Below average M3 - feeling worried about specialty choice?

[hopefullydoc117]

Hi everyone,

I'm wondering what fields do "average" or "below average" med students end up in? I have been below average my entire preclinical (we are a true pass-fail system in preclinicals but they release average scores and standard deviations), got a 230 on Step 1, and am looking to go into internal medicine. At a mid-tier MD school.

However, I am in my 2nd week of 8 week IM rotation, and just feel too dumb all the time. I can barely answer 25% of the questions I am pimped on. It's not that I don't know any of the answers but these kinds of verbal thinking-on-the-feet type situations just make me freeze or blurt out completely wrong things. I am involved in public-facing extracurriculars like student government, have done research, have worked in the past where I had to speak in meetings...so it's not that I am incapable of expressing myself verbally. I get along with the Deans and come off well in the communications/teamwork part of M3 year. But, it's the understanding question + quickly developing answer + saying it process that just causes me to freeze and panic - especially on these early weeks of a clerkship. I have generalized anxiety disorder and take medications for it, so I know that is a contributing factor too. I also learned English as a teenager, and while I communicate well in it and have gone to college here in the US, in these panic situations, I am not as eloquent as others at explaining pathophysiology. I am great at explaining diseases and plans to patients though - probably because I don't feel pressed for time and anxious that they are grading me. So far I have received all high passes, and 1 honor in 3rd year, so I know that by the end of the rotation I learn enough to get ~75 percentile in shelf exams.

The reason why I am concerned is that I think this likely led my surgery clerkship residents/attendings to give me lower scores on the "medical knowledge" section of evals. (Overall, I got a high pass for both the shelf and the clinical). And, I worry that will happen with IM as well We had individual feedback sessions today (because this was the mid-way point with this attending) and while the attending praised my patient education/communication skills, they provided constructive feedback that "the thing they are worried about is my medical knowledge". This has me completely doubting myself. It feels like I am not good enough for IM. I know there is so much medical content I need to brush up on + my memory for details (like dsDNA etc) isn't good. And, I have forgotten a lot of the step 1 content - as in I remember the basics and can use that to develop assessment and plans, but I'm slower at doing it and don't remember it well enough to answer pimping questions. Another thing is that it's hard to go from symptoms to assessment and plans at this stage. I am a non-traditional student so completely understand that that is part of the learning process and there are years of learning and improvement and have no qualms about being in the bottom half of the class. My co-medical student on this team is so smart and gets all the pimping questions right + can think on their feet great. I am impressed and try to learn from classmates' presentation style/confidence - but in comparison, I look even more stupid.

Anyways, this essay is basically because I am really worried about whether I am good enough for IM. So, I am wondering where do below-average medical students end up? FM is an even broader knowledge base (plus I want to work with an adult patient population). I am not interested in procedural specialties.

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[Maximus2020]

You are great - plain and simple. Don't get down on your luck. Remember, you will graduate and become a physician; that is more than most could ever dream of.

The honest answer is that any specialty is possible, especially IM. I have anxiety and take medication for it as well. I was scared in 3rd year. I hated many parts of 3rd year. I questioned my future, changed my specialty choice, etc. This is not uncommon. But I didn't let that stop me from becoming a great physician. A favorite Latin phrase from the Handmaid's Tale sums this up: "Nolite te bastardes carborundorum"

You have to go with your gut - what specialty can you see yourself thriving in? If the answer is IM, then sign up for the AI/sub-I. Practice with interns/residents. Continue to read, study, etc. Whatever it takes.

 

[Redpancreas]

Hi everyone,

I'm wondering what fields do "average" or "below average" med students end up in? I have been below average my entire preclinical (we are a true pass-fail system in preclinicals but they release average scores and standard deviations), got a 230 on Step 1, and am looking to go into internal medicine. At a mid-tier MD school.

However, I am in my 2nd week of 8 week IM rotation, and just feel too dumb all the time. I can barely answer 25% of the questions I am pimped on. It's not that I don't know any of the answers but these kinds of verbal thinking-on-the-feet type situations just make me freeze or blurt out completely wrong things. I am involved in public-facing extracurriculars like student government, have done research, have worked in the past where I had to speak in meetings...so it's not that I am incapable of expressing myself verbally. I get along with the Deans and come off well in the communications/teamwork part of M3 year. But, it's the understanding question + quickly developing answer + saying it process that just causes me to freeze and panic - especially on these early weeks of a clerkship. I have generalized anxiety disorder and take medications for it, so I know that is a contributing factor too. I also learned English as a teenager, and while I communicate well in it and have gone to college here in the US, in these panic situations, I am not as eloquent as others at explaining pathophysiology. I am great at explaining diseases and plans to patients though - probably because I don't feel pressed for time and anxious that they are grading me. So far I have received all high passes, and 1 honor in 3rd year, so I know that by the end of the rotation I learn enough to get ~75 percentile in shelf exams.

The reason why I am concerned is that I think this likely led my surgery clerkship residents/attendings to give me lower scores on the "medical knowledge" section of evals. (Overall, I got a high pass for both the shelf and the clinical). And, I worry that will happen with IM as well We had individual feedback sessions today (because this was the mid-way point with this attending) and while the attending praised my patient education/communication skills, they provided constructive feedback that "the thing they are worried about is my medical knowledge". This has me completely doubting myself. It feels like I am not good enough for IM. I know there is so much medical content I need to brush up on + my memory for details (like dsDNA etc) isn't good. And, I have forgotten a lot of the step 1 content - as in I remember the basics and can use that to develop assessment and plans, but I'm slower at doing it and don't remember it well enough to answer pimping questions. Another thing is that it's hard to go from symptoms to assessment and plans at this stage. I am a non-traditional student so completely understand that that is part of the learning process and there are years of learning and improvement and have no qualms about being in the bottom half of the class. My co-medical student on this team is so smart and gets all the pimping questions right + can think on their feet great. I am impressed and try to learn from classmates' presentation style/confidence - but in comparison, I look even more stupid.

Anyways, this essay is basically because I am really worried about whether I am good enough for IM. So, I am wondering where do below-average medical students end up? FM is an even broader knowledge base (plus I want to work with an adult patient population). I am not interested in procedural specialties.

Honestly, your post sounds like the reflection of the average medical student. I think IM would work. Medical knowledge is the easiest thing that can be fixed.

 

[Acapedia]

Yep agree, your experience is "normal".

 

[housestaffhustle]

Internal medicine definitely will not be out of reach for you in the least with all high passes and one honors. There are many positions in internal medicine and any program would be lucky to have someone who is motivated, dedicated, and a good communicator as it sounds like you are.

I felt similarly in your position and found pimping scenarios pretty challenging. Feedback in medical school is unfortunately very subjective. A lot of it is more an assessment of how your personality/overall demeanor matches with what they expect. Being more reserved definitely didn't do me any favors. I'm someone who prefers not to speak unless I have something meaningful to contribute and I try not to speak over people or shout out answers just for the sake of doing so. Sometimes this can be perceived as "lacking confidence." Just like there is a halo effect for good qualities, there is such an effect for bad qualities. And sad to say it, but gender and ethnicity may also play a role. Perception is everything. Most attendings don't have the time or bandwidth to really assess your clinical acumen. They see you for 1-2 hours a day during rounds for perhaps 1-2 weeks and are somehow expected to pass judgement on you, leading to a grade that may significantly affect your residency application.

All of this to say, don't let the negative feedback get you down and don't compare yourself as much to others (easier said than done, I know). My advice would be to focus on how you improve form day to day and from week to week. As long as you're seeing progress in your own knowledge base and clinical skills, that should be enough. It was for me.

On a more practical level, try practicing your patient presentations ahead of time (memorizing even the first few lines can project an air of ease/confidence) and record your presentations as you deliver them to listen to afterwards. Critique yourself and make little adjustments. For internal medicine, admissions presentations are typically when you are most likely to have the attending's undivided attention. Focusing on these will get you the most bang for time spent. These skills will also transfer to residency.

As a side note, it also baffles me that med students are judged based on their ability to answer pimping questions. Knowing these answers will not make you a good intern/resident. Honesty, hard work, and compassion will. The knowledge will come with time and when you're working on the wards Uptodate will always be available to you. Getting your patient's the care they need as an internal medicine resident will depend more on how dedicated you are to follow up and making sure nothing is missed.

Sorry for the long-winded post. Good luck!

 

[hopefullydoc117]

Thank you everyone for your thoughtful responses! They really helped me when I was struggling with my confidence. Giving an update here in case it helps someone in the future: I ended up honoring my rotation with great evals (other than this 1 attending). However, even this attending gave me good scores for the patient care/interpersonal skills, etc domains. Thank you again for your help.