EM residency- when do you feel confident?

[kat82]

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hi everyone- i am an MS4 applying in EM this year. i am doing a rotation at a very busy city hospital right now. i really like it and i love emergency medicine as a field, but i have to be honest, i feel really intimidated!! i look at the 4th year residents and i am scared that i'll never be that good! i am amazed at how some of the 4th years handle multiple traumas and truly sick patients all at the same time. i would love to be that one day, but it seems sooooo far from where i am right now.

i know i am just a med student and thats what residency is for, but i was wondering how other residents/attendings felt at the very beginning of their residency training. is it normal/ok to feel like this? at what point during your training did you feel confident??

thanks alot!
-kat

 

[kungfufishing]

I think everyone feels like that. Spend several years practicing the specialty and reading about it all the time, get better at it.

 

[Hard24Get]

hi everyone- i am an MS4 applying in EM this year. i am doing a rotation at a very busy city hospital right now. i really like it and i love emergency medicine as a field, but i have to be honest, i feel really intimidated!! i look at the 4th year residents and i am scared that i'll never be that good! i am amazed at how some of the 4th years handle multiple traumas and truly sick patients all at the same time. i would love to be that one day, but it seems sooooo far from where i am right now.

i know i am just a med student and thats what residency is for, but i was wondering how other residents/attendings felt at the very beginning of their residency training. is it normal/ok to feel like this? at what point during your training did you feel confident??

thanks alot!
-kat

I am feeling you, kat! I am doing my EM Sub-I right now and I feel dumb as heck! I never felt this incompetent in medicine or surgery rotations and I'm not exactly at the bottom of my class, so it is pretty unsettling. In fact, it is the one thing I don't like about EM - that I'm no good at it. 😛

 

[kat82]

haha, my thoughts exactly! i think we feel dumb/incompotent because every single patient we see is probably much sicker, at least in the more acute sections of the ED. being on the medicine/surgery wards seems like a breeze now (excluding the ICUs of course!) because you are generally not afraid that your patient who is post op day #1 s/p lap chole, or your r/o MI, is going to code suddenly!!

 

[iatrosB]

I'm sure you both deserve much more credit than you are giving yourselves...

curse that med student syndrome!

 

[Sessamoid]

Depending on your definition of "confident", I'd guess I felt really comfortable in my job about 2 years after I finished residency. That first year out was a little scary at times.

 

[EctopicFetus]

I def dont feel comfortable yet. I think the key is to accept that feeling and work to fill in those areas of "discomfort".

 

[Hard24Get]

haha, my thoughts exactly! i think we feel dumb/incompotent because every single patient we see is probably much sicker, at least in the more acute sections of the ED. being on the medicine/surgery wards seems like a breeze now (excluding the ICUs of course!) because you are generally not afraid that your patient who is post op day #1 s/p lap chole, or your r/o MI, is going to code suddenly!!

Yes, it is easy to sit in quiet respite and ponder the 5-6 new patients one picks up every 4th night after they are already stabilized. 😡

On the other hand, making the diagnosis is SO fun! I felt so good tonight because I caught a PNA in a pt with N/V/D, figured out how to examine a foot without an x-ray, detected a corneal abrasion, diagnosed rib fractures, etc tonight. Par for the course for the attending, but I felt like a real doctor! 😀

The initial diagnosis and the stabilization - that's where it's at. 😎

I'm sure you both deserve much more credit than you are giving yourselves...

curse that med student syndrome!

The whole time I'm presenting to the attending or senior resident, I feel like they are thinking "how did this idiot get into my medical school?" and then they are like, "good job". I think they are just being nice, but boy does my fragile ego need it. 😳

 

[edinOH]

Feeling confident vs. being competent occured at two different stages of my training.

The confidence occured early into the second year of training. They say that there is no more dangerous time in residency than the middle of the second year. That is just about the time most residents are begining to feel somewhat comfortable with their job. They've seen most things at least once and now think they've seen it all. That is when you start missing things and killing people. This is somewhat true for the ED but most assuredly true for the ICU and moonlighting. At least the ED always has an attending around to keep you from hanging yourself and your patient. I know it was true for me and most of my colleagues a time or two.

Competence truly comes about half way through the third year. You've seen plenty of patients and have seen or made enough mistakes to give you some persepective of the fact that not all patients present or finish like they should. By then you should have enough respect for the field that you understand that if EM were easy everybody would be doing it.

I've been out over a year now and I can honestly and humbly tell you that competence is something I work on everyday. I know what I'm doing in the ED but I still learn something valuable daily.

 

[DrQuinn]

F
I've been out over a year now and I can honestly and humbly tell you that competence is something I work on everyday. I know what I'm doing in the ED but I still learn something valuable daily.

Agreed. I am like edinOH, 14 months out as an attending, and I still learn new stuff everyday on my patients. I'm not as scared anymore, and my confidence is pretty solid (although like Sessamoid said, the first year as an attending is pretty scary), but my ease with pateints is better. Now I am able to really increase my proficiency in charting, am able to focus more on keeping the patient happy/increasing rapport, and just "enjoying" working. Although I'd rather be home on Xbox Live.

Q

 

[kat82]

ah, that makes me feel better. i really do love EM and cant see myself doing anything else. i agree with hard24get, making the diagnosis and stabilizing is the most fun and interesting part of medicine in my opinion. every time im in the ER i have a blast, despite the fact that i always get the pre-shift jitters

im glad that feeling a little scared/nervous is normal, because im making that big commitment to a field and i want to make sure that its all going to work out in the end!

🙂