I finished my first year and when I shadow, I still feel like I don't know a lot. Is that normal?

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CuriousMDStudent

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Thread title sums it up. I'm currently working to review old material but when I shadow sometimes, I get asked a question from an attending and they let me off easy because they know I only just finished MS1. But I still feel embarassed. I am much more familiar with a lot of the terminology and etc but I still feel I can't make a diagnosis and etc.

Just wanted to see how other rising MS2's felt and if older medical students could chime in. Is this normal? Am I slacking? Regardless of what people say, I am definitely going to work my hardest to review my old material as I want to know as much medicine as possible but I'm curious on how other people are feeling with regards to their competency after completing MS1.
 
Can confirm- M3 on first rotation and patients will literally say textbook things but since it wasn't presented in a question stem I'm like "hmmm doesn't seem to be straight up ____ but then the resident would be like "yeah but they did say ____ remember? " and then I look at my notes and indeed even wrote that down and then reply with "I guess that is exactly what they said and meets the criteria"
 


Perhaps Osler’s most notable achievements at Johns Hopkins were his revolutionary contributions to medical teaching and training. For the first time, he took medical education out of the lecture theatre and brought it to the bedside. His student ward rounds became legendary, and he showed great humility too, often using his own clinical errors as teaching examples. This famous quote by Osler shows the level of importance he placed on learning in a clinical setting:

“Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first.”



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Thread title sums it up. I'm currently working to review old material but when I shadow sometimes, I get asked a question from an attending and they let me off easy because they know I only just finished MS1. But I still feel embarassed. I am much more familiar with a lot of the terminology and etc but I still feel I can't make a diagnosis and etc.

Just wanted to see how other rising MS2's felt and if older medical students could chime in. Is this normal? Am I slacking? Regardless of what people say, I am definitely going to work my hardest to review my old material as I want to know as much medicine as possible but I'm curious on how other people are feeling with regards to their competency after completing MS1.
so, to sum i up:

1. doesnt matter how far you are in training (M3? M4? intern?) you still wont feel like you know everything, and even - you'll probably feel like you know NOTHING half of the time (i have a "i am dumb as a board" feeling most of the time.hhahah). And its ok.
2. whoever asks you a question KNOWS you probably feel this way. Ill tell you a secret (this is what a few attendings told me, so maybe not true for all attendings and residents) - most of the time they are not asking you to get the right answer out of you, even though sometimes that might be the case. They are asking you a question to focus you on a certain aspect or to communicate that aspect to you. think of this as a beam of light that points "LOOK HERE, KNOW THIS".

and probably most importantly (Read this slowly and SEVERAL TIMES)
3. a good doctor is not a doctor who knows everything. It is a doctor who knows what their weaknesses are, is honest about them, and knows where to looks for information they need.

as far as making diagnosis - as a raising M2 you are not supposed to be good at making diagnosis yet. Thats the level of second part of M2, when you are done with all the systems. During M2 they will teach you how to make differential diagnosis, how to prioritize them, etc. M3 is for learning how to weed out commo stuff vs "zebras" and how all that knowledge translates into reality. M4 - no idea, will tell you next year 🙂

SOOOO: trust the process. Take it one step at a time. be proud of what you do know, and of what you do not know. tell them - i do not know, but if i was to guess... blah blah blah. And thats fine!!! and write down what you dont know to research it later.
 
Thats the “great” thing about Medicine.
Every 2-3 years, you ARE the dumbest person on the team.

Get through first 2 years of med school, to then be the “know-nothing” 3rd year.
Get through 2 years of rotations, to then be the “hope he doesn’t kill pts” intern.
Get through 3-5 years of that to be the “he thinks he’s so smart but doesnt know 💩” fellow…….. 😏
 
M4, I know nothing John Snow.

general consensus I’ve heard is that you start to get the hang of things in PGY2
 
New attending here and feel the same way sometimes. Now there’s no more right answer or attending to sign off on things; I just make a decision and have to wait and see how the patient does. That and you text your mentors constantly with all the stupid questions you didn’t think to ask in training. Sure is fun though, can’t lie.

Medical training has a knack for teaching you a LOT while also making you keenly aware of how much you don’t know. And you’ll never know all of it. I remember a lecture from a very famous facial plastic surgeon and he had recently changed the way he did a rhinoplasty after seeing a patient from 25 years ago who had brought her daughter in for one. So even a quarter century into a distinguished career you can still learn new things even about the operation you’re most famous for. It never stops.

When I ask a preclinical student a question I have zero expectations and I’m not grading them anyhow. It really is just to reinforce things I know they’ve learned and also give them a taste of what’s to come. If I’m judging them on anything it’s how engaged and interested they are, what questions they ask me, how they treat the patients. Since shadowing is optional, they all tend to excel.
 
M4, I know nothing John Snow.

general consensus I’ve heard is that you start to get the hang of things in PGY2

Do NOT bring GoT into this…. That was a worse let down than….. I can’t even think of a worse one!!!

Also, I found the NEJM review articles to be great for A—> Z on the disease.
I would type up a summary of the article, attach to original and then save in DropBox, then when you get a pt with PE, you can review it, and (hopefully) be prepared for some Qs.
Ideally you review it less and then less as rotations go on, and then its off to the races.
 
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I feel the same as you. Particualrly when I look at a CT and see the spleen only to find later in the report "Spleen is surgically absent."

Edit: In fairness two attendings whom I asked the "WTF?" did say it's the spleen. Still puzzled.
 
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The moment of realization that you now "get" a lot of things and have a degree of competence comes, for most people, during PGY2 year.
 
MS1s don't know anything. You simply aren't prepared to know anything that is relevant to clinical medicine. You are prepared to answer questions about basic science and the foundations of medicine. But until you learn about pathophysiology, you really don't know much about clinical medicine which is why you aren't getting the questions right. When med students are pimped in the clinical setting, it's almost never about the stuff you learn in MS1. You're not going to get a question about how many ATPs you get from the various biochemical pathways (because the pimpers don't even know that one). You're going to get questions that are relevant to the diagnosis and treatment of the patient. That stuff you'll learn in MS2 year and as you go through clinical rotations in MS3 year. By MS4 year, you'll have picked up on these important details.
 
New attending here - over time you will get comfortable with what you know and what you don’t, and you’ll have a plan for what to do when you don’t know something. A MS stressing about not knowing anything is basically expected. I worry more about the ones that think they have little more to learn.
 
MS1s don't know anything. You simply aren't prepared to know anything that is relevant to clinical medicine.

But a first year PA or NP student knows everything and is basically a doctor
 
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