How to survive internship/residency

[fromthebox]

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Good morning everyone. I'm currently just over 3 months into an academic rotating internship. On paper I should be having the time of my life. I matched to my #1 which was also my clinical rotation school (SGU grad). I know my faculty, I know a lot of the basic hospital policy, I know where to find things.
The problem is, my intern class did not bond. There are 9 of us and beyond having a beer on the prescribed day of the week and talking superficially, I can't be sure if they have my back or not. This leaves me without a sounding board for "is this normal?" As there are also many fewer hard measures of performance and requirements for the interns I don't have any objective benchmarks. Without that, I have to rely on my brain and observation to determine if I am staying afloat/on par with expectations and I am really hard on myself. Additionally, the faculty remember me as a 4th year and are really pushing me to be great (and I want to not disappoint them). What this all adds up to is a disconnect: I feel like a complete and utter screwup. Like all I do is get things wrong. Not catastrophically wrong, but not perfect. And I feel like, without a rubric, that it is a zero sum game, either you are doing it all or you might as well quit because you just got something wrong in front of one of your potential LOR writers again and you will NEVER get a residency. Because the expectations are nebulous. What might pass muster for intern A is not good enough from intern B because they know you. They, on the other hand apparently think I'm doing ok?

Anyway, I literally had a mental breakdown on the clinic floor last week. They sent me home. Ostensibly because my patient care was compromised. Which makes me feel worse. Right now I know I still want a surgical residency but I am really afraid I won't match or that I won't get good letters from the surgeons. During my breakdown one of the intmed people came over and told me he'd write me a stellar letter. But now I don't trust that it wasn't said just to calm me down.

Anyone want to talk about internship/residency or tell me about residency match or that I'm not the only crazy one? Any tips for interns? Apologies if this is a little disjointed, I'm not a functioning human yet after last week.

 

[JaynaAli]

If you want to PM about anything, just shoot me a message. I don't have time right now for a huge reply, but know you're not alone in your thoughts. Internship is hard. I don't regret doing it and did learn a lot, but it is a special kind of torture. When the new interns came to my program though, I could suddenly see how much I had actually learned from that time a year ago. It was just a little painful getting there.

I did not bond with my internmates. They did social things together and I sometimes was included. It did/does feel a little disheartening not to have that strong bond so many people talk about with their internmates. I have spoken to them literally twice in the 16 months since we finished. Similarly, I can't say I am close with my residentmates now either. We're definitely friendly, but we don't hang out like other services outside of work very often. I am from a completely different background than most of them and have a hard time relating to them (i.e. they're liberal, I'm somewhat conservative, I'm from very rural America, they are from large cities, etc.). It is good to have friends from diverse backgrounds, but I miss having someone who really gets where I come from/my point of view.

 

[SocialStigma]

What you're feeling is very common amongst interns. And you will feel it again as a 1st year resident. It's totally normal to feel like you have no clue what you're doing and are just bumbling through your internship/residency. This will hopefully improve with time as you gain more experience and your confidence grows. It sucks that your intern class isn't close, but hopefully you have other friends/family who you can turn to for emotional support. Feel free to PM me if you have any questions about the residency match (I'm a surgery resident).

 

[Filly Bay]

I dont have any advice but wanted to say you're not alone. I'm also doing an internship (equine though) at the same school where I went to vet school and feel like there are things I should have already known because of that and hate asking for help. Despite a good first review, I constantly feel like I'm doing everything wrong or not good enough and disappointing people. I have one internmate who I get along with and hang out with but one of us is on call at all times so its hard to actually do things. I don't feel like any of the residents and some of the techs like me which gives me a complex and more anxiety. I stress over decisions I've made and didn't make and I've hardly actually done anything by myself yet. Just starting to take my own emergencies on ambulatory without clinicians. I don't feel ready for it and I dont know how to change that feeling.

Additionally, my personal life is currently a complete and utter mess right now. I have a lot of tough stuff going on and I'm super depressed and anxious all the time. I don't want to get out of bed most days and I come home and do nothing at the end of the day. I actually feel better at work because I'm keeping busy and not letting my mind wander but its certainly affecting me at work too which sucks. I've broke down bawling in front of my attending clinicians (at the end of the day, and not in front of clients, but still) because of things going on outside of work and they've been nothing but supportive which is nice.

I have no idea if this is helpful or what you're looking for but feel free to pm me too if you want to talk or just vent your feelings/worries/frustrations anytime.

 

[LetItSnow]

I stress over decisions I've made and didn't make and I've hardly actually done anything by myself yet. Just starting to take my own emergencies on ambulatory without clinicians. I don't feel ready for it and I dont know how to change that feeling.

I didn't do an internship, so maybe I'm not really qualified to talk, but I think you just have to DO IT and get more comfortable. I mean, my first GDV I was all "ugh ugh ugh ... more fluids? decompress now? tube vs trocharize? WHAT?" and I stressed over it. I stressed over drug choices and dosages. But then by the 5th or 6th it's just pretty routine and you figure out how you like to do it and that's that. I think it's that way with a lot of stressful situations. And once you're comfortable, even when you're presented with something new, you have enough confidence that you just muddle through it, and you also get to the point of being able to say "ok, it isn't just me - this is an unusual or novel thing, so pretty much everyone would be winging it."

I used to call this one super experienced ER vet for advice fairly often. One time I apologized for bugging him and he said "I don't expect ANYONE to know what they're doing in this job until they've done it for 5 years."

So, yanno, it just takes time.

 

[DVMDream]

I feel like veterinary medicine in general is a lot of "flying by the seat of your pants". If you're lucky, you might get a few weeks to months of mentoring then it is kind of "fly bitch" and you kind of learn to just figure it out or how to beg others for help/opinions.

Then you kind of just hope/pray that nothing you just did ****ed up the pet more than it already was.

Don't know how it works with an internship as far as mentoring goes, but yeah, I think feeling clueless is normal and you only start to get a bit more comfortable with time and experience.

 

[that redhead]

Not catastrophically wrong, but not perfect. And I feel like, without a rubric, that it is a zero sum game, either you are doing it all or you might as well quit because you just got something wrong in front of one of your potential LOR writers again and you will NEVER get a residency.

So while it may seem obvious, it needs to be said: no one will EVER be a perfect veterinarian. Sometimes you vaccinate a dog with feline FVRCP vaccine. Sometimes you will partially reverse the alpha2 and your demon patient will wake up and try to kill everyone in the middle of a neuter. Sometimes your auto-ligated cat testicle un-ligates and sucks back up into the body and it hemorrhages everywhere. Sometimes you will prescribe an NSAID when the dog is on chronic steroid. Sometimes your obstructed cat dies under anesthesia while you're trying to unblock it. And so on and so forth.

I'm only one person but I've done every one of those things (and probably more) in my two and half years out in practice. I imagine I will make many more mistakes, either benign or fatal, over the course of my career. It's scary and it sucks but what matters is a) how you handle it and b) what you learn from it. Go pull up a VIN thread on mistakes in vet med - it is comforting to read those made by others because you see that you are not alone in being an imperfect veterinarian.

Your attending clinicians and potential letter writers are simply other humans in your chosen profession. They are not perfect either. Sit down with one of them and ask them to name one mistake they've made in their career; they'll probably have a list for you, cases or patients or clients they won't ever forget because something went wrong along the way. No one expects you to be perfect, they expect you to do your best for the animal and learn from your mistakes.

Hang in there.

 

[DVMDream]

So while it may seem obvious, it needs to be said: no one will EVER be a perfect veterinarian. Sometimes you vaccinate a dog with feline FVRCP vaccine. Sometimes you will partially reverse the alpha2 and your demon patient will wake up and try to kill everyone in the middle of a neuter. Sometimes your auto-ligated cat testicle un-ligates and sucks back up into the body and it hemorrhages everywhere. Sometimes you will prescribe an NSAID when the dog is on chronic steroid. Sometimes your obstructed cat dies under anesthesia while you're trying to unblock it. And so on and so forth.

I'm only one person but I've done every one of those things (and probably more) in my two and half years out in practice. I imagine I will make many more mistakes, either benign or fatal, over the course of my career. It's scary and it sucks but what matters is a) how you handle it and b) what you learn from it. Go pull up a VIN thread on mistakes in vet med - it is comforting to read those made by others because you see that you are not alone in being an imperfect veterinarian.

Your attending clinicians and potential letter writers are simply other humans in your chosen profession. They are not perfect either. Sit down with one of them and ask them to name one mistake they've made in their career; they'll probably have a list for you, cases or patients or clients they won't ever forget because something went wrong along the way. No one expects you to be perfect, they expect you to do your best for the animal and learn from your mistakes.

Hang in there.

Sometimes you drop the ovarian pedicle on the 10 month old deep chested German Shepherd after ligating it, everything is fine and going well and then suddenly the abdomen just fills with blood and you just want to go cry in a corner, but you have to find the bleeding and stop it. Sometimes you realize after a dog has left that your new tech wrote your NSAID instructions as give 1/2 tablet every 8-12 hours and you cringe because you wrote every 12-24 hours (but you probably should have checked the label before the dog left however you were drowning in the multiple patients/walk ins and you can't be expected to check every rx label on every patient), and even though you didn't type up that rx, it is still on you if anything happens to that patient. You freak out more as no one can get in touch with the owners over the next few days to inform them to not give every 8 hours, then you start thinking.... well thankfully I only sent home x number of tablets so if they do give it every 8 hours the most damage based on toxic doses will be some GI side effects. Then you start thinking, but it was an older dog and they declined blood work and what if its kidneys were already shot... then you breathe a sigh of relief when they call back 3 weeks later wanting refills of meds, so now you know the dog is "ok" and you can adjust the previous error.

Sometimes you think, geeze this seems like a lot of pro-heart for this size dog, but it is one of your better techs so you give it, then check it later and realize you gave double the dose the dog actually needed... oh and it is a collie.

Then there are the stupid silly things like calculating a drug at bid dosing but only sending home enough as if giving sid and having to deal with the owner bitching about this "awful, horrible mistake" and how inconvenient it was on her.... and blah, blah, blah, blah.


Yeah, mistakes they happen, they suck, some owners are great about them and take everything in stride, some owners are dinguses about it.

 

[jmo1012]

For everyone going through the residency application process (and potentially internships too), a popular question is what is the last mistake/tell me about a mistake you've made, and how you handled it, what you learned from it, etc. Just something to remember as you are making mistakes in life, because as was mentioned above we are all humans and not robots so unfortunately that means no perfection. I was asked some variation of this question by a number of programs, and had had a recent case that haunted me that I was able to M&M during interviews and it was well received.

 

[LetItSnow]

For everyone going through the residency application process (and potentially internships too), a popular question is what is the last mistake/tell me about a mistake you've made, and how you handled it, what you learned from it, etc. Just something to remember as you are making mistakes in life, because as was mentioned above we are all humans and not robots so unfortunately that means no perfection. I was asked some variation of this question by a number of programs, and had had a recent case that haunted me that I was able to M&M during interviews and it was well received.

That question (or a variant) is used frequently in vet school applications out here. I used it a lot last year doing interviews. It is amazing how many people just can't give a direct answer and openly deal with having made a mistake. A surprising number of people will redirect that question and deflect responsibility. It's a real character-revealing question in a lot of ways.

 

[DVMDream]

That question (or a variant) is used frequently in vet school applications out here. I used it a lot last year doing interviews. It is amazing how many people just can't give a direct answer and openly deal with having made a mistake. A surprising number of people will redirect that question and deflect responsibility. It's a real character-revealing question in a lot of ways.

Yup and as a vet, if your assistant makes a mistake, that is your mistake regardless of if you had anything to do with it. Sucks, but you are the one ultimately responsible for everything involving that patient, so get used to owning your mistakes and even some of those that others make.

 

[VetMedSurvivalGuide]

Medical errors will happen to everyone. The difference is that more experienced veterinarians will make less errors and they'll also be less severe. If you make a mistake, learn from it and make sure it won't happen again. It is always better to be open about them and not try to hide it.