Feeling not competent?

[Doctor Bagel]

I started a thread earlier about juggling too many things as a 2nd year, and I'm thinking maybe this is all part of this. Anyway, I've had a few not so great experiences in the past 6 months, including a slightly negative 2nd month of IM wards (did really well in October and kinda mediocre in April largely due to knowledge gaps between me and medicine folks who had been doing medicine all year), a non-enjoyable EM month with average evals and now a transition back to psychiatry with all that 2nd year stuff where I'm juggling a state hospital rotation with call at acute facilities and starting outpatient work.

Just got another super average eval for the state hospital component, and earlier this year hit some super negative comments from nursing about a difficult night on call (started a thread about that one, too, in the residency forum if you're interested). This plus my clinic stalling (lots of appointment issues + me going into nightfloat in a week) has led me feeling fairly frustrated and like I'm really not mastering things the way I should. Oh yeah, and I just took step 3 and have this lingering worry that I failed.

Anyway, I'm just feeling very frustrated with this year and having the feeling that I'm not where I should be and that it's my fault. Unfortunately, I'm not entirely sure how to remedy it either. Frustratingly I did really well in med school (good step scores, AOA, etc.) and got pretty used to positive feedback. Now, I keep on hearing I'm doing OK with nothing really good, and I'm trying to figure out if that's an issue or if my expectations are all screwed up. And yeah, I know, everyone likes it when people like me wind up not being so great, which is again feeding into my negative feelings about my performance. Again, I'm neurotic! Anybody else feel this way? Am I doing as crappy as I feel like I'm doing? Will I feel better later in my training? Jeez.

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[Doctor Bagel]

Well, bumping my own thread. I've been thinking more about this and have realized a big part of the feedback is honestly related to the attending and not to me. I feel a need for a little more affirmation than I got, but this attending is honestly not the person who's going to give that. Hopefully I get that elsewhere this year.

Other thought, again, I think 2nd year is more challenging than internship in lots of ways. I've talked to my classmates, and we're split on this one. A few overall feel more competent and less stressed out, but I think the majority feels a little worse. The competent feeling folks appear to be the people doing nightfloat, so maybe I'll get a little boost to my self confidence in the next few months.

3rd thought, starting psychotherapy training has left some of us a little raw. Even without participating in my own therapy, it's bringing up stuff. It's certainly bringing up my emotions, which I did a lot of suppression of last year.

 

[OldPsychDoc]

This may help.

 

[siked]

Feel your pain. Had a rough day at work and am just generally not enjoying being a third-year. I quickly realized that I hate doing therapy, and find myself hoping far too frequently that patients won't show up. Got a bad evaluation recently from an Attending and just have to step back and realize that it's her issues, and not mine.

 

[F0nzie]

I think you're being too hard on yourself... you probably don't feel competent because you may be over relying on others for positive feedback right now. I think you should try to accept feedback whether positive or negative and use it constructively. But I also I think it's probably hard for you to see that right now with all the major stressors ie. rotation transitions, call, and recently taking Step 3. In medical school it was easier to objectively measure your accomplishments, but not anymore. Now your sense of accomplishments need come FROM WITHIN...trust yourself!

I feel your pain...the period in which you're waiting for step 3 scores is rough. I studied harder for step 3 than I studied for step 1 and 2 combined and I still found it was a HARD test. But remember there are folks in other specialties outside of family medicine and internal medicine that have to take that test. I saw a neurosurgery resident after taking step 3 and he was like "wtf". I promise once you pass step 3 and get your license you'll be alot less stressed out. Maybe even stress-free... I'm already having a premature case of senioritis

 

[cookymonster]

I'm a 2nd year who's on my 18th straight day of work, and I'm staring at 36 hours of call this weekend. My sister got fired from her job this week. When I called her, she astutely asked if I was envious, and I had to admit that I was. I guess I'll watch Office Space again tonight with a bowl of ice cream

I feel like the retention of what I read and learn is extremely poor, and I get so frustrated by having to look the same things up over and over and over and over again (is anyone else frustrated because they can't remember all the DSM criteria for PTSD after years of trying?). The intellectual reserve I have for reading journals and textbooks at the end of a 12-hour day is minimal. I feel like I can't provide the best care without referencing some kind of text, which doesn't really work for face-to-face on-the-fly encounter.

 

[peppy]

I quickly realized that I hate doing therapy, and find myself hoping far too frequently that patients won't show up.

Are you in a program that emphasizes one particular kind of therapy or is there something about all therapy that you hate? Psychodynamic psychotherapy is really not my thing, but CBT and DBT do seem very useful to me.

 

[peppy]

Other thought, again, I think 2nd year is more challenging than internship in lots of ways. I've talked to my classmates, and we're split on this one. A few overall feel more competent and less stressed out, but I think the majority feels a little worse.

I agree that 2nd year is harder in some ways. People expect more of you yet you're still relatively inexperienced. I also think that starting to see outpatients is challenging because you don't have the controlled environment of the hospital unit and there is less supervision. It sounds to me like you're doing fine (both because others in your class feel the same way and because it sounds like your program is the kind of place where the leaders aren't shy about telling people if they have a problem with their performance). I bet you will feel better once you've passed step 3 and had some more time to gain confidence.

 

[zenman]

I'm a 2nd year who's on my 18th straight day of work, and I'm staring at 36 hours of call this weekend. My sister got fired from her job this week. When I called her, she astutely asked if I was envious, and I had to admit that I was. I guess I'll watch Office Space again tonight with a bowl of ice cream

I feel like the retention of what I read and learn is extremely poor, and I get so frustrated by having to look the same things up over and over and over and over again (is anyone else frustrated because they can't remember all the DSM criteria for PTSD after years of trying?). The intellectual reserve I have for reading journals and textbooks at the end of a 12-hour day is minimal. I feel like I can't provide the best care without referencing some kind of text, which doesn't really work for face-to-face on-the-fly encounter.

Have you tried: Remembers Atrocious Nuclear Attacks
R=re-experiencing through intrusive memories, nightmares, and/or flashbacks
A/N=avoidance/numbing of stimuli-amnesia of trauma, restricted affect, detachment, foreshortened future
A=arousal increased-insomnia, irritability, hypervigilance, startle response, poor concentration

 

[cookymonster]

I remember the three basic symptom clusters. It's remembering all the components of each cluster and how many are required that drives me nuts.

 

[nitemagi]

DSM is a foundation but only a starting point. There's a lot of strategies for learning them, or learning anything. My first chief resident used to take 1 major article a week and read/understand/dissect it really well, so she could reference it in the future. Others use quick reference flashcards, used in minutes between things. I listen to podcasts (AJP, institute of psychiatry, NEI) while at the Gym.

I suspect by the end of this year (or even now) you'll be impressed with how much knowledge you've already accumulated. The trick is to not become complacent and stop learning, which is where a lot of physicians in general end up -- coasting on their knowledge and not continuing to improve.

 

[Sneezing]

At some people you need to switch over from attending evaluations for self worth and place the feedback as a minor contributor. Start looking within as the previous poster said for what needs improving and work on it at the best pace you can. Anything else is useless self flagellation destined to burn you out.

 

[Doctor Bagel]

I definitely need to stop relying as much as external things like evals, but it's hard to extinguish that trait. Anyway, I'm feeling better now. Moving on to nightfloat and actually feel up for it.

About my program, my feeling about it now is that it's overall pretty supportive. The attending I just rotated with is actually a nice person who does a lot of teaching. She's just not a pep talk giving type of person. Also, my last rotation (state hospital) was really emotionally draining. I walked away liking psychiatry again, but I have a lot of lingering sadness around the patients there.

 

[JamesPhilly]

I definitely need to stop relying as much as external things like evals, but it's hard to extinguish that trait.

Let me get this straight: you have 1 year of consistently average evals and, upon reflection, your conclusion is to disregard outside constructive feedback from now on?

My goodness. This is why I never created a username. These thinly-veiled narcissistic threads provide too much temptation to reply with equally inane retorts.

I am envious of people like you who I think of as natural swimmers. You have talked a lot, now and in previous posts, about just how great you did in medical school. That's the frustrating thing to me: you're most likely an incredibly smart person, and there's no way that you are unable to see the answer that's literally in front of you, even written down.

I doubt that your evals just have 'ok' ticked down the line with no comments. I read your post about the nurses; you screwed up, and now you know how to stop that from happening in the future. You mention that you didn't do as well in April in your eval because you didn't know as much medicine as others. What's the problem here?

Your conclusion, to ignore 'external things like evals', is quite possibly one of the stupidest things I've ever heard, and I've worked at McDonald's. I imagine that's why you feel compelled not to 'extinguish that trait', because a smart person interested in improving outcomes would think that ridiculous.

Stop making excuses and listen to your colleagues.

 

[Doctor Bagel]

Let me get this straight: you have 1 year of consistently average evals and, upon reflection, your conclusion is to disregard outside constructive feedback from now on?

My goodness. This is why I never created a username. These thinly-veiled narcissistic threads provide too much temptation to reply with equally inane retorts.

I am envious of people like you who I think of as natural swimmers. You have talked a lot, now and in previous posts, about just how great you did in medical school. That's the frustrating thing to me: you're most likely an incredibly smart person, and there's no way that you are unable to see the answer that's literally in front of you, even written down.

I doubt that your evals just have 'ok' ticked down the line with no comments. I read your post about the nurses; you screwed up, and now you know how to stop that from happening in the future. You mention that you didn't do as well in April in your eval because you didn't know as much medicine as others. What's the problem here?

Your conclusion, to ignore 'external things like evals', is quite possibly one of the stupidest things I've ever heard, and I've worked at McDonald's. I imagine that's why you feel compelled not to 'extinguish that trait', because a smart person interested in improving outcomes would think that ridiculous.

Stop making excuses and listen to your colleagues.

Dude, jeez. I'm certainly planning on listening to constructive feedback, but I'm going to attempt to be less ego invested in them. Also, the downside with these average evals is that they're not accompanied by constructive advice either. They're pretty much "You're OK and where you should be." And the medicine thing sounds like a defense (I know it does), but there's not a single psych resident who doesn't have knowledge gaps when they rotate in medicine later in the year. We are coming from a disadvantaged position, and it makes for a stressful time.

As for the nursing thread, what would you have done differently? Just curious. Also, it looks like you're not a resident, so I'm wondering how much you know about what our experiences are like.

 

[Doctor Bagel]

I feel your pain...the period in which you're waiting for step 3 scores is rough. I studied harder for step 3 than I studied for step 1 and 2 combined and I still found it was a HARD test. But remember there are folks in other specialties outside of family medicine and internal medicine that have to take that test. I saw a neurosurgery resident after taking step 3 and he was like "wtf". I promise once you pass step 3 and get your license you'll be alot less stressed out. Maybe even stress-free... I'm already having a premature case of senioritis

Seriously! It's a hard test, and people really minimize its difficulty. I'll get my score in about 2 weeks, and yeah, I'll feel so much better if I pass.

 

[Doctor Bagel]

I'm a 2nd year who's on my 18th straight day of work, and I'm staring at 36 hours of call this weekend. My sister got fired from her job this week. When I called her, she astutely asked if I was envious, and I had to admit that I was. I guess I'll watch Office Space again tonight with a bowl of ice cream

I feel like the retention of what I read and learn is extremely poor, and I get so frustrated by having to look the same things up over and over and over and over again (is anyone else frustrated because they can't remember all the DSM criteria for PTSD after years of trying?). The intellectual reserve I have for reading journals and textbooks at the end of a 12-hour day is minimal. I feel like I can't provide the best care without referencing some kind of text, which doesn't really work for face-to-face on-the-fly encounter.

About 100% how I feel. I have this notion that I should have the DSM memorized by now, and I just plain don't. And yeah, outside reading just isn't happening, which I feel guilty about.

 

[JamesPhilly]

Dude, jeez. I'm certainly planning on listening to constructive feedback, but I'm going to attempt to be less ego invested in them.

Why? You seem to have no problem defining yourself with other evals from the past when it suited you. How many times have you mentioned your AOA status now? So why define your ego with only bits of reality? Why not get some balance and include some feedback that's unglowing for once?

Again, what is the problem here?

Also, the downside with these average evals is that they're not accompanied by constructive advice either. They're pretty much "You're OK and where you should be."

How is that not constructive feedback?

So, based on how much you kicked ass in med school, you were expecting them to say...what exactly? That you were the best resident ever? And instead you created a thread because they commented that you were a good doctor, and were doing the right things. And, by extension, you should keep doing those things that you are doing. That sounds totally ego crushing.

Jesus, can you hear yourself talk? And to round that all off you bumped your own thread after no-one would humor you with a response. Honestly.

And the medicine thing sounds like a defense (I know it does), but there's not a single psych resident who doesn't have knowledge gaps when they rotate in medicine later in the year.

Your whole post reeks of a (poor) defense.

Of course you don't know everything there is to know, and I'm not saying you are failing from an intellectual standpoint in your studies. What I'm saying is, you're whining when you have nothing to whine about, and you're doing a poor job growing as a professional if you do not heed the words of your colleagues.

Also, it looks like you're not a resident, so I'm wondering how much you know about what our experiences are like.

Here's a take home point Dr. Bagel: you are not special. Sure, you are unique as a person, your job is different from other forms of employment, and you probably have to deal with things I don't, like sexism. But regarding the former, many of us have worked in the real world for years. I have heard others talk about how hard med school and residency is, about how it's so much different than anything else, but really it's a job, and it's not completely alien. Things like evaluations, getting your ass handed to you at work, and having to get along with others is not unique to you or your profession.

 

[tkim]

Here's a take home point Dr. Bagel: you are not special. Sure, you are unique as a person, your job is different from other forms of employment, and you probably have to deal with things I don't, like sexism. But regarding the former, many of us have worked in the real world for years. I have heard others talk about how hard med school and residency is, about how it's so much different than anything else, but really it's a job, and it's not completely alien. Things like evaluations, getting your ass handed to you at work, and having to get along with others is not unique to you or your profession.

Mean MS3. Will not see.

 

[Doctor Bagel]

Why? You seem to have no problem defining yourself with other evals from the past when it suited you. How many times have you mentioned your AOA status now? So why define your ego with only bits of reality? Why not get some balance and include some feedback that's unglowing for once?

Again, what is the problem here?



How is that not constructive feedback?

So, based on how much you kicked ass in med school, you were expecting them to say...what exactly? That you were the best resident ever? And instead you created a thread because they commented that you were a good doctor, and were doing the right things. And, by extension, you should keep doing those things that you are doing. That sounds totally ego crushing.

Jesus, can you hear yourself talk? And to round that all off you bumped your own thread after no-one would humor you with a response. Honestly.



Your whole post reeks of a (poor) defense.

Of course you don't know everything there is to know, and I'm not saying you are failing from an intellectual standpoint in your studies. What I'm saying is, you're whining when you have nothing to whine about, and you're doing a poor job growing as a professional if you do not heed the words of your colleagues.



Here's a take home point Dr. Bagel: you are not special. Sure, you are unique as a person, your job is different from other forms of employment, and you probably have to deal with things I don't, like sexism. But regarding the former, many of us have worked in the real world for years. I have heard others talk about how hard med school and residency is, about how it's so much different than anything else, but really it's a job, and it's not completely alien. Things like evaluations, getting your ass handed to you at work, and having to get along with others is not unique to you or your profession.

5 posts on SDN, and two of them are specifically devoted to attacking me. I think most people wait 'til they hit at least 500 posts before displaying so much vitriol. Anyway, I'm out (from my conversation with you). I appreciate the helpful replies. And if anybody else wants to share anything about 2nd year, come on and do it.

 

[tkim]

5 posts on SDN, and two of them are specifically devoted to attacking me. I think most people wait 'til they hit at least 500 posts before displaying so much vitriol. Anyway, I'm out (from my conversation with you). I appreciate the helpful replies. And if anybody else wants to share anything about 2nd year, come on and do it.

Residency is a time of great uncertainty all the time. Do what you can to survive it. When you get out intact, your internal compass will return. You're okay. That is all.

 

[Doctor Bagel]

Residency is a time of great uncertainty all the time. Do what you can to survive it. When you get out intact, your internal compass will return. You're okay. That is all.

Thanks. As a person who actually has so called "real world" experience before joining medicine, it's still surprising just how different (and challenging) our experiences are.

 

[JamesPhilly]

5 posts on SDN, and two of them are specifically devoted to attacking me.

'Attacking' you? I called you a 'natural swimmer' who was 'incredibly smart', but foolishly ignored good advice from your peers. Not only do you believe anything less than a positively glowing review should be discarded, apparently you also think it's an attack.

As a person who actually has so called "real world" experience before joining medicine, it's still surprising just how different (and challenging) our experiences are.

I may be harsh in my criticism, but everything I've said to you has been constructive. I reread your thread and I don't think this is an overly sensitive topic: you didn't have a pt commit suicide, you weren't accosted in the hospital, etc. Receiving the equivalent of a 'B' or 'B+' and gaining constructive feedback from your peers does not translate to 'challenging'.

I think most people wait 'til they hit at least 500 posts before displaying so much vitriol.

I think 'most people' hit 500 posts and realize they should go outside more often. I'm sorry, but trying to pull the "I have more SDN posts than you, and am therefore superior" card is fairly lame. From your replies, it does seem all you have is that ad hominema ttack.

 

[Doctor Bagel]

The ignore list is pretty awesome.

On work updates, my one nightfloat shift so far was pretty easy. This might be a good rotation -- no juggling of tasks.

 

[tkim]

The ignore list is pretty awesome.

Yep, though it would be better if you didn't even know they were posting. Now *that's* what I would call an ignore button.

 

[DD214_DOC]

Dude, chill out. Each of our rotations is based on a performance scale of 1-5, with 1 being, "you should leave medicine" and 5 being, "you are ahead of your academic level". 3 is considered average.

All through intern year I got nothing but 4s and 5s. Then one month I got a 3. I was upset, but quickly realized, "who cares? It's not a 1 or 2". I listened to what the evaluator thought made me, "at my academic level" and worked on it. So far during PGY2, I have nothing but 4s and 5s. I'm sure at some point I will get a 3. Then, I will do the same thing.

If we functioned above the level of a resident all the time, we wouldn't be residents.

 

[Cinnameg]

Well, bumping my own thread. I've been thinking more about this and have realized a big part of the feedback is honestly related to the attending and not to me. I feel a need for a little more affirmation than I got, but this attending is honestly not the person who's going to give that. Hopefully I get that elsewhere this year.

Other thought, again, I think 2nd year is more challenging than internship in lots of ways. I've talked to my classmates, and we're split on this one. A few overall feel more competent and less stressed out, but I think the majority feels a little worse. The competent feeling folks appear to be the people doing nightfloat, so maybe I'll get a little boost to my self confidence in the next few months.

3rd thought, starting psychotherapy training has left some of us a little raw. Even without participating in my own therapy, it's bringing up stuff. It's certainly bringing up my emotions, which I did a lot of suppression of last year.

So, I was a med student who worked with you when you were an intern, and I thought you were great.

People get really lazy with evaluations, and it's all about how much they thought you were fun to hang out with and not at all about how good a psychaitrist they think you are, or how good a doctor they think you are. You just can't take it too seriously. When I've been on rotations where I've been really curious and asked lots of questions, I get told that I'm great personality-wise but my knowledge base is lacking. When I'm quiet and pretend I know stuff, I get told I need to improve my attitude but my knowledge base and clinical skills are fantastic. Arriving at Harvard for my first rotation, which was emergency psychiatry, I was totally intimidated and went with the latter route, and got the expected feedback. Now on neurology for my second rotation I've decided to ask lots of questions, since it could very well be my last chance to learn neurology, and probably I'll get the feedback that I don't know as much as the medical students. So, it's all a wee bit pointless, the whole thing.

In any case, Bagel, I think you're awesome.

(You should also know that one of the assistant program directors knows your screenname and browses SDN. He knows mine too. Don't worry, I didn't tell him, there are just few enough of us on here.)

 

[Cinnameg]

Dude, chill out. Each of our rotations is based on a performance scale of 1-5, with 1 being, "you should leave medicine" and 5 being, "you are ahead of your academic level". 3 is considered average.

All through intern year I got nothing but 4s and 5s. Then one month I got a 3. I was upset, but quickly realized, "who cares? It's not a 1 or 2". I listened to what the evaluator thought made me, "at my academic level" and worked on it. So far during PGY2, I have nothing but 4s and 5s. I'm sure at some point I will get a 3. Then, I will do the same thing.

If we functioned above the level of a resident all the time, we wouldn't be residents.

Way to brag about your own evaluations in the guise of giving comfort to somebody else. Not cool, man.

 

[Doctor Bagel]

So, I was a med student who worked with you when you were an intern, and I thought you were great.

People get really lazy with evaluations, and it's all about how much they thought you were fun to hang out with and not at all about how good a psychaitrist they think you are, or how good a doctor they think you are. You just can't take it too seriously. When I've been on rotations where I've been really curious and asked lots of questions, I get told that I'm great personality-wise but my knowledge base is lacking. When I'm quiet and pretend I know stuff, I get told I need to improve my attitude but my knowledge base and clinical skills are fantastic. Arriving at Harvard for my first rotation, which was emergency psychiatry, I was totally intimidated and went with the latter route, and got the expected feedback. Now on neurology for my second rotation I've decided to ask lots of questions, since it could very well be my last chance to learn neurology, and probably I'll get the feedback that I don't know as much as the medical students. So, it's all a wee bit pointless, the whole thing.

In any case, Bagel, I think you're awesome.

(You should also know that one of the assistant program directors knows your screenname and browses SDN. He knows mine too. Don't worry, I didn't tell him, there are just few enough of us on here.)

I thought that was you! I think I'm over it -- my reality testing on evaluations was a little skewed from going to fluffy super friendly medical school where evals were maybe (just maybe) a tad bit inflated. And I've got some of those pesky physician perfectionistic traits.

How's internship? I hope it's going well.

 

[MonkeyNuts!]

While JamesPhilly's posts are wrapped up in thinly veiled contempt, he does strike a good point which I believe is "man up." I'm surprised he didn't go into the "there are worse things in life" argument which would have undoubtedly resulted in confirmation of Godwin's law, but there is a little merit to what he's trying to convey.

I would say in times where you feel mis-evaluated, remember the patients, which at some point in the distant past was the fleeting raison d'etre for anyone sporting the letters M.D. If your patients received what you perceive to be good care, who gives two ****s what some supervisor (who was probably not even observing you) says, you obviously did work.

 

[jettavr6]

While JamesPhilly's posts are wrapped up in thinly veiled contempt, he does strike a good point which I believe is "man up." I'm surprised he didn't go into the "there are worse things in life" argument which would have undoubtedly resulted in confirmation of Godwin's law, but there is a little merit to what he's trying to convey.

I would say in times where you feel mis-evaluated, remember the patients, which at some point in the distant past was the fleeting raison d'etre for anyone sporting the letters M.D. If your patients received what you perceive to be good care, who gives two ****s what some supervisor (who was probably not even observing you) says, you obviously did work.

"man up" is the same message I interpreted from Jamesphilly's rant. There is some truth to that.