sab said:
I've recently begun my CA-1 year and am somewhat overwhelmed. I feel like most everything I learned intern year doesn't help me in this field. Also, the rotations as a student never made me realize how much there really is to know about what's going on and how to adequately do this job.
A lot of other residents say it's like that for almost everyone, but it just feels like I can't learn enough fast enough. Anyone else feel like they're trying to do fifteen things at once and not fully understanding many of them? How long can one expect to be going through this "initial growing pains" phase?
I do feel like I enjoy the job, just overwhelmed at how much I don't know.
Any advice is welcome. I guess I may just need a little morale boost.
Ahhhh, the CA-1 blues. Although I've only just graduated from residency, those early jitters seem like they are a lifetime away. Last year, however, I remember talking to a CA-1 in July who had transferred from an FP program. She was overwhelmed, felt unprepared, and was seriously considering quitting.
My advice to her is the same that I would give to anyone starting out in an anesthesiology residency: Know that everyone goes through this period of doubt, know that you will get through this period sooner rather than later, and know that diligent reading will bridge the knowledge gap for you at a brisk pace and keep you ahead of the curve.
Don't be concerned with the esoteric concepts of pediatric, cardiac, pain, or neuroanesthesiology. You aren't expected to know that at this stage. Focus on the basics: Airway management, pharmacology (neuromuscular blockers, sedatives, narcotics, volatiles, local anesthetics, primary adjuncts such as metoclopromide, Zantac, etc.), positioning, anesthesia machine basics, record keeping (yes record keeping), and a knowledge of the possible complications of patient comorbidities and case types should be your primary focus for the next several months.
As you become more comfortable with the basic concepts, you can start to delve into more advanced concepts. Remember that you are in this together with your fellow CA-1's, so help each other out. You will find out that your classmates have the same apprehensions as you do and by talking to each other, you may find ways of dealing with the pressure that you had not thought of before. You each will have had different experiences that the others can learn from so when you have some time between cases or at the end of the day, take a few minutes to go speak to your colleagues and see if you can pick anything up from them and vice versa.
Use your senior residents as a resource. They have been through the trenches at your program already and they know what to expect and what you will have to deal with. Not all will be willing to share their knowledge, but that doesn't mean you shouldn't try to find the ones that will.
When I was in residency, from my first day as a CA-1 to my last as a CA-3, I constantly asked my faculty to review my performance during cases (for both the previous and current case), at the end of each day, and to teach me whatever pearls they could. I can honestly say I drained each of my faculty members of all of their wisdom over those three years. If you don't ask questions, some faculty members may assume that you think you know it all already.
Be prepared to feel ignorant and downright stupid when you ask some of your questions or receive the answers. You are a newbie and that is just the way it is. Hopefully you don't have malignant faculty. Hopefully you have faculty that nurture your interests and inquisitiveness.
Above all else, stay positive: Not only are you in training, you are EARLY in training and keeping a positive, upbeat attitude no matter what happens will show your peers, the faculty, and most importantly the patients that you are eager to improve your clinical acumen and learn from, not repeat, the mistakes you have made in the past. This is a continual learning process for the rest of your life. As I noted in another thread, you are never too old or experienced to have reality slap you in the face, so expect that you will have some bumps along the pathway but don't overcorrect and drive off the cliff.
Back to my recollection of the young CA-1 last year: At the last clinical competency review committee meeting I attended, her reviews had changed from "hesitant, nervous, needs to read more, sub par airway management skills" to "superior performance, confident and knowledgeable, has a chance to be chief resident as a CA-3" in only 6 months. You too will have that growth over the next six months. By the end of your CA-1 year, you will have to fight the specter of complacency and OVERCONFIDENCE.
