Do we have a third year sucks thread for 2014 yet?

[lockian]

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I just started third year a couple weeks ago and I'm already burnt out.

I haven't had any mean or impersonal supervisors: I've been lucky in that regard. I do the schmoozing and smalltalk thing, I study my patients' charts and I have what I feel is an okay baseline of knowledge. I ask questions whenever I think of them, and I am always trying to read something useful when I am in the clinic. I also make sure to dress for the job I want, not the job I have (read: like Elle Woods.)

But I have no idea how I'm doing. So far I've only done outpatient work on the rotation that I'm on, and I work directly with attendings, taking histories, doing exams, reporting, sometimes discussing the patients beyond that. When I ask for feedback, they say they don't expect much for where I am in my education, or they give me feedback in what "they'd do differently," or what I should "try" or "practice." But I never know if it means I'm doing poorly or if that's simply part of the game, and part of learning. Sometimes I get corrected, sometimes I get everything right. Some pimp questions I know, some I don't. Sometimes I get "fed" the answer through smaller step by step questions, but then I feel like I can't really take credit.

I've heard that it's okay to get things wrong: that as long as you have a smile on your face and are willing to accept criticism and go read up on the answer.

I've also heard that in order to get more than pass you're supposed to try and take your knowledge one step further, and try to present an assessment and plan in addition to just reporting (even if they're wrong). I try, but I don't always have the opportunity, and I certainly don't always have the confidence. I'm especially bad at conferences. I'm so afraid of being publicly wrong that whenever I do answer I'm often asked to repeat myself because my voice literally dies.

I start inpatient next week, and I have a feeling outpatient was a vacation compared to that. I almost wish I'd flunk Step 1 and get pulled off rotations, because I can't deal with this anymore. I'm so anxious I can't learn. I'm too anxious to do the things I enjoy when I do have free time. In fact, the upcoming shelf exam is its own kettle of fish. It's hard to assimilate the things I read, plus the things I learn on the wards, plus complete required assignments, plus struggle with this crushing sense of confusion and insecurity every day. I should be studying now, but I'm here writing this up and I just want to quit. Somebody talk to me...

 

[Ismet]

You need to give it more time. You've only been a 3rd year for a couple weeks, you're not expected to know what to do or to have everything right. There are MS4's on the rotation with me and even though they clearly have more confidence in what they're doing, they also get things wrong and don't know what to do a lot of the times. You're there to learn as much as you can, and you'll get better as you go.

The feedback you got is called constructive criticism. If they tell you they'd do something differently, take that into account and adjust what you do, but also realize that there may not be one right way to do things. Things you should try or practice means things you need to work on. It doesn't mean you are doing poorly, it means these are things you should improve upon. You're not going to know all of the pimping questions. Either say "I don't know" if you really don't know or try to logic through it out loud. Don't just think in silence, I made that mistake a couple times with an attending who scolded me for doing so.

Ask your attendings AHEAD of time how they want you to present. I had an attending who doesn't want med students coming up with A/P's for some reason. On a 180 from that, I had an attending who expected an A/P on every patient from the get-go, when I had never presented one before. One attending only wanted pertinent +/-, another wanted me to talk through the entire physical and say what I did and what I found, even if everything was normal. You look better if you ask beforehand what they want instead of doing it one way and telling you that it's "wrong" or that they want it a different way. It's really annoying how every attending I've worked with these past 2 months seems to want something slightly different, but I've gotten used to it and I'm kind of amazed at how much my confidence has grown in just 7 weeks.

Please talk to someone about your feelings of insecurity and anxiety. I'm not saying you need psychiatric help or something, and SDN is not the place for that kind of thing, but talking to a counselor or therapist can be really helpful in these situations where you're feeling overwhelmed. You're not alone in these feelings, I'm finishing up my first rotation, outpatient as well, and it's a lot to handle. Feeling exhausted at the end of the day, too tired to study or complete assignments, etc. IMO it's a normal response to adjusting from 2 years of the relative safety of pre-clinical years and multiple choice exams to suddenly being expected to contribute to patient care. You're not expected to be a rockstar out of the gates, just do your best and keep your chin up. And please talk to someone.

Also

 

[DermViser]

You need to give it more time. You've only been a 3rd year for a couple weeks, you're not expected to know what to do or to have everything right. There are MS4's on the rotation with me and even though they clearly have more confidence in what they're doing, they also get things wrong and don't know what to do a lot of the times. You're there to learn as much as you can, and you'll get better as you go.

The feedback you got is called constructive criticism. If they tell you they'd do something differently, take that into account and adjust what you do, but also realize that there may not be one right way to do things. Things you should try or practice means things you need to work on. It doesn't mean you are doing poorly, it means these are things you should improve upon. You're not going to know all of the pimping questions. Either say "I don't know" if you really don't know or try to logic through it out loud. Don't just think in silence, I made that mistake a couple times with an attending who scolded me for doing so.

Ask your attendings AHEAD of time how they want you to present. I had an attending who doesn't want med students coming up with A/P's for some reason. On a 180 from that, I had an attending who expected an A/P on every patient from the get-go, when I had never presented one before. One attending only wanted pertinent +/-, another wanted me to talk through the entire physical and say what I did and what I found, even if everything was normal. You look better if you ask beforehand what they want instead of doing it one way and telling you that it's "wrong" or that they want it a different way. It's really annoying how every attending I've worked with these past 2 months seems to want something slightly different, but I've gotten used to it and I'm kind of amazed at how much my confidence has grown in just 7 weeks.

Please talk to someone about your feelings of insecurity and anxiety. I'm not saying you need psychiatric help or something, and SDN is not the place for that kind of thing, but talking to a counselor or therapist can be really helpful in these situations where you're feeling overwhelmed. You're not alone in these feelings, I'm finishing up my first rotation, outpatient as well, and it's a lot to handle. Feeling exhausted at the end of the day, too tired to study or complete assignments, etc. IMO it's a normal response to adjusting from 2 years of the relative safety of pre-clinical years and multiple choice exams to suddenly being expected to contribute to patient care. You're not expected to be a rockstar out of the gates, just do your best and keep your chin up. And please talk to someone.

Also

My favorite:

 

[Kahreek]

no one is ever goind to compliment you in any meaningful way.

 

[operaman]

Actually it sounds like you're doing pretty well. If you have a major deficiency in some area, they will let you know. The reality is that you're doing well for where you are in training, and just take constructive feedback as just that and try to improve.

Nobody answers pimp questions right. Period. That's the whole point. If we were graded based on who got pimp questions right, we'd all flunk.

We get graded based on our presentations. We get graded based on how well we improve. If you work hard and read and do a little better every day than the day before, you'll do really well. Believe it or not, many people never really improve.

You're going to have to come to terms with being publicly wrong sometimes. State your thoughts assertively and if you're wrong, who cares?! That's the beauty of being a student -- you're allowed to be wrong. Just say, "Oh, I didn't realize that. Looks like I've got more reading to do." Or some variation that feels natural to you. I'll actually preface answers -- especially in more public forums -- with something like, "from what I was reading about this...." Nobody cares if you know the answer, but they will care that you read and want to learn.

What you'll see through the year is the dramatic variability in attendings. You'll be managing an inpatient and have a new attending come on and you'll present the plan approved by the last attending and be told it's wrong. Some things in medicine are very black and white. Most are not. The nebulous areas make for great teaching because it's there that you start to learn clinical judgment.

Honestly it sounds like you're doing great, especially for a first rotation. No matter what people say, the expectation is MUCH lower right now. That will change. Shelf study is pretty straightforward: UWorld questions, and FINISH 2 other sources of questions (I liked Pre-Test and Lange Q&A or CaseFiles). Doesn't matter which ones, just that you pick 2 and do ALL of both. Pretty much guaranteed to honor if you do that in addition to your daily reading. Don't underestimate how much you're learning during the day because it's a lot more than you realize.