Im too nice...

[dreambig2night]

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Im sick of hearing this!!!!

7 out of the last 10 preceptors have been telling me that Im too nice, Im not assertive, Im passive and not proactive.

This is getting me into some serious ****. I know my stuff well, even if not really well, but I come across as duhhhhhh because I second guess myself, or the answer eludes me because I panic.

Any advice to overcome this?

 

[JeffLebowski]

Im sick of hearing this!!!!

7 out of the last 10 preceptors have been telling me that Im too nice, Im not assertive, Im passive and not proactive.

This is getting me into some serious ****. I know my stuff well, even if not really well, but I come across as duhhhhhh because I second guess myself, or the answer eludes me because I panic.

Any advice to overcome this?

Man, it's just confidence.

It's similar to presenting patients - practice it, go over it in your head, reflect for a few minutes on it, and then bust it out. Don't bust out your notes, don't stammer through, if you don't know something and they interrupt you and say, "what was his hydrochlorothiazide dosage" just say "actually I don't know that off the top of my head", pause in case they want someone to follow-up on it right then, but then keep forging ahead. Have the template in your head and remember your conversation with the patient, and bust it out.

Same thing with answering questions, with the added element of "always be thinking about the topic of discussion and try to anticipate what questions may arise, because you may get pimped". First off, it makes you look like you're deep in thought about the patient (because you are), if they're talking about nephrotic syndrome start going through all the things you know about nephrotic syndrome in your head, so you've got something in case they look at you, just try to keep your contribution as close to the topic at hand as possible. If they ask what the mechanism of an ACEI is, don't list the dosing regimen, that kind of dodging the question is kind of annoying.

Likewise, you don't need to answer IMMEDIATELY like a reflex or something, you can give yourself a moment or two to reflect if you do a little intro like, "well in this case we should consider..." that's a good 5 seconds right there. But here's the rub: most of the time you won't know the right answer. At least not for sure. So the times when you are pretty damn sure (or 100% sure), answer AFFIRMATIVELY, no p****y-footing around.

"Was the patient febrile overnight?"

If you read all the vitals and the patient denied subjective fevers when you checked on him this morning, say, "No, the patient has been afebrile". And when they say "are you sure" say "Yes, I'm sure". Take advantage of those times when you know for sure, because they're somewhat rare. Just be up-front, relax, think clearly (closely related to "relax"), and pay attention. No one faults you for not knowing. It sounds like they're faulting you for not being confident when you should be.

 

[RussianJoo]

just say the very first thing that comes to your mind when asked a question.. I have done that before.. thought of an answer but didn't say it because i was 100% it was the right answer and it turned out to be the correct answer...

Some doctors like it when you take a guess or a stab at the answer.. some doctors hate that and say "don't guess you either know it or you don't. if you don't know it simply say i don't know and we'll teach you." So I guess it depends on the doctor. I think the best way is to start out answering every question and taking a stab at all of them, rather than just saying i don't know all the time.. if at some point the doc says you're just guessing, stop that and next time say i don't know, then you know you should only answer q's that you know the exact answer to.

 

[surrender903]

Im sick of hearing this!!!!

7 out of the last 10 preceptors have been telling me that Im too nice, Im not assertive, Im passive and not proactive.

This is getting me into some serious ****. I know my stuff well, even if not really well, but I come across as duhhhhhh because I second guess myself, or the answer eludes me because I panic.

Any advice to overcome this?

Why arent you asking your preceptors for advice? Im not trying to snark, I really am curious if 70% of your preceptors are saying the same thing why arent you asking them what you can do better?

 

[Doctor Bagel]

So what field do you want to go into? This "being too nice" is not really an issue in most non-surgical fields. I got the whole I'm not aggressive enough in ob/gyn and will probably get in surgery and yet haven't had a single comment about it anywhere else. If you don't want to be a surgeon, don't worry about it. If you do, then worry about all those behavioral steps you can take to appear differently.

 

[mtDNA]

Im sick of hearing this!!!!

7 out of the last 10 preceptors have been telling me that Im too nice, Im not assertive, Im passive and not proactive.

This is getting me into some serious ****. I know my stuff well, even if not really well, but I come across as duhhhhhh because I second guess myself, or the answer eludes me because I panic.

Any advice to overcome this?

I have this exact same problem. literally, EXACTLY. Too quiet, and I don't sound confident enough unless I know the answer 100%. I have gotten better at this over the course of the year. One thing that can be helpful, is if you have an M4 who is an excellent student, you can kind of observe how he deals with all this crap and model that. I had a great M4 that I learned alot from in terms of how to be a good student on wards...unfortunately, it wasn't until my 2nd to last rotation of the year! Yeah...I have earned some pretty mediocre grades this year, and no honors at all.

One thing I have definitely noticed this year is that confidence is king. I have seen some of my colleagues with a pretty shaky knowledge base do extraordinally well because they are confident and outgoing. knowing the correct answers has almost nothing to do with anything, it is all about how you answer.

I can't wait until this is over, hopefully 4th year is a better year.

 

[dreambig2night]

I have this exact same problem. literally, EXACTLY. Too quiet, and I don't sound confident enough unless I know the answer 100%. I have gotten better at this over the course of the year. One thing that can be helpful, is if you have an M4 who is an excellent student, you can kind of observe how he deals with all this crap and model that. I had a great M4 that I learned alot from in terms of how to be a good student on wards...unfortunately, it wasn't until my 2nd to last rotation of the year! Yeah...I have earned some pretty mediocre grades this year, and no honors at all.

One thing I have definitely noticed this year is that confidence is king. I have seen some of my colleagues with a pretty shaky knowledge base do extraordinally well because they are confident and outgoing. knowing the correct answers has almost nothing to do with anything, it is all about how you answer.

I can't wait until this is over, hopefully 4th year is a better year.

Thank you Good Lord!...at least I know Im not alone. I was feeling miserable for a few days. Yeah I definitely got to work on my confidence.

Surprisingly, the 30% that didnt say it included my GS preceptor, and my ER preceptor. And I am interested in surgery. 😱
But my surgery preceptor does not fit the stereotypical profile. He is too nice himself. so...yeah...Ill probably get crap when I go on to another surgery rotation....unless I fix it.

I have talked to some of my preceptors...but I thought Id ask SDN peers.

Thank you all!👍

 

[Winged Scapula]

Thank you Good Lord!...at least I know Im not alone. I was feeling miserable for a few days. Yeah I definitely got to work on my confidence.

Surprisingly, the 30% that didnt say it included my GS preceptor, and my ER preceptor. And I am interested in surgery. 😱
But my surgery preceptor does not fit the stereotypical profile. He is too nice himself. so...yeah...Ill probably get crap when I go on to another surgery rotation....unless I fix it.

I have talked to some of my preceptors...but I thought Id ask SDN peers.

Thank you all!👍

Ahh but that is where the big misconception lies. We were just discussing this in the Surgery forum a few weeks back.

When nice, "normal" students are found to be interested in surgery, on non-surgical rotations, they are FREQUENTLY told, "oh you're too nice to be a surgeon".

However, not a single medical student, resident, fellow or attending posting in the Surgery forum was ever told that BY A SURGEON, although many of us were told that on non-surgical rotations. This is because surgeons recognize that we come in all forms, all personalities and that many of us actually are nice. 😱

Do you have to be confident to be a surgeon? Absolutely. It (and many other fields) is not the place for thoughtful, time consuming contemplation.

Do you have to be assertive? Sometimes, and occasionally very often. But assertive does not mean abusive, mean, arrogant, or any other stereotypes bandied about. Assertiveness is misinterpreted by other specialties as aggression. Many people use the terms interchangeably when they shouldn't be.

You HAVE to be proactive as patients can die. Various things I was told as a surgical resident: Apathy kills. Assumptions kill. Be proactive, not reactive. Always be a step ahead of the attending and other residents (literally and figuratively). GET the results (path, rads, etc.) don't wait for them.

There's a fun quote about surgeons: "Often wrong, never in doubt." I don't know about the often wrong part, but the never in doubt is pretty accurate. 😀

At any rate, get more feedback from your preceptors and see exactly how they are defining proactive, assertiveness, etc. AFAIK, you cannot be too nice unless it means you are letting others take advantage of you, or if it puts your patient at risk (ie, "oh, I guess you don't need to have that medication Mr. Jones, I know it doesn't taste good")

 

[sheena09]

First off, it makes you look like you're deep in thought about the patient (because you are), if they're talking about nephrotic syndrome start going through all the things you know about nephrotic syndrome in your head, so you've got something in case they look at you, just try to keep your contribution as close to the topic at hand as possible.

Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein.(proteinuria at least 3.5 grams per day per 1.73m2 body surface area) from the blood into the urine.

 

[JeffLebowski]

Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein.(proteinuria at least 3.5 grams per day per 1.73m2 body surface area) from the blood into the urine.

 

[Pontifex Maximus]

Did we just get wiki-spammed?

 

[jbp100]

Did we just get wiki-spammed?

Wik Rolled....

 

[Pinkertinkle]

Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein.(proteinuria at least 3.5 grams per day per 1.73m2 body surface area) from the blood into the urine.

what about in kids huh? how bout infants?

 

[dreambig2night]

what about in kids huh? how bout infants?

ummmmmm....do I have a life-line? can I call a friend?

Thanks Winged Scapula!

 

[QofQuimica]

Do you have to be assertive? Sometimes, and occasionally very often. But assertive does not mean abusive, mean, arrogant, or any other stereotypes bandied about. Assertiveness is misinterpreted by other specialties as aggression. Many people use the terms interchangeably when they shouldn't be.

This is so true. I am a very assertive person; this whole year, only one attending has ever suggested that I should be more assertive. It was one of those surgery attendings who is a yeller. But I think this attending greatly underestimated me. Just because I have a quieter style doesn't mean I can't advocate for my patients and get things done. No, I don't get my results by yelling and sending all the nurses and other support staff into a flustered tizzy. But what this surgeon hasn't realized is that people are usually willing to do things to help you when you ask them nicely, and they feel much less resentful about it.

OP, as others have already suggested, being called "too nice" is a euphemism that means you're too passive. Make an effort to get involved in whatever is going on. Be willing to push a little. If the resident is going to go do a procedure, ask to go observe. If they invite you to go observe and you've already seen one, ask if you can give it a try with their supervision (assuming you feel comfortable doing it). On rounds, get involved in the discussions. Whenever the team gets to your patients, step up and present them. At the end of the day, go to the sign out and sign out your patients. Read about your patients and tell the team what you've learned; don't wait to be asked to do a presentation because they're wondering if you've learned anything. Any time the attending asks a question and looks you in the eye, answer it. If you don't know the answer, try to reason it out. If they see you're trying to get it, they will often give you leading questions to help you arrive at the answer.

Note: I'm *not* saying to be obnoxious and show up your fellow students or annoy your team. Just don't let yourself be sidelined.

 

[45408]

Why arent you asking your preceptors for advice? Im not trying to snark, I really am curious if 70% of your preceptors are saying the same thing why arent you asking them what you can do better?

I concur. You're paying waaay too much to not take advantage of some of these opportunities. Ask what you can do better. Most of my rotations have "mid-course evaluations" that are either optional or mandatory. Ask your attending to fill one out, and then talk to them about it. Most of the time, their comments will be something you were aware of, but that way, you'll know what they're looking for, and you can specifically improve on that. I had one attending who REALLY REALLY wanted you to have your ENTIRE patient presentation memorized. He was just a teaching attending, not the one actual responsible for these patients, so I didn't have to present a whole lot of patients to him, but when I did, I made sure to know 100% of the information. That really impressed him, and I got a good grade. If you know what your attending wants and can tailor your efforts towards that, you'll be working smarter instead of harder.

 

[DD214_DOC]

One thing i started doing is thinking out loud. I fI was asked a specific question about X and didn't know the answer to the specific question, I would usually say, "Well ...." and spit out stuff I knew that was pertinent to the topic. This forces them to see that I DO know stuff, just not exactly what they're looking for.

You have to be pretty good at it or it can backfire. Don't just stand there in silence looking stupid.

You'll get more confidence as you progress. I'm starting my MSIV rotation and I'm really not nervous at all. Nobody is going to fail you because of a lack of knowledge (unless it's really, really profound). Show up, do your work, be interested, try to learn. Don't screw up. Be a reasonable human.

You'll be embarassed, but just remember that you've passed your boards and these attendings can't go back and change that. Once you chill out, things will come together and make more sense. Then you'll be more proactive and not afraid to be wrong.

 

[Scaredshizzles]

One thing i started doing is thinking out loud. I fI was asked a specific question about X and didn't know the answer to the specific question, I would usually say, "Well ...." and spit out stuff I knew that was pertinent to the topic. This forces them to see that I DO know stuff, just not exactly what they're looking for.

You have to be pretty good at it or it can backfire. Don't just stand there in silence looking stupid.

You'll get more confidence as you progress. I'm starting my MSIV rotation and I'm really not nervous at all. Nobody is going to fail you because of a lack of knowledge (unless it's really, really profound). Show up, do your work, be interested, try to learn. Don't screw up. Be a reasonable human.

You'll be embarassed, but just remember that you've passed your boards and these attendings can't go back and change that. Once you chill out, things will come together and make more sense. Then you'll be more proactive and not afraid to be wrong.

I think this is spot on. It just takes time getting comfortable.