Disappointing medical school performance, want to do better in residency

[Throwawaywoop]

tl;dr: I'm disappointed in my trajectory and performance in medical education up to this point and would like to hear any thoughts or advice on how to do a better job in psychiatry residency. Sorry for the novel--if you do read to the end, I really appreciate it.

I created this thread because I have overall been quite disappointed with myself and my trajectory in medicine up to now. Objectively, what I achieved is not disappointing in itself: I graduated with an MD and will start my psychiatry residency next month. I am very thankful for and excited about those things, especially given the tough year that it was for psychiatry applicants. However--and I'll explain--I feel I should have done a LOT better.

Basically, I busted ass in high school and went to a top 10 undergrad. I was probably a middling student in undergrad and likely underachieved (started off great but lost steam about halfway through due to mental health and personal reasons), but did well enough to be accepted to a US MD school that's not top tier, but offered me an excellent education. Unfortunately, I was also not a very strong student in medical school (probably middle of the pack or even bottom 1/3). I worked hard, had solid pre-clinical grades (though could have done better in some areas), and did very well on both Step 1 and Step 2, but had a rather choppy/inconsistent third year. For example, on three of my rotations, I received bad reviews from one or two residents/attendings. These were amidst very strong reviews from other residents/attendings on those rotations, so my overall grades for those rotations were good, but the bad reviews likely cost me honors for those rotations and/or eligibility for honor societies and other clinical recognitions. I should note that I did exceedingly well on my third year psychiatry rotation and all of my psychiatry rotations thereafter, including my sub-I.

(Given that this is SDN, I know some readers may be tempted to say "OP clearly has a personality disorder because who the hell gets more than one bad review?" Yes, I've made some mistakes in the past and learned from them. Perhaps I do have something deeper going on, I don't know, but I promise that I'm committed to becoming the best physician I can be.)

Anyways, long story short, I matched into a psychiatry program that was not my top choice, but that I liked a lot when I interviewed there, and that is ultimately in a better location for me than the programs that I had ranked higher. However, it is an IMG-and DO-friendly program and probably considered lower-tier, and I've read mixed things about it on the internet. (As an aside, I feel quite bad about that last sentence, as I've had the privilege of working with some truly wonderful and admirable residents and attendings who are IMGs/DOs, and I'm looking forward to learning from my future IMG/DO colleagues. I apologize if I've offended anyone.) All this to say that given the circumstances, I probably should have done better with my education, especially considering the opportunities that were available at my undergrad and the fact that I was interested in psychiatry since undergrad, tailored my extracurriculars and research towards psychiatry, and wrote a very heartfelt personal statement that outlined my interest. I don't mean to say that I should have gotten something I didn't deserve: I recognize that most of the responsibility is mine. But I'd be lying if I said I don't feel ashamed, especially compared to people I know who have upward trends (e.g. did so-so in college but are superstars in med school), or even many of my classmates who matched at really impressive institutions.

Thus begs the questions: how can I make a "comeback" in residency? What can I do beyond the obvious (be present, treat my patients with care and attentiveness, read about their conditions, stay up to date with the literature, be kind to and teach medical students, perhaps get involved in more research)? How can I capitalize on some of my strengths (e.g. writing) in ways that I wasn't able to in medical school, and how can I work on qualities that may be viewed as weaknesses (e.g. I'm quite introverted and tend to be unsure of myself, which perhaps didn't come across well and spurred some of the bad reviews in third year)? I don't want to approach residency with the attitude of chasing recognition, as that seems counterproductive, but I also don't want to miss opportunities or make costly mistakes as I seem to have done in the past. Additionally, just out of curiosity, has anyone else felt similarly?

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[Attending1985]

Residency is worlds different than medical school. Show up, work hard , be honest, ask for help when you need it, treat others with respect, do your best to provide good patient care and you will do great. Don’t put so much pressure on yourself to excel. It’s not a competition this is learning for your career and providing actual care for people. unlike medical school which is let’s face it a lot of bs.

 

[deleted736562]

Well, my piece of advice is the less you care about how to successful in the "system", the happier and the better you are. Doctors and other professionals get sucked into this whole "ranking" system from HS and they internalize it, to their own detriment.

Treat residency like an independent adult with an actual job with responsibilities (i.e be professional, show up on time..etc), follow your interests ---> happy(ier) person and a more personally successful one.

 

[NickNaylor]

Agree with the above in that the skills and types of performance to be a "good" resident are not the same as those that typically make someone a "good" medical student. The emphasis is a lot more on being a good worker than simply being an academic god. Fairly simple things like being able to work well with others, being a team player, being responsible and reliable, having a strong work ethic, and taking good care of your patients is much more important. Being able to navigate the workplace setting and managing relationships with others is, I would argue, far more important than actually having a strong knowledge base, though the latter is obviously much more important with respect to providing quality care.

It's just a whole different beast altogether. I was a below average medical student but am an above average resident.

 

[AD04]

It seems like you're all over the place and not sure what you want. You just want to be better in a general sense. Many people can dream big but few people actually accomplish their big dreams.

Before you think you're too good for your program, make sure you can actually back up your feelings with accomplishments:

1. be reliable and do good work (know your patients, make sure notes are done)
2. provide excellent patient care (interviewing, proper diagnosis and differentials, and treatment)
3. score the highest on the PRITE exam (standardized and rough indicator of your knowledge)

If the IMG / DO is better than you on #1 - #3, you have no right to think you're better.

And if I can offer you one advice, it is to FOCUS. Pick one aspect of psychiatry and WORK on it.

If you want prestige, you can focus on getting into a brand-name fellowship.

If you want money, you can focus on learning about business and negotiation.

If you want to publish articles and books, you have to make time to write daily.

You are also a bit harsh on yourself. You need some self-confidence. Instead of trying to impress everyone, it may behoove you to grow a thicker skin and to stand up for yourself. Learn how to tell people to F off -- nicely, if possible.

It's just a whole different beast altogether. I was a below average medical student but am an above average resident.

I don't believe that.

 

[Throwawaywoop]

Thank you for the thoughtful responses, folks. Your advice is very helpful, and I will keep it in mind.

Before you think you're too good for your program, make sure you can actually back up your feelings with accomplishments:

1. be reliable and do good work (know your patients, make sure notes are done)
2. provide excellent patient care (interviewing, proper diagnosis and differentials, and treatment)
3. score the highest on the PRITE exam (standardized and rough indicator of your knowledge)

If the IMG / DO is better than you on #1 - #3, you have no right to think you're better.

I don't think I'm too good for my program--truthfully, it's a good fit for me--but I occasionally feel a bit embarrassed since many of my classmates, including some of those in psychiatry, matched at much more impressive institutions. Sometimes I wonder, "if I had just not f'd up x, or if I had done y better, could I have been in their position?" Nonetheless, I appreciate the reminder to stay humble, as that's always an important but easily overlooked quality.

I do struggle with self-confidence and have for a long time. On the topic of being a "good" medical student, I've noticed that while some are academic gods, some of my classmates who were inducted into AOA (senior, not junior) or Gold Humanism or received mostly honors in third year were not necessarily the smartest people, but worked well on the wards and were generally likable people (I'd like to think I'm a good worker, likable, and compassionate, though certainly not perfect, but perhaps didn't "stand out" in these areas as much as these classmates of mine). I suppose much of that does come from a sense of self-confidence, which does not come easy for me. Has anyone else struggled with self-confidence, and if so, what did you do to work on it?

If you want to publish articles and books, you have to make time to write daily.

I'm curious about this. I'm not too interested in research--I've done research projects in undergrad and medical school, mostly because it was what was expected, and none of them really amounted to much--but I do love to write and am good at it. What are some other ways to get involved in publishing within the field that don't necessarily have to do with basic or clinical research? I should note that I might have had more interest in research or academic projects in the humanities or global health, but haven't yet explored those areas.

 

[NickNaylor]

The AJP Resident’s Journal is a great way for residents to pump out publications and, if you’re interested, to get involved with the editing side of things as well. The only downside is that the journal isn’t indexed, but the plus side is that turn around is fairly quick and the scope of the journal is quite broad. I would look into that if you’re interested in publishing. They also a publish a variety of different article types that don’t require that you complete a formal research project.

 

[AD04]

It's not about being humble. It is about excellence. If you think you're that good, prove it.

As men, we should have a competitive spirit and that's good because competition promotes excellence. Did your peers get into a better residency than you? If so, what are you going to do about it? How will you best them later on in life? As men, we respect people that walk the walk, not just talk the talk.

How do you do that? Choose benchmarks for success. As you hit and surpass the benchmarks, your self-confidence will grow.

Let me give you an example:

I was in the bottom 1/3 of my medical school class. I thought school was stupid and did the bare minimum to pass. My residency program is not the most prestigious either.

In terms of medical school grade and prestige of residency, what I've accomplished is not that impressive.

Yet, if I ever run into my former classmates, I will hold my head high. Why? Because I've hit and surpassed my benchmarks.

- I am in better shape than them.
- I have better style than them.
- I write better than them.
- I accomplished more in medical school than them (not just in terms of being a president of a club or something generic but I did something very unique).
- I am ranked very high in my massive residency program (backed with up scores and feedback from patients / attendings). Basically, I'm excellent in what I do.

And I have no doubt I will be among the most financially successful from my medical school class. I have confidence in this because I put in the WORK to make that happen. This work goes beyond medicine. And I work a lot.

Because I know how I stack up against others and what I am capable of, I know that people's lives will be worse without me than with me. That gives me great confidence.

As cocky as I sound, I do have the humility to approaching people better than me and ask for advice. Most people are happy to give it. And then I implement that advice.

So basically, you have to choose your own benchmark(s). FOCUS and WORK. No other way.

(During and after residency, no one is going to care about medical school grade or induction into AOA or gold humanism award or whatever feel-good trophy you listed. So choose something more meaningful.)

Regarding writing, if you want to become really good at writing, you have to write every day. It doesn't even have to be in research. There are so many aspects of writing -- copywriting, stories, how-to, poems, and more. But only you can decide what you will write about.

Here is a no-cost method that will take away all excuse for not writing:

Start a free-blog and write daily. If your writing is any good, people will find it and read. Or just post on SDN. =)

 

[whopper]

I've seen several stellar residents not do well in medical school. See residency as a new chance to re-establish yourself. In residency it's about hard work, dedication, and caring about people much more so vs memorizing large volumes of data in short periods of time.

 

[NontradCA]

It's not about being humble. It is about excellence. If you think you're that good, prove it.

As men, we should have a competitive spirit and that's good because competition promotes excellence. Did your peers get into a better residency than you? If so, what are you going to do about it? How will you best them later on in life? As men, we respect people that walk the walk, not just talk the talk.

How do you do that? Choose benchmarks for success. As you hit and surpass the benchmarks, your self-confidence will grow.

Let me give you an example:

I was in the bottom 1/3 of my medical school class. I thought school was stupid and did the bare minimum to pass. My residency program is not the most prestigious either.

In terms of medical school grade and prestige of residency, what I've accomplished is not that impressive.

Yet, if I ever run into my former classmates, I will hold my head high. Why? Because I've hit and surpassed my benchmarks.

- I am in better shape than them.
- I have better style than them.
- I write better than them.
- I accomplished more in medical school than them

I’d contend that this is the exact opposite mentality that the OP should have when entering residency. OP, don’t act like you have something to prove. Please act like you’re trying to prove the worth of others. Don’t believe me? Try this:

Make it a point to complement someone else every time you complement yourself and see how much better life becomes.

 

[Throwawaywoop]

Yeah, I'd like to avoid comparing myself to others as much as possible since (as is probably obvious from my posts) I have a tendency towards it, and more often than not it just makes me unhappy. I want to get to a place where, if I do instinctively compare myself to others, I can say "well, that person may be on their path, but I'm doing or have achieved something equally awesome," but I guess I'm not there yet, since, well, I haven't achieved things that are equally as awesome as what some of my former classmates in both undergrad and med school have achieved. I see what you're saying, though--that it's important to set benchmarks for yourself and measure yourself by how well you're working towards YOUR benchmarks (not others'). Of course, it's much easier said than done, and I always seem to go back to comparing myself to others (I mean, it seems natural when you've been surrounded by people who not only excelled in med school but also were in great shape, had great style, had awesome social lives, etc.), but I want to work on it.

Make it a point to complement someone else every time you complement yourself and see how much better life becomes.

This is a beautiful exercise that I'm going to start implementing as soon as possible! Thank you.

The AJP Residents' Journal sounds like a really neat opportunity and something I'd definitely be into.

 

[nexus73]

This may not apply to you, hopefully it doesn't. But if you drink alcohol, smoke weed, or are using any habit forming substances, I strongly recommend getting sober immediately.

 

[michaelrack]

Yes there are two paths you can go by but in the long run there's still time to change the road you're on

 

[Shufflin]

And it makes me wonder