Just started residency and I feel totally stupid

[Seaunicorn]

I just started my intern year and I'm a complete idiot. It's my third day (MICU) and I've never done an ICU rotation and I feel like I don't know what's going on with any of the patients on my team and can barely figure out why we're doing things for my own patients. Everything takes me forever because I'm stumbling around the EMR trying to figure out how to get stuff done while also knowing nothing about medicine anymore. My presentations are horrible. The senior residents have to help me with everything and the first 2 days they put in half my orders because I was slow and didn't have them all in by rounds. Third years absolutely know more than me and I'm scared that I'm going to get in trouble for being a terrible intern.

I can at least say that I do work really hard. Haven't been eating lunch and I've been staying late every day so that I don't leave tasks for the night team. I'm also trying to study when I get home but I feel like my knowledge will never catch up.

I guess I wrote this post just because I'm worried that my best won't be enough for intern year. My program is very supportive and wonderful but I don't want to be a downer and blab about my fears to my fellow interns. I think we're all tying to maintain a positive attitude.

Is the level of incompetence that I'm struggling with unusual? Any tips?

---

Members don't see this ad.

 

[Ismet]

You're not an idiot. You're an intern on your 3rd day, starting on one of the hardest rotations to start on. Cut yourself some slack. It's completely normal to fumble with the EMR until you know where everything is, you've never had to put in orders before where it actually matters, so you're learning that too. You've never done ICU before, and ICU is a whole other world for presentations and patient management. Sounds like you drew the short straw in starting in MICU, but also sounds like you're a hard worker and you know what you don't know. Although starting on a hard month sucks, it will certainly help prepare you for the stuff to come. Also, you'll find that the beginning of every month is a transition period, getting used to a new service, new attendings, new knowledge base and expectations, and how things work. You're not going to perform at 100% from the get-go, please do not hold yourself to that standard. Respond to feedback and improve.

I started intern year on wards nights. Brand new intern me and a brand new senior. I sure as hell needed my senior to walk me through orders. It would take me a couple hours to write an H&P. Every phone call I got from a nurse asking a question, I ran it by my senior, even stupidly simple things like ordering Tylenol. So many things that I look back on with my current knowledge base and experience, and I would know exactly what to do. A year from now, you will look back on this month and realize how far you've come. Now I'm going to be a senior and I certainly will not expect my interns to have any baseline knowledge of where things are in the EMR, how to admit a patient, how to page a consult, how to find the ED, how to find the bathroom...it's July. It's fine. They'll learn just like we learned.

Oh and talk to your fellow interns. Most likely everyone else is feeling the way you are.

 

[bannie22]

Its ok. MICU is a tough rotation to start on.

 

[BoardingDoc]

Welcome to being an intern. This is normal. I think everyone here would be far more concerned if you said you felt like you knew exactly what you were doing.

 

[anonperson]

You are an intern. By definition you are an idiot. You're as useful as a second a$$hole.

I don't say this to be mean but it is the truth. I fondly remember the times when I was a mouth breathing incompetent intern. It gets better with time/experience and studying.

You sound like you are fine and will do well. And I think you're underestimating yourself if you think some doofus medical student is doing better than you. I mean, they follow like one patient.

 

[guitar45]

btw, nurses can be gr8 resources (if they have time)...be very nice & it could help.

 

[Dejavu]

Just try approaching a patient with a systems approach. Starting with cardiac, then pulmonary, then renal, etc.

This will help keep you and your presentations organized. You'll look like a star.

Every decision you have to make, choose only two choices and make mental two-choice algorithms. Pick one and go on to the next two-choice decision tree.

Few decisions need more than two choices.

Just my way of making life more organized, to this day.

Also, I will second the notion that nurses make a great resource. Don't worry about looking stupid in front of them. They see people like you every month, month in and month out, and will appreciate you for not blindly plunging ahead and possibly harming their patient.

 

[Dral]

I had ICU as my 4th rotation intern year. I started on a floor month and pretty much hit the ground running. By the time I hit my ICU month I was presenting on rounds without any paper and was fairly confident.

I thought that would fly in the ICU. I was mistaken. My first week SUUUUCKED in the ICU...and again, it was my 4th rotation. Actually the whole month sucked. Hated it. Would not do again.

The point is, the ICU is difficult for interns, especially as a first rotation. I got through mine, you'll get through yours.

And I also have to echo the sentiment of consulting the ICU nurses. In my experience, most of the MICU nurses are rock stars.

 

[Smurfette]

It's normal. You started in the MICU, which is a hard rotation with really sick patients. This is on top of getting used to being a resident, using the EMR and figuring out where things are. Your seniors know you are new and need help.

My only tip is to keep notes so that you can apply the info to other, similar patients going forward. i.e. think generic ICU admit orders, DKA orders, CHF orders, sepsis-specific orders, hepatic encephalopathy related orders, hyperkalemia orders, GI bleeder orders, etc. If you have good standard order sets for these, you still need to know what's in them (this can help you develop a plan in your notes) and how frequently you'll be checking follow up labs, etc. Also keep track of attending preferences which you can review in the future when back on this rotation.

 

[LUCPM]

I did my ICU rotation at the end of my intern year and I still felt stupid. Most importantly, try not to let that feeling interfere with your learning. You are there to learn, not expected to know everything.

Sent from my SM-G935R4 using Tapatalk

 

[Keona]

Better to feel stupid than to think you know everything and make very bad orders as a result. If at the end of the year the upper levels are putting in most of your orders then it would be a problem, right now we don't expect you to be able to order Tylenol without help. By the end of day one ordering Tylenol successfully should be possible. Each day you'll learn several new things, I also kept a notebook of the orders I needed to put in on each patient as well.

 

[Seaunicorn]

Yeah you guys are right. I think what's really getting to me is that my clinical reasoning skills are super rusty. Today a pt had a hgb and hct of 12 and 27 and I just sort of froze and didn't know how to work it up. I just had random bits of things I used to know flying around in my brain. I had to read uptodate and then was like "ohhh I remember this now". But it makes me sad that I have to look everything up basically most of the time.

 

[The white coat trainer]

You will be amazed at how quickly you will learn the things you have to look up. You are going to continuously see patients for the same complaints and they will have similar issues. Soon enough you will realize that bread and butter things like anemia will be second nature to you

 

[Dral]

Another point is that most educational endeavors we experience in our life give us the knowledge to do jobs, but don't actually teach us how to do the job. I have a PhD in molecular genetics. I haven't worked in that area for years. While I used to do specs to find 260/280 readings daily or multiple times a day, I don't even remember the exact way to do it anymore.

You learn about metoprolol and Lasix in med school. Even see it being managed a bit during clinical rotations, but until you do it day by day it just doesn't come naturally. I knew all about that stuff by the end of intern year (prelim, not categorical). I have little to no recollection of how to manage those things now.

The point is, you're learning how to do your job. As long as you still have the knowledge (or it comes back to you as soon as you look it up), you're at a normal place. You'll soon be looking up few things. The Zebras that come through...even attendings will be reading up about those...because they aren't a part of their daily job. But they harbor the past knowledge to learn about how to handle them quickly.

Basically, welcome to the adult work force.

 

[mppcc]

OP- you should only be worried if you don't feel this way on day three. Starting in the micu is being thrown in the deep end of the pool. Keep working hard to swim . Keep your head up, listen, learn from your experiences, and be willing to adapt. Agree with listening to the nurses. 95% of the time the will lead you in the direction. Your senior can help you with the rest.

 

[hallowmann]

Yeah you guys are right. I think what's really getting to me is that my clinical reasoning skills are super rusty. Today a pt had a hgb and hct of 12 and 27 and I just sort of froze and didn't know how to work it up. I just had random bits of things I used to know flying around in my brain. I had to read uptodate and then was like "ohhh I remember this now". But it makes me sad that I have to look everything up basically most of the time.

This is by far the thing that's freaking me out the most right now. Feeling like I don't know and can't remember anything. I expected not to know how to do stuff I've never done on the EMR or to get lost or to have to constantly ask for help. The having to look up every little thing because suddenly I'm not sure of anything I thought I knew.

OP, you're on a crazy hard rotation, but even on a light one, I feel the same way. Hopefully we're both fine.

 

[mvenus929]

This is by far the thing that's freaking me out the most right now. Feeling like I don't know and can't remember anything. I expected not to know how to do stuff I've never done on the EMR or to get lost or to have to constantly ask for help. The having to look up every little thing because suddenly I'm not sure of anything I thought I knew.

OP, you're on a crazy hard rotation, but even on a light one, I feel the same way. Hopefully we're both fine.

I hear the same thing happens in your first attending job. Things you were completely comfortable with as a resident suddenly make you second guess yourself.

 

[Iso4ane]

Also started my intern year in the MICU; learning curve was definitely a little steep (as I didn't really do an internal medicine or an adult ICU rotation 4th year), but look at the bright side, by the end of this month, your other rotations will (hopefully for you, as it did for me) be much easier in comparison.

 

[Vandalia]

I hear the same thing happens in your first attending job. Things you were completely comfortable with as a resident suddenly make you second guess yourself.

One of the old pathologists used to tell the story of his senior residents. Their last week of residency they were calling out diagnoses immediately and without hesitation. Then their first day as an attending looking through the microscope it was "Ummm...I think it might be a liver... no it might be a spleen...no I think it is a liver...." Now how much of that is medical urban legend I do not know, but it doesn't contradict what I have seen.

 

[hmockingbird]

Agree with a lot of what has been said as a new PGY-2... also, don't forget to eat/allow yourself to not eat. Not sure what your program's culture is like but even if it's an energy bar in the workroom it will help you keep going.

 

[rokshana]

Agree with a lot of what has been said as a new PGY-2... also, don't forget to eat/allow yourself to not eat. Not sure what your program's culture is like but even if it's an energy bar in the workroom it will help you keep going.

that was one of the things i did as a resident...always had a bag full of snacks and microwave meals in the team room. It can get busy, esp on call days and by the time you could sit down and eat, the caf was usually closed. The interns (and some fellows that could hunt out free food) seem to appreciate it.

 

[dienekes88]

I just started my intern year and I'm a complete idiot. It's my third day (MICU) and I've never done an ICU rotation and I feel like I don't know what's going on with any of the patients on my team and can barely figure out why we're doing things for my own patients. Everything takes me forever because I'm stumbling around the EMR trying to figure out how to get stuff done while also knowing nothing about medicine anymore. My presentations are horrible. The senior residents have to help me with everything and the first 2 days they put in half my orders because I was slow and didn't have them all in by rounds. Third years absolutely know more than me and I'm scared that I'm going to get in trouble for being a terrible intern.

I can at least say that I do work really hard. Haven't been eating lunch and I've been staying late every day so that I don't leave tasks for the night team. I'm also trying to study when I get home but I feel like my knowledge will never catch up.

I guess I wrote this post just because I'm worried that my best won't be enough for intern year. My program is very supportive and wonderful but I don't want to be a downer and blab about my fears to my fellow interns. I think we're all tying to maintain a positive attitude.

Is the level of incompetence that I'm struggling with unusual? Any tips?

Eh. You might be incompetent, but more than likely you aren't. Most people survive and go on to be perfectly reasonable physicians.

Show up early to pre-round and get through all the data, and thoroughly organize your presentations. Unfortunately, this may be really freaking early if you're having major struggles. Also, you can start thinking about your plans for the next day starting the night before.

Adapting to the EMR can definitely be challenging. I still struggle with the VA computer system, because I haven't been there in a while.

Make sure you eat. You can always bring a lunch (or buy lunch) and continue to work while eating.