Intern still feeling stupid

[MedicinePowder]

So there was a thread earlier about feeling 'dumb' and questioning one's ability in the ED. I'm a first year in a three year EM program. I'm doing my first month of Peds ED and I'm second guessing myself again in terms of ever becoming a competent ED doc.

I ALWAYS manage not to ask certain questions. I was feeling better in the adult ED but now again, I feel dumb. Not sure if the particular peds EM attendings I'm working with are anal, but without question there is ALWAYS something lacking in my presentation that i have to go fetch, and in an attempt to be thorough I've been known to throw in some non-pertinent negatives that have the attendings asking: "why'd u ask that?". damn, i'm stupid!

had a kid with what turned out was a malfunctioning VPS. bulging fontanelle? i described it to the attending as a normal fontanelle and when she examined the child, she was like: "this is an obvious bulging fontanelle!" hey, it didn't look or seem bulging to me! god, i'm dumb!

any consise practical EM books out there? i read from tint on most/all my cases but my knowledge base just doesn't seem to catch up.

i'm considering changing specialities. it's that bad.

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[The White Coat Investor]

So there was a thread earlier about feeling 'dumb' and questioning one's ability in the ED. I'm a first year in a three year EM program.

i'm considering changing specialities. it's that bad.

Did you ever wonder why its a three year program? This is why.

 

[Dr.Evil1]

If you already knew what to do then you wouldn't have to do residency. Don't change specialities just because you are having a hard time right now.

Attendings will ALWAYS ask 1 more question than you know the answer to especially if there is not a clear diagnosis in mind by your presentation. They do this to teach you what to look for the next time you see a similar patient.

It will all work out. Keep your chin up.

 

[AmoryBlaine]

Even though I'm a lowly M3 I hope I can offer some encouragement...

Med students/interns/residents who aren't scared and possessed of some self-doubt scare the shi** of me. If you felt like like you could manage all comers after 3/4 of an intern year you'd be dangerous.

One of the worst things about medical education (IMHO) is this culture that says that you should always be one level above where you are. When you get 1/2way though M3 people start saying "you're going to be an M4 soon so you should be almost at the level of a sub-i at this point." M4s are expect to "act as interns." I can only imagine that 2 years into a 3 year program you starting getting the "you should be acting pretty much as an attending" talk.

Anyway, it's not healthy. To the OP, if you're really struggling you might ask your attendings for some solid feedback. Good or bad it's going to clarify things.

 

[Aloha Kid]

Dude,

Happens all the time.

I missed zoster on a female complaining of RUQ abd pain.

Then again, her rash was early and suspiciouisly nondermatomal due to her obese abd and stretching of the skin. The yeast infections in all of her skin folds, the malodorous stench, and her huge sagging breasts only added to the problem. She was also in the hallway and couldn't sit up. Felt bad about that one for a week.

 

[Snoopy]

My whole intern year, I could NEVER imagine how I could make it to the point where I would be a competent attending.

By the end of my second year, I could envision that I MIGHT someday be able to be a competent attending.

By the end of my third year, it was hard to tolerate being a resident because I was so ready to get out there and be an attending.

Now, that's not to say I wasn't scared to death of actually being an attending, but I was ready. After a year as an attending I have days where I feel brilliant (few), days where I feel competent (most), and days where I feel totally incompetent (few and usually because I can't figure out complicated patients or the department is just so overwhlemed with volume).

This is the natural progression of things in EM and in all fields. If you ever get to the point that you feel 100% comfortable and 100% competent, quit your job and run as fast as you can away from the hospital.

 

[DrQuinn]

So there was a thread earlier about feeling 'dumb' and questioning one's ability in the ED. I'm a first year in a three year EM program. I'm doing my first month of Peds ED and I'm second guessing myself again in terms of ever becoming a competent ED doc.

I ALWAYS manage not to ask certain questions. I was feeling better in the adult ED but now again, I feel dumb. Not sure if the particular peds EM attendings I'm working with are anal, but without question there is ALWAYS something lacking in my presentation that i have to go fetch, and in an attempt to be thorough I've been known to throw in some non-pertinent negatives that have the attendings asking: "why'd u ask that?". damn, i'm stupid!

had a kid with what turned out was a malfunctioning VPS. bulging fontanelle? i described it to the attending as a normal fontanelle and when she examined the child, she was like: "this is an obvious bulging fontanelle!" hey, it didn't look or seem bulging to me! god, i'm dumb!

any consise practical EM books out there? i read from tint on most/all my cases but my knowledge base just doesn't seem to catch up.

i'm considering changing specialities. it's that bad.

Relax. Peds EM is very different from Adutl EM. Adult EM, in my opinion, is a bit easier. Peds EM is a bit scarier, because, well, its relatively EASY to do, but hard to do well. Know what I mean? There can be a lot of intricacies in peds, especially those < 1 year old... that are nowhere even close to what you've learned in Adult EM. Remember that most Peds EM people are pediatricians or those that did fellowhsips. Meaning they have a LOT of more specialized training than an intern at a PGY1-3 program.

Shoot. There were times when I was a PGY-2 in our Pedi ER where I was like "damn why didn't I think of that?!!"

That being said, I'm in an adult only EM now, which is nice. I did have a little one that came in today, that I diagnosed with hand-foot-mouth... go me. Considering I haven't seen a kid in like 9 months.

Q

 

[Eidee]

I'm also an intern at a 1-3 program and see that my residency is almost 33% done and its scary that I still feel incompetent, sometimes don't know exactly why we are admitting a patient and just feel slow compared to my upperclassmen and even fellow interns. I've really tried to pick up the amount of patients I see but I then sacrifice my time to chart which can become problematic when it's time to admit this patient and I need to step back and take a look at the big picture again (which helps when I have some hx written down).

I dunno maybe i should do things differently...anyone having similar problems??

 

[beyond all hope]

You should be scared. Residency should be scary.

I felt uneasy leaving residency. Then once I got out I realized that everything seemed easy compared to being a resident.

My job as an attending is to challenge you now so that when you come out in two years you'll be ready for anything.

 

[Wackie]

So there was a thread earlier about feeling 'dumb' and questioning one's ability in the ED. I'm a first year in a three year EM program. I'm doing my first month of Peds ED and I'm second guessing myself again in terms of ever becoming a competent ED doc.

I ALWAYS manage not to ask certain questions. I was feeling better in the adult ED but now again, I feel dumb. Not sure if the particular peds EM attendings I'm working with are anal, but without question there is ALWAYS something lacking in my presentation that i have to go fetch, and in an attempt to be thorough I've been known to throw in some non-pertinent negatives that have the attendings asking: "why'd u ask that?". damn, i'm stupid!

had a kid with what turned out was a malfunctioning VPS. bulging fontanelle? i described it to the attending as a normal fontanelle and when she examined the child, she was like: "this is an obvious bulging fontanelle!" hey, it didn't look or seem bulging to me! god, i'm dumb!

any consise practical EM books out there? i read from tint on most/all my cases but my knowledge base just doesn't seem to catch up.

i'm considering changing specialities. it's that bad.

Chin up! Nothing good ever comes easy.
The docs I work with, who are also attendings, tell stories of their residencies. None of them have ever said they had a clue after their intern year. The few interns who come through with cocky know-it-all attitudes are the ones the attendings worry about.

If it makes you feel any better, some of the attendings pick each other's brains occasionally.