Feel so useless as a ENT intern

[turboE36]

Posting this out of desperation...

I'm a relatively new ENT intern (been working for one month now) and I've been feeling pretty depressed with the way things have been going so far. I was a awesome away rotator and interviewee (so I've been told), but I've been having a really miserable time as a resident. I'm ashamed to admit that the thought of quitting has even entered my mind. Some of the things which have contributed to my misery:

- I can't stand some of my residents. One of the PGY 2s I work with has been ridiculously overbearing. She tries to help me by showing me how to do things (orders, discharging, etc) but never actually allows me the autonomy to do things on my own. I feel like this is a serious crutch to my learning.
- I feel like the pace is too fast. My seniors expect me to see a new consult and write it up in half an hour or less. I feel like I'm not doing justice to the patient by working them up so fast. The worst is when I get two consults at the same time.
- I have no idea what is "abnormal." I thought a inflamed EAC was otitis externa but in actuality it was just "dry" from debrox usage. When I do FFLs I don't really know what I'm looking at or how to describe the anatomy.
- I feel completely useless in the OR. I typically get put into "basic" cases on the schedule, but even these are sometimes a struggle. How am I supposed to know how a attending likes their suspension set up for a micro laryngoscopy when no one has even showed me the proper instruments for the case? Also as soon as I make one mistake (cutting too close to a nerve) the attending takes away the case from me and I basically go back to just retracting.
- Speaking of the attendings I feel like they don't trust me. I will present a consult but all questions will immediately be directed to the upper levels? It's like I'm invisible to the attending. On a similar note, during cadaver and sinus labs, I feel like I'm completely ignored by the faculty.

Feeling really hopeless....does it ever get better? Is there hope at the end of the tunnel? I love ENT and I don't mind working hard/staying late.. But I can't help but feel like maybe I'm just not cut out for this kind of stress...

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[illixir]

Don't get frustrated, it does get better. It's only August, not even two months or 1/6 of the way through the year. You will be that PGY-2 next year and your senior residents in the future. The fact your attendings let you try to do some of the actual surgery and then have to take it away is huge, most people dont even get that opportunity as an intern. Everyone would get the case taken away from them as a new intern. Trust from attendings comes with time, time on the order of months to years. Focus on watching what they're doing in those instances and work on improving the basic skills. Read and practice when you're not at work. You will get better and you will gain trust if you apply what you learn and play nice with everyone-- fellow residents, nurses, staff and attendings. You will learn whats abnormal by doing those exams over and over again, soon your eyes will "get it". The pace should be fast, you may have to adjust to what level of detail you go through everything and the most efficient way to capture all relevant information. When you have the opportunity watch how others do consults. And even if they don't do this, you can still provide appropriate patient care without the patient feeling rushed if you are attentive in your interactions. And above all, please figure out a way you can talk about these issues off-line with someone- friends/family/any other support structure. And reach out and seek help if needed, mental health resources are everywhere and your institution may likely have some in place for residents if you look into it.

If you love ENT and enjoy putting in the work for it, you are exactly who's cut out for this.

 

[OtoHNS]

I think part of what you are experiencing is totally normal for a new intern, and part of it is not.

The part that is normal is that you are SUPPOSED to be useless and not know anything. We had a saying in my residency when an intern or junior resident didn't know something: "that's why it's a 5 year program." At the very beginning of those 5 years, you don't know very much at all. And that's fine and to be expected.

Right now, just focus on being an excellent INTERN, and not on trying to know everything your chiefs and attendings know. And ultimately, that really just means A. writing down a list of menial tasks and getting them done, and B. learning to recognize when there is a big problem and efficiently communicating that to your seniors. Once you get that handled, you can move on to bigger and better things. But that's the foundation, and you can't build a house without a solid foundation.

When you are on your ENT months, just try to pick up as much as you can, but there is no way you're going to learn it all immediately, so don't put so much pressure on yourself to be perfect. Instead, when you don't know something, just focus on doing it better next time rather than being clueless again the second time you see it.

Since you are someone who matched into ENT, I can presume you have probably been a high achiever your whole life and you are used to being the best (or near the best) at whatever you do. It is hard to adjust to being useless, clueless, and the low man (or woman) on the totem pole. But you won't stay there forever. Look at your chiefs and realize they were exactly where you are 4 years ago. That's where you will be in 4 years. Don't sweat the process- it works.

Going back to the top of my post, there is something going on here that *may* be abnormal. And that is the feeling of despair and hopelessness. It's always hard to tell what is really going on from an internet forum post, but please talk to someone, including mental health professionals if necessary, if you need it!

 

[VisionaryTics]

Posting this out of desperation...

I'm a relatively new ENT intern (been working for one month now) and I've been feeling pretty depressed with the way things have been going so far. I was a awesome away rotator and interviewee (so I've been told), but I've been having a really miserable time as a resident. I'm ashamed to admit that the thought of quitting has even entered my mind. Some of the things which have contributed to my misery:

- I can't stand some of my residents. One of the PGY 2s I work with has been ridiculously overbearing. She tries to help me by showing me how to do things (orders, discharging, etc) but never actually allows me the autonomy to do things on my own. I feel like this is a serious crutch to my learning.

Some seniors are more overbearing than others. It's part of working in a professional environment...you're not going to gel perfectly with everyone. The trick is to learn to work with them and get the job done. And it's August, so the upper level residents are still new to be upper level residents. And they're paranoid that you're going to make them look bad because they are trying to mature into their roles.

I figure you guys run the list after rounds, so just tell her, "I'll d/c the drain, discharge so and so, etc, etc, etc". Make it clear that you think of these things as your responsibility. And if she really wants to waste her time writing the intern's discharge summaries, let her. Her loss.

- I feel like the pace is too fast. My seniors expect me to see a new consult and write it up in half an hour or less. I feel like I'm not doing justice to the patient by working them up so fast. The worst is when I get two consults at the same time.

You'll get faster. Speed takes time. Try to figure out ways to speed up consults. When you initially get the consult, think if you'll need anything in the room. Scope, lac kit, etc, etc. Call the nurse to have it ready for you. It should take you 10-15 minutes to do a history and physical...we're not medicine doctors. Focus on the problem. When writing consult notes, use speed phrases and templates. I have phrases for physical, scope findings, all sorts of procedures, plans for epistaxis, PTAs, angioedema, etc. Takes me a couple of minutes to write a note.

- I have no idea what is "abnormal." I thought a inflamed EAC was otitis externa but in actuality it was just "dry" from debrox usage. When I do FFLs I don't really know what I'm looking at or how to describe the anatomy.

That's why you're an intern. That's why someone is checking what you see. You're supposed to be learning. No one gets taught this stuff in med school (which is why every pediatrician calls a red TM or canal "otitis media").

- I feel completely useless in the OR. I typically get put into "basic" cases on the schedule, but even these are sometimes a struggle. How am I supposed to know how a attending likes their suspension set up for a micro laryngoscopy when no one has even showed me the proper instruments for the case? Also as soon as I make one mistake (cutting too close to a nerve) the attending takes away the case from me and I basically go back to just retracting.

The fact that you're even getting a shot in the OR at something like MDL is great. Just be a sponge in OR. Try to learn as much as possible about every detail. How do we position patient and why? Where does microscope go? How do you set it up? What's the focal length? What's the difference between these laryngoscopes? What's the difference between these graspers? Are they in the same set? etc, etc, etc. Like the above poster said, it's a 5 year program.

- Speaking of the attendings I feel like they don't trust me. I will present a consult but all questions will immediately be directed to the upper levels? It's like I'm invisible to the attending. On a similar note, during cadaver and sinus labs, I feel like I'm completely ignored by the faculty.

Tip: They DON'T trust you. Trust is earned and not by matching to your program. You will spend years earning the trust of your attendings, which is why they look at the seniors. They look at the seniors because ultimately, the patient is their responsibility, and because they trust the seniors. And interns sometimes get ignored in sim labs. Who will benefit more: the intern who can't tell a turbinate from skull base, or the PGY3 who is getting more independent with sinus cases but needs some coaching in specific maneuvers? Try to find a chief to show you stuff.

Feeling really hopeless....does it ever get better? Is there hope at the end of the tunnel? I love ENT and I don't mind working hard/staying late.. But I can't help but feel like maybe I'm just not cut out for this kind of stress...

Replies to your specific issues above.

Learning to be a surgeon is stressful. And it doesn't stop. As soon as you get comfortable with your role or a procedure, they throw something harder at you.

There's a great book on surgical error called "Forgive and Remember". Classifies errors into four categories: technical, knowledge, normative (things like lying, ignoring orders, laziness, etc), and pseudo-normative (things like using Afrin instead of cocaine or closing with nylon instead of Prolene which is what Dr. X prefers).

He found that residents didn't get hammered for errors in technique or knowledge. That's why we're residents, to learn that stuff. We get hammered for normative errors. Focus on being hardworking, trustworthy, etc, and things will work out.

BTW, two months down, 58 to go. Does that give you some perspective?

 

[neutropeniaboy]

I don't have much more to add after reading the posts from OtoHNS and VisionaryTics.

I've been an attending now for a good amount of time and have seen more than a few cycles of residents go around at our program. I was one of the opponents of having interns be on the ENT service for more than 1 month, but no one listened to me on that front.

I hated my intern year, but I learned an incredible amount of medicine during that year. I don't think I operated much that year and I didn't even have a month on the ENT service. This is knowledge I have kept close to me over the years, and I've been surprised when rounding with residents and asking vent questions, questions about the respiratory cycle and basic cardiovascular medicine only to be met with blank stares or "we're having the hospitalist manage that."

Concentrate on learning to be a good doctor (intern) as OtoHNS said. Be glad that someone (your PGY-2) is doing a lot of the stuff for you at this stage. One of the things I see a lot in you Millennials is that you just want to jump in the deep end and get it all done; you want to start at the top and move sideways. Be patient and learn from your superiors.

I've taken away many cases from residents for many reasons: taking too long, operating carelessly, operating out of sequence, not being prepared before surgery, etc. I've done this to PGY-1s, 2s, 3s, 4s, 5s, and fellows. It's just a fact of training: you will be put in your place more than once.

Your attendings may listen to you present, but you may be presenting like a medical student and aren't getting to the point, which is where the attending wants you to be because we're a surgical service, not a medical service. We don't round and pontificate all day. On the other hand, your attending may be used to interns who are not as savvy as you and may reflexively look to the upper levels for clarification and answers. More than likely, your attendings are directing their attention to the upper levels because you -- admittedly -- don't know what you're doing, what you're seeing and why you're doing it.

THAT'S OK.

That's part of training.

Your training will end at some point, and then you gotta leap from the nest. Trust me; at some point after jumping you will doubt whether you learned enough.

Keep learning.

 

[turboE36]

Thanks for the replies everyone (especially the attendings taking time to post on here). It's been 6 weeks since I made my original post and looking back, things are definitely MUCH improved. Also happy to report my mental well-being has also been pretty OK too.

 

[Irishlass]

turboE36, glad that you are feeling better.

I too have felt "useless" a bit since starting. I also find it hard to keep up with the speed of the consults and at times I am not sure I am up to the task. Rushing has caused me to make a few mistakes.

The first month was really rough, everything was new and I constantly felt like I was in the wrong place at the wrong time.

I did a preliminary surgery year and two AIs and never felt like that. I wonder if I could have gotten this far and not be "smart enough" to do this or if I chose the wrong program.

It would be good to know if anyone else is struggling with the pace. I hope no one is, but if they were, it would be of comfort to know that I am not the only one.

If anyone has any strategies for keeping up that would be great.

 

[Irishlass]

100 + views, but no comments, I guess that means that either no one else is having trouble (which is awesome for them) or they are too busy to check out this site.

 

[OtoHNS]

100 + views, but no comments, I guess that means that either no one else is having trouble (which is awesome for them) or they are too busy to check out this site.

I think what you are feeling is universal among interns and new residents. I certainly felt the same way many times during the early years of residency.

I would just repeat what I said above- trust in the process, it works. And relax! You're not supposed to know it all or be expert at everything from day 1.

Right now, stay organized and keep a list of your daily tasks (and make sure they are all handled before you leave).

Try and identify issues that give you difficulty or slow you down, and plan how you will deal with them better/more efficiently when you see them again. A lot of this job is pattern recognition, and you will get better and faster at recognizing the patterns with more experience.

 

[Irishlass]

Thank you for your words of encouragement, at times it feels as though everyone gets it and I don't. It's good to know that this is a a common feeling.

All of us who have gotten this far are used to not just getting things done, but excelling. This feels like going from Little League to the Pros without a stop in Farm League!
One day at time....

 

[Irishlass]

Wondered how the OP is feeling now that the intern year is almost over. Personally had a bumpy start, worked hard to get more efficient and organized. Looking forward to next year.

Hope the entire class of 2021 had a great year!

 

[turboE36]

Just an update to this thread. Definitely feeling a lot more comfortable as a PGY-2. I think my off service rotations were pearls in my development as physican. At our institution we simply do not manage many "medical" problems on our ENT service.

Of course PGY-2 has it's own challenges. First night of call: 13 consults!