How to head off possible failures in Residency?

[deleted815127]

Hello,
I am one of the lucky students who was matched to a program this year. I wanted some advice from any residency faculty or interns on the forum. I failed a rotation in Medical School third year and am scared of repeating that. One of the ways I combated that moving forward, is I made it a point to sit down with my attending or clerkship director midway and have a sort of midpoint eval.

In residency, however, can I do this? or like how can I get feedback from faculty and upper levels without sounding like I am suffering from crisis of confidence.

Additionally, I am scared of the following two rotations in a residency programs.
1) IM
- Most residency failure stories that I have heard or seen, usually come and hang around this rotation. I am taking preventative measures such as studying books and videos right now, however, I also want to make sure that at the end of my rotation, my senior or faculty doesn't come up and say, "listen it's not working out.."
2) OB
- I am scared of people screaming and that is what most OB is to me. I don't plan to do OB in my future practice, but, do understand that residency program needs an OB rotation to be done. Besides this, I have delivered only one "hand on hand" delivery during medical school. What can I do to seek help early on from midlevels, faculty or seniors.

What I am trying to get at I guess is, what is a safe way to ask for help, to ask for improvement, without getting a target on your back with people thinking that resident is under confident or that resident is lacking?

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[Sardonix]

Hello,
I am one of the lucky students who was matched to a program this year. I wanted some advice from any residency faculty or interns on the forum. I failed a rotation in Medical School third year and am scared of repeating that. One of the ways I combated that moving forward, is I made it a point to sit down with my attending or clerkship director midway and have a sort of midpoint eval.

In residency, however, can I do this? or like how can I get feedback from faculty and upper levels without sounding like I am suffering from crisis of confidence.

Additionally, I am scared of the following two rotations in a residency programs.
1) IM
- Most residency failure stories that I have heard or seen, usually come and hang around this rotation. I am taking preventative measures such as studying books and videos right now, however, I also want to make sure that at the end of my rotation, my senior or faculty doesn't come up and say, "listen it's not working out.."
2) OB
- I am scared of people screaming and that is what most OB is to me. I don't plan to do OB in my future practice, but, do understand that residency program needs an OB rotation to be done. Besides this, I have delivered only one "hand on hand" delivery during medical school. What can I do to seek help early on from midlevels, faculty or seniors.

What I am trying to get at I guess is, what is a safe way to ask for help, to ask for improvement, without getting a target on your back with people thinking that resident is under confident or that resident is lacking?

Why did you fail the rotation in 3rd year?

It does sounds like you are suffering a crisis of confidence/imposter syndrome. That's not an attack, that's just recognizing the fact that because of your past rotation failure you seem to feel as though you're destined to fail again. A couple things:

- I am also just an M4 soon-to-be FM intern. I understand that while I am expected to put my best foot forward, residencies are first and foremost looking for a sociable, hard working, and eager to learn intern. There will be an adjustment period. I will make mistakes. I will annoy some people. That's okay.
- Remember that you passed boards, both written and in person, passed medical school, interviewed, matched, and are soon going to graduate. That speaks to a basic level of competency already. Focus on what you accomplished to get here. Focus on the ways you rebounded from failure, not the failures themselves.
- Don't ask yourself "How can I avoid failing." That thought process implies negative connotations that bleed into self image and actions. Ask yourself "How can I succeed." I say this as someone who has a HUGE imposter syndrome issue.
- Unless you are attending an especially TOXIC residency program, no one should be angry at you for asking for regular feedback. Just be reasonable and show that you're reacting to said feedback appropriately.

 

[deleted815127]

Why did you fail the rotation in 3rd year?

It does sounds like you are suffering a crisis of confidence/imposter syndrome. That's not an attack, that's just recognizing the fact that because of your past rotation failure you seem to feel as though you're destined to fail again. A couple things:

- I am also just an M4 soon-to-be FM intern. I understand that while I am expected to put my best foot forward, residencies are first and foremost looking for a sociable, hard working, and eager to learn intern. There will be an adjustment period. I will make mistakes. I will annoy some people. That's okay.
- Remember that you passed boards, both written and in person, passed medical school, interviewed, matched, and are soon going to graduate. That speaks to a basic level of competency already. Focus on what you accomplished to get here. Focus on the ways you rebounded from failure, not the failures themselves.
- Don't ask yourself "How can I avoid failing." That thought process implies negative connotations that bleed into self image and actions. Ask yourself "How can I succeed." I say this as someone who has a HUGE imposter syndrome issue.
- Unless you are attending an especially TOXIC residency program, no one should be angry at you for asking for regular feedback. Just be reasonable and show that you're reacting to said feedback appropriately.

ThankYou.

 

[hallowmann]

Hello,
I am one of the lucky students who was matched to a program this year. I wanted some advice from any residency faculty or interns on the forum. I failed a rotation in Medical School third year and am scared of repeating that. One of the ways I combated that moving forward, is I made it a point to sit down with my attending or clerkship director midway and have a sort of midpoint eval.

In residency, however, can I do this? or like how can I get feedback from faculty and upper levels without sounding like I am suffering from crisis of confidence.

Additionally, I am scared of the following two rotations in a residency programs.
1) IM
- Most residency failure stories that I have heard or seen, usually come and hang around this rotation. I am taking preventative measures such as studying books and videos right now, however, I also want to make sure that at the end of my rotation, my senior or faculty doesn't come up and say, "listen it's not working out.."
2) OB
- I am scared of people screaming and that is what most OB is to me. I don't plan to do OB in my future practice, but, do understand that residency program needs an OB rotation to be done. Besides this, I have delivered only one "hand on hand" delivery during medical school. What can I do to seek help early on from midlevels, faculty or seniors.

What I am trying to get at I guess is, what is a safe way to ask for help, to ask for improvement, without getting a target on your back with people thinking that resident is under confident or that resident is lacking?

These are pretty normal fears. For inpatient keep reading, studying, asking for feedback and knowing your patients. It'll be a process, but hard work and adapting yo expectations goes a long way even if you have other weaknesses.

As for OB, med school OB exposure is VERY variable, and programs know this. There will be a lot of handholding initially, and that's normal. Once you get a bit more experience here, you'll a lot better.

 

[deleted815127]

These are pretty normal fears. For inpatient keep reading, studying, asking for feedback and knowing your patients. It'll be a process, but hard work and adapting yo expectations goes a long way even if you have other weaknesses.

As for OB, med school OB exposure is VERY variable, and programs know this. There will be a lot of handholding initially, and that's normal. Once you get a bit more experience here, you'll a lot better.

Thank You.

 

[Fatalis]

Hello,
I am one of the lucky students who was matched to a program this year. I wanted some advice from any residency faculty or interns on the forum. I failed a rotation in Medical School third year and am scared of repeating that. One of the ways I combated that moving forward, is I made it a point to sit down with my attending or clerkship director midway and have a sort of midpoint eval.

In residency, however, can I do this? or like how can I get feedback from faculty and upper levels without sounding like I am suffering from crisis of confidence.

Additionally, I am scared of the following two rotations in a residency programs.
1) IM
- Most residency failure stories that I have heard or seen, usually come and hang around this rotation. I am taking preventative measures such as studying books and videos right now, however, I also want to make sure that at the end of my rotation, my senior or faculty doesn't come up and say, "listen it's not working out.."
2) OB
- I am scared of people screaming and that is what most OB is to me. I don't plan to do OB in my future practice, but, do understand that residency program needs an OB rotation to be done. Besides this, I have delivered only one "hand on hand" delivery during medical school. What can I do to seek help early on from midlevels, faculty or seniors.

What I am trying to get at I guess is, what is a safe way to ask for help, to ask for improvement, without getting a target on your back with people thinking that resident is under confident or that resident is lacking?

failing a rotation in residency is quite difficult unless something major happens. Anyone I know that failed a rotation as a resident 1) did not care 2) didn't know what they were doing/ didn't read up on stuff before having a plan....which stemmed for #1 3) lacked judgement; they were repeatedly told this/ways to fix it but thought they were doing fine...again see #1
I never delievered a baby before starting residency, never did a pelvic exam [my ob rotation was the worst as ms3], I let my upper levels know this/ where I stood AT THE BEGINNING OF THE ROTATION so they knew "that fatalis guy don't know ****" but I let them know "I know nothing but I am willing to learn" and OB turned out just fine because I was willing to learn.
Honestly the best piece of advice for being an intern: assume you know nothing when you start and you will learn. You are no longer a messenger! Even if you are dead wrong, have a plan!

 

[icykelp]

Thanks for that Fatalis. The imposter syndrome is strong with me. As a male, I spent most of the time being told to stand outside the room when it came to pelvic exams during ms3.

 

[Fatalis]

Thanks for that Fatalis. The imposter syndrome is strong with me. As a male, I spent most of the time being told to stand outside the room when it came to pelvic exams during ms3.

imposter syndrome never goes away; as long as you try that is what counts

 

[TableMD]

Ill try to help
Inpatient
- have an index card about each of your patients: SOAP to keep in your white coat and have a copy of pocket medicine
- example: Mrs F 62 yo female admitted for Sepsis Pulm Source
S (subjective) - feeling well, some dyspnea overnight, improved by duoneb q4, otherwise no issues
0: 135/70, 95, 18, 98%, pertinent labs
A: 62 yo F w/ CAP, satting well, on ceftriaxone day 2, solumedrol, azithro
P: transition to PO Augmentin [ ], #mg, q#hrs, q#days
, PO Azithro [ ] #mg, q#hrs, q#days
PO Prednisone [ ] #mg, q#hrs, q#days
d/c to home after afebrile on above for 24 hours (no PT/OT concerns)
- d/c hospital homolog, restart home Metformin
- other home meds will remain in place following d/c
- complete hospital summary [ ], will be ready for AM d/c [ ]
With the above in place, you will have a check list for tasks that need to get done, so you check them off as orders are placed
- to supplement, each time you have an admission, make sure you pull up uptodate/dynamed/pocket medicine for
1.) diagnostic criteria (hx, physical, imaging)
2.) treatment interventions
3.) treatment monitoring
4.) treatment side effects (GI/cardiac), plan for how to monitor (labs/ekg)
5.) criteria for discharge
- EVERY patient that you admit should include criteria for d/c, if you don't know what it would take for them to go home, you are INCOMPLETE in bringing them in
- Be able to use the computer to place orders and look stuff up
- Good interns: pay attention, prove to be reliable using computer, know patients well (should be checking with nurses for how everyone is doing)
- try to pull articles on disease processes for new patients
- If I am the senior and I send you for an admission, I dont expect you to know all this stuff, what I do expect is
1.) a coherent history, in order, of what happened and why they are there
2.) why they need hospital level care and can't be taken care of outpatient
3.) a general idea of what you want to do about it
- I DO expect you to look all this stuff up

Inpatient Days
- 6 AM arrival, see sick patients first, get the S in your plans above, make sure labs that will be needed have been ordered/percolating
- do a decent exam on all patients (everyone gets heart/lungs/vascular/pertinent skin/can they walk/move independently/orientation
- a critical time when you are protected from being paged!
- 7AM sign out from night service, take down over night events on your patients and pending labs they may have ordered, be sure to check and take down when done
- sign out over
1.) place orders
2.) check with consultants if anything is missing
3.) check with nurses if any pending concerns
rounds: 10 AM (or whenever)
- present each patient
- keep brief, but know more than what you say, stick to SOAP format (your senior/attending can always ask for more info)


- make sure you know your patients well, with priority being
1.) why they are admitted
2.) what hospital is doing for them
3.) what it will take to safely discharge them

OB
- I am a sports doc, had a G4, P3 at 37 weeks whom I found out about a few minutes before a 10K I was providing med care for. Needless to say the plan was for her to contact volunteers if something happened, thank god it didn't.
- learn what you can, very few (but a decent minority nonetheless) go into OB, but you are expected to be
1.) a good historian
2.) know the patients
3.) have a good attitude and show initiative


Good luck
- ask seniors for feedback often, its not a bad thing to prove that you are TEACHABLE

 

[drake19]

Hello,
I am one of the lucky students who was matched to a program this year. I wanted some advice from any residency faculty or interns on the forum. I failed a rotation in Medical School third year and am scared of repeating that. One of the ways I combated that moving forward, is I made it a point to sit down with my attending or clerkship director midway and have a sort of midpoint eval.

In residency, however, can I do this? or like how can I get feedback from faculty and upper levels without sounding like I am suffering from crisis of confidence.

Additionally, I am scared of the following two rotations in a residency programs.
1) IM
- Most residency failure stories that I have heard or seen, usually come and hang around this rotation. I am taking preventative measures such as studying books and videos right now, however, I also want to make sure that at the end of my rotation, my senior or faculty doesn't come up and say, "listen it's not working out.."
2) OB
- I am scared of people screaming and that is what most OB is to me. I don't plan to do OB in my future practice, but, do understand that residency program needs an OB rotation to be done. Besides this, I have delivered only one "hand on hand" delivery during medical school. What can I do to seek help early on from midlevels, faculty or seniors.

What I am trying to get at I guess is, what is a safe way to ask for help, to ask for improvement, without getting a target on your back with people thinking that resident is under confident or that resident is lacking?

when you ask for help just be confident in asking, no one expects you to be an attending but they do expect the below. If possible you could right down things and look them up later but obviously if life or death I.e. don’t want to give wrong dose then I would ask right away.

most attending do give some feedback but you really need to seek it out. You’ll know when you are an intern. You could start by trying what works now as a medical student

What is expected will be program specific but fm inpatient service and ob will be one of the harder rotations.
I was in your position.
I would say a good majority of what will get you there is:

1. showing up on time and being present
Hardworking and not a jerk
2. Basic foundational skills - people skills(empathy, communication, ethics), presenting, history, physical ,management , understanding natural course/.pathogenesis
3. Learn along the way, read afp articles, up to date to fill in gaps.
4. Make sure you are present and in time so you absorb information And are aware of surroundings, learn from seniors, find good mentors

You’ll be amazed of transformation at the end I know I was...it’s hard to really prepare all other interns will be in your same shoes, just bring the above

also moonlighting is a great way to hone your skills, it really was a stepping stone for me, not to mention more than doubling your salary, seek that opportunity as soon as possible whether inpatient, urgent care etc.

 

[MarsDominus]

when you ask for help just be confident in asking, no one expects you to be an attending but they do expect the below. If possible you could right down things and look them up later but obviously if life or death I.e. don’t want to give wrong dose then I would ask right away.

most attending do give some feedback but you really need to seek it out. You’ll know when you are an intern. You could start by trying what works now as a medical student

What is expected will be program specific but fm inpatient service and ob will be one of the harder rotations.
I was in your position.
I would say a good majority of what will get you there is:

1. showing up on time and being present
Hardworking and not a jerk
2. Basic foundational skills - people skills(empathy, communication, ethics), presenting, history, physical ,management , understanding natural course/.pathogenesis
3. Learn along the way, read afp articles, up to date to fill in gaps.
4. Make sure you are present and in time so you absorb information And are aware of surroundings, learn from seniors, find good mentors

You’ll be amazed of transformation at the end I know I was...it’s hard to really prepare all other interns will be in your same shoes, just bring the above

also moonlighting is a great way to hone your skills, it really was a stepping stone for me, not to mention more than doubling your salary, seek that opportunity as soon as possible whether inpatient, urgent care etc.

To hijack this thread, say you have a new attending who does not know your patients, how would you present? I struggle with this because I don't know the balance between being too detailed and not giving enough information. Can you give me an outline? Thanks very much

 

[drake19]

To hijack this thread, say you have a new attending who does not know your patients, how would you present? I struggle with this because I don't know the balance between being too detailed and not giving enough information. Can you give me an outline? Thanks very much

this is difficult to answer
Practice makes perfect, keep on practicing

typically when you are billing everything is problem based so as attending, care about chief complaint and then typically go straight to the assessment and plan for each problem.

For outline if new patient just do the standard format
Hpi, Ros, physical exam.....assessment plan.

for Followup patients present with soap note format.

if you have a new attending that doesn’tknow patient and you have to run the list typically I just do cc and problem and plan stuff to followup and disposition

can watch a ton of YouTube videos for how to present.

 

[BigSib]

The answer is highly dependent on the culture of the residency, whatever site you're at, or individual doctor you're with. Most doctors/preceptors are very open to teaching or giving constructive criticism if you ask in the right way. Try to learn the dynamics ahead of time if you can or clarify with them when it is appropriate to ask. Would be a good question for your program director or mentor there.

 

[Gos81238ia]

Hello,
I am one of the lucky students who was matched to a program this year. I wanted some advice from any residency faculty or interns on the forum. I failed a rotation in Medical School third year and am scared of repeating that. One of the ways I combated that moving forward, is I made it a point to sit down with my attending or clerkship director midway and have a sort of midpoint eval.

In residency, however, can I do this? or like how can I get feedback from faculty and upper levels without sounding like I am suffering from crisis of confidence.

Additionally, I am scared of the following two rotations in a residency programs.
1) IM
- Most residency failure stories that I have heard or seen, usually come and hang around this rotation. I am taking preventative measures such as studying books and videos right now, however, I also want to make sure that at the end of my rotation, my senior or faculty doesn't come up and say, "listen it's not working out.."
2) OB
- I am scared of people screaming and that is what most OB is to me. I don't plan to do OB in my future practice, but, do understand that residency program needs an OB rotation to be done. Besides this, I have delivered only one "hand on hand" delivery during medical school. What can I do to seek help early on from midlevels, faculty or seniors.

What I am trying to get at I guess is, what is a safe way to ask for help, to ask for improvement, without getting a target on your back with people thinking that resident is under confident or that resident is lacking?

The good news is, unlike medical school, your residency will be very invested in keeping you passing so they don't take a massive hit to their statistics or their call schedule by having a resident fail out. Be invested in each rotation and genuinely care for your patients, that will make you want to do what is right for them and do a good job, no matter what your baseline knowledge is. Ask for feedback regularly - understand that people are bad at giving objective feedback and often attach subjective judgements like "good" or "bad" to their feedback. Feedback should be like google maps "turn left to get to your destination", not, "you are driving poorly and will not reach your destination". Help the people giving you the feedback by phrasing your requests in a way that elicits objective advice. Ask, "is the way I present my history providing clear and concise information to you?" instead of, "how am I doing with my patient histories?". Ask people you trust and ask them regularly. Look for senior residents who are doing well, find out what they're doing and do the same. Some rotations you will dread, like you implied for OB. Make a calendar of 30 days and just cross off each day as you get through it, sometimes you just have to grin and bear it, and realize you'll never have to do OB again if you don't want to.

 

[deleted87716]

Have things changed that much? My residency was a feedback-rich environment (good or bad, like it or not...from attendings and fellow residents alike). The absolute last thing we had to do was beg anyone for feedback.

 

[brianmartin]

i had to repeat two rotations in med school due to weird circumstances. Things happen. As long as you grew and learned from them, no one cares. When you start residency, show up on time, well rested, with an open mind, and a willingness to look things up and never lie. If you don't know something, say so. Your attendings are there because they want to be, so pick their brains while you can. Some of the things they do will seem peculiar to you, but there is a reason behind all of it. Find out what those reasons are and develop your own personal approach. Also remember that you'll be in a class of other people who are also scared and inexperienced.

Someday, usually in 3rd year when you are starting to be the main supervisor of interns, you will look back and be shocked at how professional you have become. A concise accurate presentation will roll off your tongue and you will begin noticing that you are communicating with your attendings more as peers and less as superiors. Those are the moments your attendings live for, so engage with them.

OB, yea, its scary. Even if you aren't going to do OB, just immerse yourself and approach it like a fun experiment to see if you like it. It's completely okay if you don't. I don't do OB, but I am on call for a group with some who do OB. When a scared pregnant women calls at 2 in the morning, I know what to say to them, and even though I don't practice OB, my knowledge gained in residency is extremely valuable.