After the match - feeling insecure/ nervous

[Fragrance]

Hey guys,
I matched at my top choice in Internal Medicine. However, I just feel a little insecure about how I will do in residency. Mainly bc I had low board scores. I did well on clinicals and most residents/ attendings said I would make for a great resident.
I just feel insecure after hearing 240s/ 250s from classmates.
Do you guys know of anyone who had 220 or less on boards and went on to bcm a great resident? Any advice on working on my anxiety and confidence are welcome.

Thank you!

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[chromaticscale]

Of course there are residents who don't do well on board exams but are great clinicians. It's not uncommon to see that. There are those who are academically smart but don't do so well clinically. And of course those who do great on both exams and in practice.

I recommend talking with your classmates who you trust and seeing a counselor or psychiatrist early on about your concerns. Caution with the imposter syndrome. There's a difference between imposter syndrome (thinking you are not as good as others) vs. being humble (thinking you are as good as them). The recent webinar from ACP gave a good summary about that.

Mental health is important and residency is tough. Set yourself up for success by having a therapist. Depression rate is high in medicine and it's not surprising given the high demands and long hours.

I'm still working on myself, but general advice is to follow the three A's in order: available, affable, and able. Ask for feedback constantly so you can work on your weaknesses early on.

Moreover, the main concern with low board scores is that your medical knowledge isn't up to par. However, if you demonstrate great knowledge when presenting patients to the attendings and giving a concise, relevant assessment and plan, they will be impressed.

 

[Fragrance]

Of course there are residents who don't do well on board exams but are great clinicians. It's not uncommon to see that. There are those who are academically smart but don't do so well clinically. And of course those who do great on both exams and in practice.

I recommend talking with your classmates who you trust and seeing a counselor or psychiatrist early on about your concerns. Caution with the imposter syndrome. There's a difference between imposter syndrome (thinking you are not as good as others) vs. being humble (thinking you are as good as them). The recent webinar from ACP gave a good summary about that.

Mental health is important and residency is tough. Set yourself up for success by having a therapist. Depression rate is high in medicine and it's not surprising given the high demands and long hours.

I'm still working on myself, but general advice is to follow the three A's in order: available, affable, and able. Ask for feedback constantly so you can work on your weaknesses early on.

Moreover, the main concern with low board scores is that your medical knowledge isn't up to par. However, if you demonstrate great knowledge when presenting patients to the attendings and giving a concise, relevant assessment and plan, they will be impressed.

Thank you so much for your advice. I will attend psychological counselling as soon as I can.

 

[rokshana]

Hey guys,
I matched at my top choice in Internal Medicine. However, I just feel a little insecure about how I will do in residency. Mainly bc I had low board scores. I did well on clinicals and most residents/ attendings said I would make for a great resident.
I just feel insecure after hearing 240s/ 250s from classmates.
Do you guys know of anyone who had 220 or less on boards and went on to bcm a great resident? Any advice on working on my anxiety and confidence are welcome.

Thank you!

I know people that failed a step and went on to be great clinicians...doing well on a step just means you are good at standardized tests and will most likely pass your boards...that is why programs look at it...and use to filter though the thousands of applications they get.

Don’t worry about it.

 

[Fragrance]

I know people that failed a step and went on to be great clinicians...doing well on a step just means you are good at standardized tests and will most likely pass your boards...that is why programs look at it...and use to filter though the thousands of applications they get.

Don’t worry about it.

Thank you so much for sharing that

 

[Perrotfish]

Any advice on working on my anxiety and confidence are welcome.

Its tough to tell without knowing you. On the one hand you're not supposed to be confident. You don't know what you're doing yet, and anxiety is an appropriate reaction when someone is asked to do something important that they don't really know how to do. The most dangerous thing you will ever see in a hospital is an Intern who is confident in July.

However there's a limit to how much anxiety you can have and how much confidence you can lack before it becomes a problem. If you lack confidence in what you've learned, so you double check everything in uptodate before doing it and spend the first month running all the sick looking patients by your senior, then that's a 100% appropriate reaction to being a new Intern. If you're so anxious that you're not sleeping, can't study, and you are routinely busting into tears at work then you are way past the point where it is helpful.

Can you give any more details about what you are thinking/feeling? Also do you still have rotations or are you now stuck in your apartment with your thoughts?

 

[Fragrance]

Its tough to tell without knowing you. On the one hand you're not supposed to be confident. You don't know what you're doing yet, and anxiety is an appropriate reaction when someone is asked to do something important that they don't really know how to do. The most dangerous thing you will ever see in a hospital is an Intern who is confident in July.

However there's a limit to how much anxiety you can have and how much confidence you can lack before it becomes a problem. If you lack confidence in what you've learned, so you double check everything in uptodate before doing it and spend the first month running all the sick looking patients by your senior, then that's a 100% appropriate reaction to being a new Intern. If you're so anxious that you're not sleeping, can't study, and you are routinely busting into tears at work then you are way past the point where it is helpful.

Can you give any more details about what you are thinking/feeling? Also do you still have rotations or are you now stuck in your apartment with your thoughts?

Thanks so much for sharing your thoughts. I definitely imagine myself as the first case, running everything by my senior. I am not quite getting mental blocks or emotional outbursts. More of the anxiety of not being as good as other interns. And, anxiety around upsetting my seniors if i ask them too many questions. I am doing uworld at the moment.
Any other thoughts will be welcome

 

[deleted815127]

Fragrance, I am in your position as well, albeit different residency. I too have low board scores and did post something similar, I am in Family Medicine though. I am doing U world, 1 EKG, CXR and 2 ABG's practice per day. I got my hands on some old ITE's and am currently reviewing them. I have finished Comquest for level 3 and will do Combank once.

My plan is to keep my head down and take things one day at a time. I am also watching Onlinemeded videos, reading their tables book and will soon start prepping with case presentations.

The way I keep my anxiety in check is I talk to my folks, I confide in my mother.

 

[arafatni]

i am in a same spot ! I highly recommend onlinemeded residency course ( no I am not any shape affiliated or getting paid by them). it has reduced my anxiety.

 

[Flash Forward]

Fragrance, I am in your position as well, albeit different residency. I too have low board scores and did post something similar, I am in Family Medicine though. I am doing U world, 1 EKG, CXR and 2 ABG's practice per day. I got my hands on some old ITE's and am currently reviewing them. I have finished Comquest for level 3 and will do Combank once.

My plan is to keep my head down and take things one day at a time. I am also watching Onlinemeded videos, reading their tables book and will soon start prepping with case presentations.

The way I keep my anxiety in check is I talk to my folks, I confide in my mother.

Could you share where you got the old ITE's from?

 

[star.buck]

Do you have a good source for the EKG's, CXR, and ABG's? Those that have questions and answers/explanations? I'd be interested in starting this as well - tis a very good idea!

 

[siliso]

I could never tell, in residency, who had had trouble with board scores and who hadn’t, unless their clinical skill also stunk. You will make a fine resident, you will just need to be proactive about studying for boards. Your ITEs will give you a clue.

 

[arafatni]

I could never tell, in residency, who had had trouble with board scores and who hadn’t, unless their clinical skill also stunk. You will make a fine resident, you will just need to be proactive about studying for boards. Your ITEs will give you a clue.

I didn’t have good clinical training and barely passed cs. Any suggestion ?

 

[QuizzicalApe]

I was very unimpressed with my own step 1. I think it was 220 or something? I did a lot better on step 2, which was a bit of salve for my wounded pride. Regardless, I got into the IM residency I wanted, did well clinically, matched to a reasonably competitive specialty (heme/onc), and graduated without issues.

You'll be fine. Flaws in your ability to memorize esoteric biochemistry are not necessarily reflective of your skill as a clinician.

Besides, half the secret of being a good intern is just showing up and placing orders and consults in a timely manner.

 

[Spectreman]

Was about to post my own thread of this same issue...
I’m starting GS, I had crappy scores and did a billion auditions to match. I’m super worried I’m too dumb to be here and it’s compounded by the fact that I haven’t heard from my PD once since my initial interview. I can’t help thinking I was bottom of the barrel on their list and they’re like “oh boy... well I guess we’re stuck with him for now.”

I have been off rotations since early April though and when I’m not busy I tend to ruminate and get like this. Hoping the chaos of intern year actually helps me feel normal again.

 

[anonperson]

Was about to post my own thread of this same issue...
I’m starting GS, I had crappy scores and did a billion auditions to match. I’m super worried I’m too dumb to be here and it’s compounded by the fact that I haven’t heard from my PD once since my initial interview. I can’t help thinking I was bottom of the barrel on their list and they’re like “oh boy... well I guess we’re stuck with him for now.”

I have been off rotations since early April though and when I’m not busy I tend to ruminate and get like this. Hoping the chaos of intern year actually helps me feel normal again.

You may have been low on their rank list but they still thought highly enough of you to keep you on there.

Keys to being a good intern/resident:
1. Show up early
2. Follow through with your duties/ work
3. Read
4. Have a good attitude

I was the true definition of a bottom barrel medical student (repeated MS2, Step 1 was 197, professionalism comment on my MSPE).

Matched at the near bottom of my list (I think second to last).

I worked hard and didn't do the mistakes that contributed to my issues in medical school. Scored highly on my in service exams (by last year of residency was in the ~97th percentile), matched fellowship etc. Now I am board certified and reasonably good at my job.

 

[Spectreman]

You may have been low on their rank list but they still thought highly enough of you to keep you on there.

Keys to being a good intern/resident:
1. Show up early
2. Follow through with your duties/ work
3. Read
4. Have a good attitude

I was the true definition of a bottom barrel medical student (repeated MS2, Step 1 was 197, professionalism comment on my MSPE).

Matched at the near bottom of my list (I think second to last).

I worked hard and didn't do the mistakes that contributed to my issues in medical school. Scored highly on my in service exams (by last year of residency was in the ~97th percentile), matched fellowship etc. Now I am board certified and reasonably good at my job.

Extremely inspiring, thank you. Those 4 things sound like basically what I did to excel on my auditions. I guess it just seems so much more daunting when I would see interns doing all this other crap I had never done, like putting in orders or handling ICU problems overnight. It’s going to be a steep learning curve, but I’ll really try to keep your 4 things in mind as I get going, I can handle that.

 

[guytakingboards]

Extremely inspiring, thank you. Those 4 things sound like basically what I did to excel on my auditions. I guess it just seems so much more daunting when I would see interns doing all this other crap I had never done, like putting in orders or handling ICU problems overnight. It’s going to be a steep learning curve, but I’ll really try to keep your 4 things in mind as I get going, I can handle that.

Good attitude to have.

There was a saying in my residency program "it all comes out in the wash". I.e. some people are better than others as interns. Others will progress a lot faster later on program. But generally by the final years, most trainees will have reached basic competency level. That's what you should focus on.

IMHO, intern year should be a kick in the nuts. You shouldn't feel comfortable right away.

Personally, I was a horrible GS intern at the beginning of my intern year. My med school clinical training did not much prepare me for it. Lol, my PD even said as much in my final eval that i was well below par starting out. But he went on to say I worked hard, learned a lot and solidly finished in the finished in the middle of the pack by the end of the year. I took that as a huge compliment as a 1/3 of interns were categorical and i was just a prelim.

 

[Chads2]

To the Op, @Fragrance, how did your intern year go?

 

[LukeChester]

It's like some students have a 2.8 GPA, but they aren't sure if they can apply to a Master's program since a 3.0 is average. Don't worry, I'm sure that you can become a great resident if you like what you do, if you know your goals, and if you're ready to master your skills always.