IMHO, you really don't have a good idea of anything until the end of your first year.
By second year, you're a sophomore again like high school. Now you have a clue, but because you have a clue you might think yourself better than you really are.
By the end of second year I thought I had inpatient down very well minus the really weird cases. I still wanted attending support for the weird cases, or the high risk cases where I knew what was going on, but what was to happen should be completely up to the attending because it was so high risk. I was doing better in inpatient than some of the attendings,l though I was still green in other areas (like the rare cases). I, however, did notice that even some of the attendings didn't seem to know what they were doing on some areas, but were used to having everyone listen to them and not challenge them so they didn't feel clueless, and were happy in their comfortable stagnation.
From there I noticed that the really good attendings were the ones that saw their profession as a lifelong learning process. The bad attendings were the ones that did everything the same way (e.g. person is psychotic--they always gave the same antipsychotic. They didn't have a sophisticated or common sense method for picking antipsychotics).
By third year, I noticed I was ahead of about 1/2 the attendings, in at least what I frequently did. E.g. admissions, inpatient, etc, but the stuff I was encountering for the first time, such as long term psychotherapy, I was green at that.
I still consider myself needing to know a lot more in psychotherapy to consider myself good at it, but I do think I'm much better at it than several I've worked with based on my evaluation and performance scores at 4 institutions (residency, the state, a community psychiatry organization, and in fellowship). I'd like to attend a few seminars focused on psychotherapy. Real psychotherapy is a lifelong learning process. In fact real mastery in anything is ironic because to be one, you must always be a student in your state of mind.
IMHO once you've done something for awhile there's different tiers...
1. Getting it down to the point where you can survive the end of the day...
2. Then getting to the point where you are surviving, now you need to increase the efficiency and reinforce the memory tracts on performing that task...
3. You've gotten it down to the point where you can work the job and have a "normal day." (Where you're not having a panic attack or other acute anxiety situation).
4. Once you've gotten to the point where you've gotten it down and can perform it relatively easy, you now got to pick apart at what you've already learned and try to improve upon it.
The difference IMHO between a good psychiatrist and one that is not good is the good ones push beyond #3 and go to 4. Several are comfortable with #3 and will stay there for the rest of their career---> and those are the ones I've noticed where I was performing better than them by the end of my 2nd year in the areas where I've worked.
