Advice from attendings/ senior residents

[JSteele167]

Hi. Hope everyone had a great Thanksgiving this year. I apologize in advance if this post is long, but I was hoping if anyone here can give me some advice. I am currently 5 months into my CA-1 year and still have doubts about my choice. I was thinking of switching back to medicine but unsure if it is still too early to feel this way. Although I have gotten more use to CA-1 year I still have moments of uneasiness in the field. I realize medicine can be tough, but I felt like I actually knew what I was doing most of the time, unlike in anesthesiology. I haven’t even done the subspecialties yet, so I could only imagine what it would be like later on as I get more senior. I also don’t enjoy procedure as much and many times feel like a nobody in the operating room. Some attendings still stress me out because of how detailed orientated they are (I know these attendings mean well). I also don’t know if I am looking at medicine through a preliminary year perspective as I was not pressured as much but I felt like I had more happy days in medicine than in anesthesiology. All the problems in medicine (rounding/ social work issues) really did not bother me at all. I also thought about the possibility of not being able to get great fellowships in medicine but even with that thinking I still have thoughts of changing. I am not sure if this is common in CA-1 year and I know ultimately I have to make my own decision but just hoping if anyone has felt this way or know of anyone who ended up switching. Thanks.

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[partydoc]

I had the same feelings as a CA1 for about the first 6 months. I'm a fellow now and sometimes still feel like I have no idea what i'm doing. I would be concerned if you were getting poor evaluations and/or doing poorly in your AKTs/ITEs.

It gets better. Keep your chin up

 

[leaverus]

weird. I'm curious how common this actually is because I never once felt like that in residency - on the contrary I was so glad to be done with prelim year. its possible anesthesia simply isn't your calling.

 

[IlDestriero]

Medicine is clinic.
I’d do path before something with a significant clinic.
The more you read the more you’ll learn and understand the meds and why you’re using them, the conditions and why your plan is what it is. Then you can worry more about the patient and vigilance and predicting what’s going to happen.
It takes a while.


--
Il Destriero

 

[Orin]

I felt like I actually knew what I was doing most of the time, unlike in anesthesiology.

Anesthesiology in the OR is completely different from most of your medical school or preliminary training. That's why you do a residency. This is about the time of year folks start having doubts and being unsure of their life decisions. You look around and feel a little behind the curve as compared to your cohort. That can snowball quickly, so talk to someone about how you're doing and get some real feedback on things. That's normal. Some places have a very sheltered CA-1 year to prevent that from happening, but I suspect even there they have folks that deal with these fears.

The question you need to answer is more about whether you like the field or whether you just like being good at something.
You can get good at anesthesia, but you can't make yourself enjoy it.

Down the road though, you might prefer doing a critical care, pain medicine, or non-OR based fellowship, but I suspect you're just going through the usual CA-1 winter jitters. I prefer that to the folks that tell me they've peaked at 3 months in.

 

[MoMoGesiologist]

It's normal to feel overwhelmed the first half of CA1 year. It's a lot of new information, new ways of integrating data and coming up with a response in real time, having to learn whole new body movements (drawing up and giving drugs, procedures, periop charting, etc). You feel like a fish out of water.

I'm sure the start of intern year you felt like you didn't know what you were doing either. CA1 year is the same. Once you've done it for a while, routine cases (lap choles, appys, ortho, uro) will start to feel much more comfortable and you will start to get to the point where you can do multiple things and think and ask questions and try new techniques in the OR. Then you'll move onto your sub specialty rotations, feel like you know nothing again, but then readjust again. Being outside your comfort zone is how you grow in the OR, but you shouldn't be too far outside your comfort zone or feel like no one is there to help you or the patient. A lot of times it's you yourself putting a lot of pressure on you to be perfect in the OR and get things done right the first time. No one was born knowing how to do this job.

Do you remember what drew you to anesthesia in the first place? A lot of the things you may have liked in medicine are things we deal with in the OR, just in a more real time and less BS way. Nothing in your post indicated you like gen med more than anesthesia, just that you felt more comfortable with it.

 

[The Physician Philosopher]

I agree that there is a distinction to be made here. When you say you don't enjoy procedures that makes me think you don't like certain aspects of anesthesiology.

However, if it is simply a confidence in not knowing enough about what is going on that problem can be resolved by studying, learning, and some fortitude. Everyone, everywhere has felt moments of uncertainty in their knowledge during their training. If they haven't, they were overconfident at some point (which can be more dangerous than not knowing enough).

Some of the best residents I have worked with had self-doubt at the beginning of residency. However, they all enjoyed the craft, they simply hadn't honed their skills yet.

 

[deleted697535]

It is hard to enjoy something when you are no good at it. I was 3 months before I even intubated the trachea!! Esophagus every time lol

When you start to get good at things you enjoy it a bit better. Eventually I loved it and couldn't do anything else

 

[deleted162650]

Dude, you're an internist. No self-respecting anesthesiologist has ever longed for the days of internship once starting their CA-1 year. Quite the contrary. Everyone I know couldn't wait to be done with their internship, and everyone was so grateful that year was over and done with. It's OK, this isn't the right fit for everyone. If you prefer discharge planning to procedures, then you need to start working on your exit strategy now before you get further down this rabbit hole.

 

[anbuitachi]

WHen i was a CA1, in the first few months, i felt like i knew nothing. near the end of CA1 I felt like i knew so much. Then when CA2 started and i realized i actually knew nothing. It's like a rollercoaster.
I recommend reading more if you have time! Esp if you dont get teaching during workdays

 

[deleted682700]

If you think Anesthesiologist are not respected, you are not alone. Internal medicine, pediatrics are thankless specialities. Unless you do cards or GI fellowship which is again procedure oriented.

You are not alone in feeling like you have described. The question is do you feel like that every day and every week or it is occasional? Residency is not easy. But it will be over and you will be calling the shots

 

[Hoya11]

Hi. Hope everyone had a great Thanksgiving this year. I apologize in advance if this post is long, but I was hoping if anyone here can give me some advice. I am currently 5 months into my CA-1 year and still have doubts about my choice. I was thinking of switching back to medicine but unsure if it is still too early to feel this way. Although I have gotten more use to CA-1 year I still have moments of uneasiness in the field. I realize medicine can be tough, but I felt like I actually knew what I was doing most of the time, unlike in anesthesiology. I haven’t even done the subspecialties yet, so I could only imagine what it would be like later on as I get more senior. I also don’t enjoy procedure as much and many times feel like a nobody in the operating room. Some attendings still stress me out because of how detailed orientated they are (I know these attendings mean well). I also don’t know if I am looking at medicine through a preliminary year perspective as I was not pressured as much but I felt like I had more happy days in medicine than in anesthesiology. All the problems in medicine (rounding/ social work issues) really did not bother me at all. I also thought about the possibility of not being able to get great fellowships in medicine but even with that thinking I still have thoughts of changing. I am not sure if this is common in CA-1 year and I know ultimately I have to make my own decision but just hoping if anyone has felt this way or know of anyone who ended up switching. Thanks.

definitely felt that way. it passes. thats the thing with anesthesia, you have to be OK sucking at it for a period of time until you dont suck.. 6 months to a year or more. you have to be OK with attending criticism for silly reasons. get through CA1 year and reevaluate. I suspect you will settle in and be happy with your choice as I have been. IME from residency, one in every class could not adapt, needed to be praised, could not handle the criticism, and went back to IM very early on. Just do your best, keep an open mind, ask questions, procedures will come. The field is not about procedures.. its about medicine, you just cant see that yet

 

[JSteele167]

Thank you all for the response. Really needed this. I guess I will still continue. I think I started to dislike procedures only cause I wasn’t as good at them. Hopefully it will get better.

 

[JSteele167]

Also yeah it’s just hard to gauge how i am doing when I’m by myself in the OR a lot. Will try and get some feedback.

 

[2Fast2Des]

We have a good intern year that involves us doing Anesthesia and being part of the GenA pool early on so we call our medicine months as Anesthesia appreciation months. I honestly felt I became a better physician being in the OR as an intern getting Anesthesia time early since I felt more comfortable on non-anesthesia rotations managing more complex patients. That being said a couple of my med school classmates who were gung ho Anesthesia switched to IM after 1 year, so you could be part of that type as well. I myself love the procedural and 1-1 care that this job offers so you have to see if this what floats your boat.