Feelings of inadequacy

[agranulocytosis]

As the first month of residency has come and gone, I am beginning to harbor the constant feelings of inadequacy. There's always something I feel as though I can do better, like having the foresight to know the social dispo and mention it before someone asks, to following up with a discharge of a patient being set and ready to go but who ends up staying because he feels like he's not ready to leave yet.

As a prelim vying for a categorical spot in the coming match cycle, is this normal? Over the past couple of weeks I feel as though as I'm totally lagging behind, even though no one's told me. I'm in constant anxiety because I know I have to be on the top of my game, but I feel like I'm always apologizing for something that I should know or know how to do.

Any reassurance or constructive criticism is welcome as I need to either relax or definitely step things up a few notches in the coming weeks before app season opens.

 

[SocialistMD]

As the first month of residency has come and gone, I am beginning to harbor the constant feelings of inadequacy. There's always something I feel as though I can do better, like having the foresight to know the social dispo and mention it before someone asks, to following up with a discharge of a patient being set and ready to go but who ends up staying because he feels like he's not ready to leave yet.

There is a reason surgical training is 5 years. Everyone has these problems, you just seem to have the insight to realize it in yourself. Don't sweat it; you likely aren't any worse than your co-interns.

 

[ZagDoc]

Same feelings. Every other intern I've talked to feels the same way. You don't realize how easily things can go awry with patients until you're the one responsible for them.

Great quote given by an attending the other day: "Great insight comes from experience and experience comes from poor insight." I think most things "we learn to predict" (whether its social issues with dispo, ordering that post-op CXR, etc) come from the times we don't do it and get burned.

 

[dpmd]

I think most things "we learn to predict" (whether its social issues with dispo, ordering that post-op CXR, etc) come from the times we don't do it and get burned.

Or even better, is when we see other people missing things and pay attention/ remember/apply if in the future (have seen plenty of people fail in one of those three aspects and that is enough to look bad the next time).

The fact that you feel inadequate means one of two things.
1. You are actually not doing as well as you should and you know it (probably you would have been told this by now, but as long as you know it and are improving it should work out).
2. You hold yourself to a higher standard and therefore when you fail to reach it you end up at an acceptable level and people think you are doing fine or maybe even doing well (and you will probably always find something to feel inadequate about, but again it will just make you better)

 

[SLUser11]

As the first month of residency has come and gone, I am beginning to harbor the constant feelings of inadequacy. There's always something I feel as though I can do better, like having the foresight to know the social dispo and mention it before someone asks, to following up with a discharge of a patient being set and ready to go but who ends up staying because he feels like he's not ready to leave yet.

As a prelim vying for a categorical spot in the coming match cycle, is this normal? Over the past couple of weeks I feel as though as I'm totally lagging behind, even though no one's told me. I'm in constant anxiety because I know I have to be on the top of my game, but I feel like I'm always apologizing for something that I should know or know how to do.

Any reassurance or constructive criticism is welcome as I need to either relax or definitely step things up a few notches in the coming weeks before app season opens.

My opinion may contrast the previous posts, and probably make me look like a jerk, but I've always tried to be completely honest.

It is quite possible that you are under-performing. Since you are a prelim, the expectations may also be low, and you won't necessarily receive appropriate feedback. DPMD said you would have been told by now if you were doing poorly, but I don't think that's true. Often, people will just talk about you behind your back, and you won't know until it's too late.

I can't remember where you did med school, but I think it was in the Caribbean. Do you think it's possible that your school did not adequately prepare you for intern year? Is there a way for you to measure your performance against the other interns? Do they seem equally confused and nervous? I think it's obvious that not all interns are created equally. It's important to ensure that you're not considered the "weak intern," because every program has one.

I think you are in a tough spot because many of your feelings are normal for a brand new intern, but you are right that as a prelim, you are always under a microscope, and a strong performance is crucial to your future in surgery.

So what can you do? Well, there are some things that are out of your control, such as inherent bias against prelims and IMGs, and lack of experience. But there are other things that are within your control, and this is where you should concentrate. The rest of my post is unsolicited advice, and you can ignore it if you want.

First of all, be sure to work extremely hard, and never let your co-interns out-work you. That means longer hours, more patients, etc. Never mention your work hours or post-call status, and never dump consults or busy-work on other residents. If you split prerounding in the AM, be sure to always get there earlier and see a few more patients than your coworkers.

Secondly, be sure to read a lot. Anytime you encounter a clinical subject that you don't understand well, go home and master it. Anytime you see a drug or dosage you don't know, look it up immediately. Anytime you have an OR case, know the anatomy very well and the steps to the case. You have to have a voracious intellectual appetite that can never be satiated....i.e. a sponge soaking up clinical knowledge.

Thirdly, be sure to practice constantly to improve your technical skills. Even if you're pretty good at suturing and knot tying, become better. Work in the lab on laparoscopic stuff or endoscopy. Use your non-dominant hand. Improve your speed.

Next, it's important to find a mentor that you respect and you can trust. I would find a senior resident (PGY-4 hopefully) and also an attending. Use these people for advice, and get as much feedback as possible. The PGY-4 is more likely to hear if you are underperforming than you are. Sit down with your bosses next week and ask for advice on improvement (basically a mid-rotation eval). Don't wait for them to volunteer information, because it may not come.

Lastly, be sure to have an outlet for frustration outside of work. For you, this may be weightlifting. This was a similar outlet for me, and it can be very cathartic. Don't get in the habit of complaining or s#@t-talking your program or residents/attendings to others, because this may ultimately get back to the wrong people.

If you do all these things, you may still feel nervous overall, but you'll have some comfort in knowing that you've done everything possible to maximize your performance.

Good luck.

 

[dpmd]

SLUser is right. Just because I always make it completely clear when someone on my service is not measuring up to my expectations (which may or may not be set too high), does not mean that other people are doing that. My program has traditionally been fairly good at letting the weak residents know they are weak and what they need to shape up on (at least as far as I could tell), even if it was just the chief and not necessarily from the attendings. It would be nice if that was more universal instead of just talking crap behind the back since at least then there is a better chance for improvement (especially for those folks that don't know they suck).

 

[SocialistMD]

It would be nice if that was more universal instead of just talking crap behind the back since at least then there is a better chance for improvement (especially for those folks that don't know they suck).

I think that is program-dependent. While I don't enjoy the behind-the-back talking, either, the residents that I have seen at my program that weren't any good and had no insight to that fact didn't change even when it was brought to their attention by senior residents and faculty. They just assumed they were right and the faculty were wrong. Most of them are no longer residents here. If you are at a place with residents who have never failed (or even been average) in life, they are reluctant to believe that they may be underperforming, sometimes defiantly so.

 

[SLUser11]

If you are at a place with residents who have never failed (or even been average) in life, they are reluctant to believe that they may be underperforming, sometimes defiantly so.

Agreed. I am always very vocal about what the junior residents are doing wrong and right. I provide frequent feedback, and it's not always received well. I don't want to sound sexist, but the females tend to be the least receptive to criticism for some reason...it might be a local effect.

I've had to modify my techniques a little to adjust for this. Now, I always start out by telling them something they have done well, then after their ego is adequately fluffed, I gently let them know of areas for improvement. Otherwise, the residents can get defiant and defensive, and then the entire teaching point is lost because they're just pissed off.

I guess I need to get all my inflammatory posts out of the way in this thread. I apologize to all females and IMGs that feel attacked.

 

[dpmd]

Agreed. I am always very vocal about what the junior residents are doing wrong and right. I provide frequent feedback, and it's not always received well. I don't want to sound sexist, but the females tend to be the least receptive to criticism for some reason...it might be a local effect.

I've had to modify my techniques a little to adjust for this. Now, I always start out by telling them something they have done well, then after their ego is adequately fluffed, I gently let them know of areas for improvement. Otherwise, the residents can get defiant and defensive, and then the entire teaching point is lost because they're just pissed off.

I guess I need to get all my inflammatory posts out of the way in this thread. I apologize to all females and IMGs that feel attacked.

I guess I can see that criticism by a man can be difficult for some women (either getting defensive with it, or being overly sensitive), just like some men have a hard time getting criticism from a woman chief (feel emasculated so ignore or argue back).

It may seem overly touchy feely, but the technique you describe is supposedly the best way to teach adults.

 

[ESU_MD]

Theres nothing wrong with a little discipline and guidance in our profession. I think the pendulum has swung too far to the "give everyone a chance" side. Unfortunately, some people just arent willing to work hard enough to learn surgery, or arent capable and they should be weeded out along the way somehow.

SLU do you have much interaction with the UT gen surg residents? There was a time not too long ago when they actually had a reputation in the med center as the most malignant program with an almost pyramidal turnover rate. Unsure if this was due to getting some bad apples in the match, or other factors.

 

[SLUser11]

SLU do you have much interaction with the UT gen surg residents? There was a time not too long ago when they actually had a reputation in the med center as the most malignant program with an almost pyramidal turnover rate. Unsure if this was due to getting some bad apples in the match, or other factors.

I don't interact with them much, but I have a good friend in the program. I think they've earned a lot of their reputation, but things have gotten better. There's an old thread on the topic that included some resident pictures that I won't dredge up.

Their reputation as clinicians and technicians is actually pretty good, and attendings seem to prefer to work with them over Methodist or Baylor residents.