How confident should I feel at this point?

[IonClaws]

PGY-1 internal med in specialty field residency, about 5 months into intern year.

Yeah, so at this point, I feel sort of ok doing stuff for patients, particularly after a recent 2-week nights stint with only myself and senior. I know to trend troponins and EKGs with chest pain, give KCl for low potassium and how fast to run it in peripheral vs central venous access, how to treat SVT vs. afib with RVR (vagal maneuvers, adenosine, and/or verapamil for the former, metoprolol tartrate/diltiazem, first IV push, then either dilt or even esmolol drip in ICU for the latter), how to treat inpatient htn (hydralazine low dose 1-3 times tab or IV, then cardizem drip in ICU for stubborn HTN), and more or less how to approach sepsis (usually levophed or other pressor drip, abx, blood and/or urine cx depending on symptoms). The finer points of insulin for T2 diabetics inpatient is still somewhat of a mystery but I feel ok giving extra short-acting insulin based on previously ordered sliding scale insulin. I'm not really into procedures like putting in central lines and stuff like that.

I still feel really nervous, like I'm not doing enough and like I'm an idiot daily. How normal is this to feel almost halfway into intern year??

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[Gastrapathy]

Completely normal. Its the interns who don't feel nervous after a few months who are really dangerous.

 

[857937]

You should feel nervous because from your description above you still know nothing.

Keep an open mind and keep on learning.

Always double check with your seniors even for silly stuff.

 

[Perrotfish]

I still feel really nervous, like I'm not doing enough and like I'm an idiot daily. How normal is this to feel almost halfway into intern year??

1) Yes its normal

2) Make sure you are getting feedback. Its normal to feel like an idiot, its NOT normal to have your attendings tell you that you're struggling.

 

[rokshana]

PGY-1 internal med in specialty field residency, about 5 months into intern year.

Yeah, so at this point, I feel sort of ok doing stuff for patients, particularly after a recent 2-week nights stint with only myself and senior. I know to trend troponins and EKGs with chest pain, give KCl for low potassium and how fast to run it in peripheral vs central venous access, how to treat SVT vs. afib with RVR (vagal maneuvers, adenosine, and/or verapamil for the former, metoprolol tartrate/diltiazem, first IV push, then either dilt or even esmolol drip in ICU for the latter), how to treat inpatient htn (hydralazine low dose 1-3 times tab or IV, then cardizem drip in ICU for stubborn HTN), and more or less how to approach sepsis (usually levophed or other pressor drip, abx, blood and/or urine cx depending on symptoms). The finer points of insulin for T2 diabetics inpatient is still somewhat of a mystery but I feel ok giving extra short-acting insulin based on previously ordered sliding scale insulin. I'm not really into procedures like putting in central lines and stuff like that.

I still feel really nervous, like I'm not doing enough and like I'm an idiot daily. How normal is this to feel almost halfway into intern year??

You’re normal

 

[FutureInternist]

Attending for 5 years and I still wake up each day thinking “How am I going to mess up today” and “Who will I kill today”.
For me that is the only way to not get complacent