I feel like I’m going to be an awful Sub-I, and that I know absolutely nothing.

[Latteandaprayer]

I’m an M3 at a 1-year preclinical, so this year is Steps and sub-Is. I just took Step 1 last week, I feel okay about it (passed all my practice tests, didn’t feel awful leaving the exam but who knows). I’m now studying for Step 2, and it’s really kicking my butt. Despite already completing my core clerkships last year, I feel like I know literally nothing. I can barely tell you next steps, best treatment, disease course, really anything.

Despite getting Honors in everything except surgery, my clinical performance grades tended to be right at average or just below average. I think I’m good at knowing basic science facts, but I suck at the actual craft of medicine. I frequently got feedback that my differentials are limited and could be improved, which I really tried to work on throughout but I guess it was never enough. I still feel lost as heck.

I’m terrified I’ll be a Sub-I in a couple months and will get a patient and not know anything and go blank. I’m scared I’m going to be known as the dummy. I felt during core clerkships, attendings were impressed if I showed up and knew that crackles could mean heart failure. As a sub-I, I’m worried that won’t be enough and I’ll fail. In February I’ll be doing an elective in the field I plan to apply to, but based on how I’m doing on the topic on Step 2 UWorld right now I don’t even know if I can generate a reasonable differential.

I don’t know what I’m looking for. Advice? Maybe just a glimmer of hope?

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[DarkBluMage]

Also interested in this feedback as I’m quickly coming up on preparing for my electives and aways. Just really concerned about making the jump in skill/differential diagnoses from 3rd to 4th year.

 

[EmbryonalCarcinoma]

I’m an M3 at a 1-year preclinical, so this year is Steps and sub-Is. I just took Step 1 last week, I feel okay about it (passed all my practice tests, didn’t feel awful leaving the exam but who knows). I’m now studying for Step 2, and it’s really kicking my butt. Despite already completing my core clerkships last year, I feel like I know literally nothing. I can barely tell you next steps, best treatment, disease course, really anything.

Despite getting Honors in everything except surgery, my clinical performance grades tended to be right at average or just below average. I think I’m good at knowing basic science facts, but I suck at the actual craft of medicine. I frequently got feedback that my differentials are limited and could be improved, which I really tried to work on throughout but I guess it was never enough. I still feel lost as heck.

I’m terrified I’ll be a Sub-I in a couple months and will get a patient and not know anything and go blank. I’m scared I’m going to be known as the dummy. I felt during core clerkships, attendings were impressed if I showed up and knew that crackles could mean heart failure. As a sub-I, I’m worried that won’t be enough and I’ll fail. In February I’ll be doing an elective in the field I plan to apply to, but based on how I’m doing on the topic on Step 2 UWorld right now I don’t even know if I can generate a reasonable differential.

I don’t know what I’m looking for. Advice? Maybe just a glimmer of hope?

It sounds like you suffer from low confidence but that you are doing everything you need to. Focus on the things you wrote that I bolded. You don't need to know very much to do well as a sub-I; you're a sub-I, not an attending, and there's a reason you still need years of training before you can practice independently. Just demonstrate that you're learning and improving.

 

[Billiam95]

I’m terrified I’ll be a Sub-I in a couple months and will get a patient and not know anything and go blank. I’m scared I’m going to be known as the dummy.

Only a MS4, but medical knowledge is maybe the 3rd most important component of sub-I performance IMO. Availability > Affability >> Medical knowledge.
Not to say you can be dumb as a bunch of rocks, but, ya know, within reason.

I frequently got feedback that my differentials are limited and could be improved, which I really tried to work on throughout but I guess it was never enough.

Evergreen critique for all medical students.

 

[LunaOri]

Recognizing that you don’t know is huge! I would take a student who knows what they don’t know over one who thinks they know it all! Ask questions. You will be fine.

 

[mrbreakfast]

Just focus on effort and energy. See a lot of patients and ask a lot of questions, and go home and read about the stuff you don't know. It's not about where you start, it's about how much you grow. And stick around until the residents leave (assuming it's a reasonable hour). All the cool stuff comes in as the last case of the day, it seems.

 

[operaman]

Sounds like you're right where you need to be. Agreeing with the above that I'd rather have a student who knows their limitations than the ones who think they already know it all. It's pretty rare in medicine to get burned by the thing you're aware of and focused on; it's always the thing you aren't thinking about that gets you.

You're doing very well in clerkships from what you're saying. Just keep pushing ahead and I think you'll be surprised with how well you do. By next year, you'll be shocked at how far you've come and you'll first realize it when you're helping orient the new M3s when you're doing your Sub-I .

 

[annoyedpsychiatrist]

I’m an M3 at a 1-year preclinical, so this year is Steps and sub-Is. I just took Step 1 last week, I feel okay about it (passed all my practice tests, didn’t feel awful leaving the exam but who knows). I’m now studying for Step 2, and it’s really kicking my butt. Despite already completing my core clerkships last year, I feel like I know literally nothing. I can barely tell you next steps, best treatment, disease course, really anything.

Despite getting Honors in everything except surgery, my clinical performance grades tended to be right at average or just below average. I think I’m good at knowing basic science facts, but I suck at the actual craft of medicine. I frequently got feedback that my differentials are limited and could be improved, which I really tried to work on throughout but I guess it was never enough. I still feel lost as heck.

I’m terrified I’ll be a Sub-I in a couple months and will get a patient and not know anything and go blank. I’m scared I’m going to be known as the dummy. I felt during core clerkships, attendings were impressed if I showed up and knew that crackles could mean heart failure. As a sub-I, I’m worried that won’t be enough and I’ll fail. In February I’ll be doing an elective in the field I plan to apply to, but based on how I’m doing on the topic on Step 2 UWorld right now I don’t even know if I can generate a reasonable differential.

I don’t know what I’m looking for. Advice? Maybe just a glimmer of hope?

As an attending let me tell you a secret. You know the best medical student is? The smartest medical student isnt necessarily the best one. Medical students can be taught, and grow. Hard work and a good personality, are a lot harder to teach. An audition rotation isnt just about you going there and being brilliant. Its about you going there, showing passion/work ethic, and being someone that people are like "Wow I really like him/her. I would love to work with that person". I expect all medical students to suck at clinical skills, and even the best ones that have rotated under me still butcher psych interviews and have no idea what to ask and get differentials wrong. However, the best ones are the ones that can demonstrate empathy and that people enjoy being around. Ive had plenty of smart medical students with zero personality and patients didnt respond well to that.

 

[esob]

Ive had plenty of smart medical students with zero personality

I've interviewed a couple of those for residency slots this cycle

The ability to have a genuine conversation with someone while being an avid listener is the top skill you need for a sub-i. A good history will trump your Anki knowledge any day of the week.

 

[JuicedToTheSocks]

Just focus on effort and energy. See a lot of patients and ask a lot of questions, and go home and read about the stuff you don't know. It's not about where you start, it's about how much you grow. And stick around until the residents leave (assuming it's a reasonable hour). All the cool stuff comes in as the last case of the day, it seems.

Not to be annoying but it's all about where you start if you're measuring growth, right?

Anyways, OP honored most of their rotations -- not really sure what this post is besides a dear diary/humble brag.