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.