M3, feeling guilty and imcompetent

[maybedeadcat]

I'm currently on my surgery rotation and I feel pretty guilty about how disengaged I am with the whole thing.

I barely understand 25% of what the residents discuss on rounds. I did well on step 1, but it still feels like everyone is speaking a different language. So much clinical stuff just goes completely over my head, like brand names of antibiotics, different types of drains/tubes, pacing for advancing diet/pain management, and so many other things. I try my best to look up the stuff that I don't know, but often I'm so lost that I don't even know where to begin researching.

Even the sub-Is seem to know what they're doing 10000 times more than I do. I'm expected to be that competent in 1 year, and I feel like there's absolutely no way I'm going to get there. I want to be a good physician, but right now I feel like I am less than useless.

Because of all this, I spend all day trying to go home as early as possible while still being "helpful" enough to get good evals... And my attempts to be helpful usually result in more work for the residents. I.e. making phone calls for residents frequently ends with me needing to hand the phone over, I have to be taught how to do even minor procedures like removing NG tubes, etc etc.

What can I do to be a better M3? I hate feeling like I want to leave all the time, I'd so much rather be productive and helpful. How can I make sure that I'll be at least somewhat competent by the time I'm a sub-I?

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[QueenJames]

Surgery sucks ass.

Period.

 

[Oso]

welcome to medicine

felt the exact same way (and sometimes still do) a few months ago when i started intern year

 

[mistafab]

The difference between a student at the beginning and end of surgery rotation is astronomical.

You’ll all of a sudden notice that everybody is making sense, and by then, you’ll be on your last week of rotation lol. Don’t sweat it too much.

 

[akwho]

The competence difference between a MS3 and a sub-i is astronomical. Don't compare apples to oranges.

You do need to fix your attitude though. The surgical attitude is, "what's next." Not, "doing the bare minimum until I can go home." That will be sniffed out very quick and held against you, we know when med students don't want to be there. Work until there isn't any work left. You're done with your work? Good you can help the intern or the resident. Get everyone out of the hospital faster. If you don't learn a single thing about surgery, but you learn how to emulate the surgical work ethic it will be an useful rotation for you.

 

[Dares Dareson]

Third year is all about making you feel as stupid as possible. We've all been there. I just submitted applications for general surgery residency and I was a complete idiot in my surgery clerkship third year.

The one thing that will screw you over on surgery is trying to duck out early. Plan on staying there as late as possible, regardless of what the schedule says. When it comes to evals, they're not going to mark you down for lacking knowledge. They will, however, mark you down for appearing lazy. At the end of the day, surgery values hard work and teamwork above all else.

 

[hmockingbird]

Third year is all about making you feel as stupid as possible. We've all been there. I just submitted applications for general surgery residency and I was a complete idiot in my surgery clerkship third year.

The one thing that will screw you over on surgery is trying to duck out early. Plan on staying there as late as possible, regardless of what the schedule says. When it comes to evals, they're not going to mark you down for lacking knowledge. They will, however, mark you down for appearing lazy. At the end of the day, surgery values hard work and teamwork above all else.

Plus, a lot of this is stuff you CAN’T learn from a book alone, such as when to advance a diet... you just need to see as many patients as possible to learn something like that.

 

[Psai]

Every year you look back and see the new people come in. You realize how far you've come in a year. It'll happen to you too.

 

[CougarMD]

I'm currently on my surgery rotation and I feel pretty guilty about how disengaged I am with the whole thing.

I barely understand 25% of what the residents discuss on rounds. I did well on step 1, but it still feels like everyone is speaking a different language. So much clinical stuff just goes completely over my head, like brand names of antibiotics, different types of drains/tubes, pacing for advancing diet/pain management, and so many other things. I try my best to look up the stuff that I don't know, but often I'm so lost that I don't even know where to begin researching.

Even the sub-Is seem to know what they're doing 10000 times more than I do. I'm expected to be that competent in 1 year, and I feel like there's absolutely no way I'm going to get there. I want to be a good physician, but right now I feel like I am less than useless.

Because of all this, I spend all day trying to go home as early as possible while still being "helpful" enough to get good evals... And my attempts to be helpful usually result in more work for the residents. I.e. making phone calls for residents frequently ends with me needing to hand the phone over, I have to be taught how to do even minor procedures like removing NG tubes, etc etc.

What can I do to be a better M3? I hate feeling like I want to leave all the time, I'd so much rather be productive and helpful. How can I make sure that I'll be at least somewhat competent by the time I'm a sub-I?

As several other posters have said, the learning curve is steep and you will not always realize how much you know and have learned until you look back and see those that come after you. Everything you are feeling is completely normal. Every time I am reminded that I actually know things, I am a little shocked (and I am a third year resident).

For a few ways to help you out with being a better M3:

1. Forget the good evals for a week, and get a little selfish. And what I mean by that is spend a week trying to learn as much as you can without worrying about how people see you. This means asking questions that may be stupid. You don't have to ask them on rounds, or in front of attendings...but when you're scrubbing in with a resident or walking behind the pack to a far-away patient room, ask a quick question of whomever on the team you are closest to. Don't forget resources like PharmDs, RDs, PTs, PAs, and NPs if they are regulars on your team and rotate with you. There should be a lot of people around you that don't evaluate you and you can be "stupid" around. Also, asking questions of people and gaining an understanding of when they are giving you good answers versus bad answers is very helpful. As you go through your learning journey you are going to get bad and incomplete information....from patients and from those that are teaching you. The more you ask questions and hear answers, the better you will be at sussing out who is giving you good information.

2. Take one day on rounds and make a note of every abbreviation and topic that people talk about that you don't understand. Spend the rest of the day looking those things up. This should be something you do on every rotation, but on those rotations where the learning curve is steep it is especially important. You won't catch everything, but see how much it changes your perspective.

3. Instead of feeling bad about "being taught to do even a minor procedure like removing NG tubes", try as often as you can to do these minor procedures. There are several things that med students should learn on surgery and don't, so let this be a running list of things you can focus on:

A - Why do surgeons place drains, what types of drains, and why do they place them in the locations they do?

B - What are all of the different types of dressings you can do on a wound (Xeroform, wet to dry, mepelex, VAC, etc etc.) and why do you use each? You're going to be doctor....shouldn't you know as much (if not more) than nurses about how to dress a wound? If you go camping with a group and someone gets hurt, won't you feel like an idiot if you know nothing about dressings? To this end, ask if you can spend some time with the Wound/Ostomy nurse. You are taking initiative and asking to learn. If they say no.....that says a whole lot more about your program...and that is a totally different discussion.

C - Why are there different types of anesthesia used for different types of cases?

D - For common problems that all doctors will see (epistaxis, bowel obstruction, appendicitis, cholelithiasis) exactly WHEN do you need to involve a surgeon? This is really one of the fundamental things that 3rd year is trying to teach you. You're not going to go into all of these specialties....but you should know when you need to consult them.

E - Management of all of the tubes, drains, etc that surgical patients have. When they should or should not be on suction, how much suction, when to remove them, etc. At the very least, in intern year you will deal with this stuff no matter what your specialty is. Figure out the commonalities and overall management strategies.


You are learning. I promise. It sounds like you know how to pull an NG tube out....most MS2s don't know this

 

[takeurmeds02]

Everything that's been said is great. Another small comment - You're also being really hard on yourself. I don't know you but the expectation is that as a 3rd year, you've never done clinical work before. You're not supposed to know how to place or remove an NG tube..especially a couple months into M3. Hell, they had to show me how to remove staples the other day haha. You take it on the chin and keep it moving. Your job is to be a good learner. They'll be annoyed having to show/tell you how to do things and yes, it's unwarranted but if they have to keep showing/telling you, that's a problem.