am not letting ANY of it go when I walk out of the door and I am waking myself up multiples times a night terrified that I forgot to coach Mrs. Smith on how to take her opiates or that I didn't send Mr. Johnson home on aspirin, or that I should have put in 7 sutures instead of 6 on that chin lac...

I used to be cool, too.

Man, residency.

 

[deleted109597]

No, you don't feel like an idiot, you are an idiot. But that's ok, we were all idiots once. That's why there's a training program in place. Next year, you'll be saying "god, these interns are idiots. And slow, I'm having to pick up all these charts myself"
It's a 3 or 4 year residency, not a 2 month residency.

 

[EskimoFriend13]

No, you don't feel like an idiot, you are an idiot. But that's ok, we were all idiots once. That's why there's a training program in place. Next year, you'll be saying "god, these interns are idiots. And slow, I'm having to pick up all these charts myself"
It's a 3 or 4 year residency, not a 2 month residency.

So true! I was examining a patient the other night at the end of a 70 + hr week when my senior told me to make sure I palpate the liver. Totally started palpating the left side. Halfway through I realized what I was doing and looked up, mortified. My senior just smiled and said "it happens."

 

[deleted547339]

No, you don't feel like an idiot, you are an idiot. But that's ok, we were all idiots once. That's why there's a training program in place. Next year, you'll be saying "god, these interns are idiots. And slow, I'm having to pick up all these charts myself"
It's a 3 or 4 year residency, not a 2 month residency.

It's amazing how a new crop of interns makes you feel like you've learned something, lol.

And yea @emememem - I woke up several times in my intern year in a cold sweat thinking "what if I missed mesenteric ischemia?" or "omg, I forgot to tell the admitting team X, Y or Z." or "oh crap, i didn't think to order a, b, or c."

The good news is that it gets less frequent (until you start moonlighting). And it's usually pretty hard to kill people.

 

[saintsfan180]

Definitely happens your first year out as well. As much as it always irritated me as a 3rd year to present patients, and I'd usually just get an "ok", it was nice having someone agree with what you're doing. Being out, sometimes I think to myself how this would sound if I were presenting the case, or if someone presented it to me. Do they have an emergent condition? Will admission benefit this person? Does it sound reasonable? Sure! So quit second guessing yourself! I guess as mostly type A people, we need to talk ourselves down a lot. Even still sometimes I get really stressed out over a case where everything probably turned out fine. Just keep talking to your buddies at your same level, or folks who have been there before.