MS1 feeling unfit for medicine

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In the last few weeks I have been seriously questioning whether I belong in medical school. I enjoy the material and I've been doing really well in my classes this year (not that it matters, true P/F school), but lately I have received some feedback that has made me question myself.

For example, I recently had a physical exam skills session where I could not for the life of me feel the femoral pulse on the newborn I was examining. The instructor chastised me and cautioned me against entering fields like IM where physical exam skills are essential. I'm sure I'm overreacting, but it seriously scared the **** out of me. I can study as much as I want, but I can't make my fingertips more sensitive or whatever.

Two weeks ago, in small group, my facilitator said that I made excellent contributions, but that they were negated by the way that I delivered them because I so obviously had low self-esteem. She told me that 3rd and 4th year, this will be mistaken for stupidity and/or incompetence. I have always had low self-esteem and knew it could be a problem in medical school, but this facilitator so blatantly called me out (and even mocked me in front of my classmates) that it's making me think 1) my low self-esteem will prevent me from doing well in 3rd/4th year, and 2) my low self-esteem can't handle the criticism I am sure to get during the clinical years. This incident has seriously sent me into a tailspin (unreasonable, I know) of self-doubt and misery. This makes me think I probably lack the coping skills to deal with rotations.

I also have a leadership role requiring me to regularly volunteer in our student clinic, and I passionately hate it. I always knew primary care wasn't for me, so it's not that shocking, but it's just another factor that's really making me question myself. It might just be the patient population I'm working with or the fact that I'm so new at everything, but I feel incompetent/desperate/miserable during and after clinic. I sort of enjoy interacting with patients, but I HATE giving pelvic exams or doing blood draws, especially while the patient is screaming in pain the whole time. 🙁

I don't want to drop out of medical school. I like what I'm learning and it's not like there's something else I'm qualified to do right now, or even really something I'd rather be doing. But my experience in clinic and my feedback is making me wonder if I'm even capable of finishing medical school, let alone having a career in medicine. If I'm too incompetent or have too weak of an ego or whatever, I probably should drop out, right? I have no debt. Have I just been unlucky with two bad comments in the last month? Or is this a warning sign? I'm also on the young side at 22 if this makes a difference. Thanks.

 

[GalenAgas]

Two questions:

1) Are you a girl?
2) Are you pretty?

 

[kexy]

Two questions:

1) Are you a girl?
2) Are you pretty?

1) Yes
2) Well, I have cripplingly low self-esteem, there is no way I can accurately answer that question.

Both of these incidents have happened with women though. It occurred to me that female physicians might "eat their young" just like nurses do, but I'd also like to think I'm at a kindhearted hippie granola school where things like that don't happen.

 

[Wordead]

Physical exam skills are learned via experience. I don't know what decent teacher would expect a first year to be at all competent in PE. I still can't find the optic disc half the time. That's ridiculous to say that you can't do IM because you couldn't find a pulse one time.

The self-esteem issue is probably true though - nobody will take you seriously if you have no confidence behind what you say. That's true in pretty much any field, anywhere. Not to mention if 2 random negative comments from strangers have you questioning medicine entirely, you're going to get annihilated on the wards. You're going to have to find a thicker skin somewhere.

 

[umean2tellme]

Don't worry too much about your skills as an M1. The more experience you get the better your skills will be and the more confident you will appear.

 

[metalgirl14]

First of all, you're only an M1. Nobody can do a perfect physical exam on their first try. These things take practice. If you're still uncomfortable with the physical exam after M3 and M4, there are several fields that require minimal physical exam skills (Psych is one example of this).

Second, you really shouldn't worry about 1 or 2 negative comments. Negative comments are pretty common, so you'll just have to get used to them. As for the low self esteem, this is just something you will need to work on.

 

[penguin24]

Don't beat yourself up about the physical exam, which is going by the wayside w/ all the labs and imaging available.

Some physical findings are just impossible to make, especially in our society of 300 lb and up patients. Just like girls sometimes fake orgasms, I sometimes fake thyroid exams 'Oh yes, I feel that right thyroid nodule', fake pelvic exams 'Oh yes, I feel the ovaries and they are normal in size', and of course you have to fake abdominal exams 'Oh yes, based on my percussion the liver is approximately 10 cm in length'.

 

[Thyroxine]

In the last few weeks I have been seriously questioning whether I belong in medical school. I enjoy the material and I've been doing really well in my classes this year (not that it matters, true P/F school), but lately I have received some feedback that has made me question myself.

For example, I recently had a physical exam skills session where I could not for the life of me feel the femoral pulse on the newborn I was examining. The instructor chastised me and cautioned me against entering fields like IM where physical exam skills are essential. I'm sure I'm overreacting, but it seriously scared the **** out of me. I can study as much as I want, but I can't make my fingertips more sensitive or whatever.

Sounds like a douchebag instructor to me - you're less than a year into the course, no-one should expect you to have perfect clinical skills at this point. Furthermore, how you perform as a first year doesn't predict how you'll do in the next 40 years of your career, or what you should specialise in.

We've all had rubbish days when we've felt totally incompetent - a good instructor should support you, not make you feel worse.

Two weeks ago, in small group, my facilitator said that I made excellent contributions, but that they were negated by the way that I delivered them because I so obviously had low self-esteem. She told me that 3rd and 4th year, this will be mistaken for stupidity and/or incompetence. I have always had low self-esteem and knew it could be a problem in medical school, but this facilitator so blatantly called me out (and even mocked me in front of my classmates) that it's making me think 1) my low self-esteem will prevent me from doing well in 3rd/4th year, and 2) my low self-esteem can't handle the criticism I am sure to get during the clinical years. This incident has seriously sent me into a tailspin (unreasonable, I know) of self-doubt and misery. This makes me think I probably lack the coping skills to deal with rotations.

Wow, seriously, what is it with the staff at your medical school? It doesn't sound like a very nice environment to be in - but that doesn't mean that you're at fault here, or you're not good enough to be doing medicine.

I also have a leadership role requiring me to regularly volunteer in our student clinic, and I passionately hate it. I always knew primary care wasn't for me, so it's not that shocking, but it's just another factor that's really making me question myself. It might just be the patient population I'm working with or the fact that I'm so new at everything, but I feel incompetent/desperate/miserable during and after clinic. I sort of enjoy interacting with patients, but I HATE giving pelvic exams or doing blood draws, especially while the patient is screaming in pain the whole time. 🙁

You can't love everything. Just consider it as another hoop to jump through. If you've already identified that primary care isn't for you, then that's simply means you shouldn't become a primary care physician - which you didn't want to do anyway! So what's the problem? 😛

I don't want to drop out of medical school. I like what I'm learning and it's not like there's something else I'm qualified to do right now, or even really something I'd rather be doing. But my experience in clinic and my feedback is making me wonder if I'm even capable of finishing medical school, let alone having a career in medicine. If I'm too incompetent or have too weak of an ego or whatever, I probably should drop out, right? I have no debt. Have I just been unlucky with two bad comments in the last month? Or is this a warning sign? I'm also on the young side at 22 if this makes a difference. Thanks.

Honestly? I think you're going through what nearly every one of us goes through in first year - self doubt and lack of self confidence. This isn't abnormal or a sign of weakness. What IS disappointing is that the staff at your med school seem so unsupportive and downright unkind at times - you shouldn't be made to feel that way!

It's not a warning sign of anything in my opinion. You've identified that you're doing well in exams, you still enjoy medicine, and you want to be a doctor. That's all there is to it really. Take things as they come, no rational person expects (or should expect) you to have the same knowledge and clinical acumen as a fourth year.

If you like, you can PM me if you want to talk more about this. All the best.

 

[NeuroLAX]

I wouldn't get so down on yourself about these things. Your facilitator might have said those things to strengthen and build your confidence, albeit more blunt than you were expecting. Take it as a learning experience. She obviously appreciated your contributions, so her only criticism was to be more confident.

Nobody is expecting you to be a pro at everything. Practice, practice, upon more practice makes it manageable. Also, just because you can't find a pulse on someone doesn't mean you don't know how to do it. This is why it is important to practice on different body types. Not all your patients will have the physique of your fellow classmates.

 

[gimghoul]

MS1 has basically no bearing on anything worthwhile.

 

[bashir]

Your lack of physical exam skills is NOT a problem at this point. My advice would be to work on improving your skills as opportunities arise (depending on your school, this may not happen much until third year) and whatever you do, don't stress about it.

Your crippling self-doubt is, well, crippling. You say "If I'm incompetent, or have too weak of an ego, I should probably drop out." Absolutely not. You've given us no reason to think you're incompetent; it sounds like dropping out is appealing to you because it would allow you to ignore your self esteem issues, but they won't go away or cease to be a problem in some other profession, so you might as well deal with them head on rather than throwing away everything you've worked toward thus far. Get some counseling. You have what it takes to succeed on this path, but you may need some professional help convincing yourself of that.

 

[dd128]

Don't beat yourself up about the physical exam, which is going by the wayside w/ all the labs and imaging available.

Some physical findings are just impossible to make, especially in our society of 300 lb and up patients. Just like girls sometimes fake orgasms, I sometimes fake thyroid exams 'Oh yes, I feel that right thyroid nodule', fake pelvic exams 'Oh yes, I feel the ovaries and they are normal in size', and of course you have to fake abdominal exams 'Oh yes, based on my percussion the liver is approximately 10 cm in length'.

Best post I've seen on here in a while 👍

Completely agree. Old docs love trumping how residents now a days have it so easy, can't perform physical exams properly, are lazy, bla bla bla. A lot of the stuff they are teaching is fine, but when is it ever important to know how effing long the liver is. If I can feel it 10 cm below the costal margin it's too damn big, other than that I don't really care that much and will see what the ultrasound says. What I really hate are the ones who make you do completely unnecessary vaginal and rectal exams. Everyone knows the, "I want you to check rectal exams on every admit," attending.

And to OP everyone is nervous and doubts themselves, even in residency. This won't be going away any time soon, but will slowly get better as you just get more practice. And unfortunately you are always going to get crummy feedback at points, such is life.

 

[ucladoc2b]

Best post I've seen on here in a while 👍

Completely agree. Old docs love trumping how residents now a days have it so easy, can't perform physical exams properly, are lazy, bla bla bla. A lot of the stuff they are teaching is fine, but when is it ever important to know how effing long the liver is. If I can feel it 10 cm below the costal margin it's too damn big, other than that I don't really care that much and will see what the ultrasound says. What I really hate are the ones who make you do completely unnecessary vaginal and rectal exams. Everyone knows the, "I want you to check rectal exams on every admit," attending.

And to OP everyone is nervous and doubts themselves, even in residency. This won't be going away any time soon, but will slowly get better as you just get more practice. And unfortunately you are always going to get crummy feedback at points, such is life.

QFT.

OP, don't let the negative evals get you down. Listen to what the evaluator has to say, but always take it with a grain of salt. In some cases, feedback is great and helpful. In other cases, the evaluator has no idea what he/she is talking about and is just using the occasion to rehash his/her sense of self-importance.

 

[xrevision]

Also, based on the feedback you're getting from attendings who know you're just an MS1, it's time to grow some thick skin. It's hard to do, but you'll feel a lot better at the end of the day when you know you're paying 100-200$ a day to get yelled at and abused by some surgical resident/attending for something out of your control.

 

[girlonfire]

That was rude and unprofessional to call you out in front of the entire group.

With that said, I think these fears are evidence of your low self-esteem. Don't let a few negative interactions dictate your perception of your competency. We all have a lot of training ahead of us that will make us great physicians. Find ways to feel better about your abilities and who you are overall.

 

[survivordo]

I agree with everyone that these comments will likely have little bearing on your future career as a physician. However, you will need to find a way to develop thicker skin as you are likely to get several more comments about this along your way.

It IS important to at least give the perception that you are self-confident as a physician. Your patients are looking toward you as a source of information, you want them to be confident in your opinion right? This all gets easier with time and as your knowledge increases!

Survivor DO

 

[xenotype]

I don't want to drop out of medical school. I like what I'm learning and it's not like there's something else I'm qualified to do right now, or even really something I'd rather be doing. But my experience in clinic and my feedback is making me wonder if I'm even capable of finishing medical school, let alone having a career in medicine. If I'm too incompetent or have too weak of an ego or whatever, I probably should drop out, right? I have no debt. Have I just been unlucky with two bad comments in the last month? Or is this a warning sign? I'm also on the young side at 22 if this makes a difference. Thanks.

You are surrounded by *******s; nobody at my school is criticized like that (ESPECIALLY not in front of others) in the first year. Talk to psych if your school allows it, and they can help you with self-esteem. Also, most M1s including me have no idea how to do pelvic exams or blood draws so I'd say you are working a bit ahead of the curve.

 

[evilbooyaa]

22 as a M1? Pssh, that's old.

Anyways, relating to your OP, the first example is an attending being kind of an ass to a fresh M1. Pulses, especially DP/PT are remarkably hard to find in patients who aren't the stunning example of health. DP, especially, can be pretty variable in location on patients. The attendng should have found it, then showed you where to put your finger so you could feel it and know where to look for it in future patients.

The second comment you posted seems like someone who is genuinely trying to help you improve. Self-esteem isn't something that can be quickyl transformed. I've had friends who would know their stuff super well, but people would doubt almost everything they said because they would start every sentence with, "I think this" or "It might be", even when they were relatively sure of it. In contrast, there were people that knew less than the prior group, but people took their word as the truth because they spoke with more confidence.

In terms of your self-esteem, there is no easy way to grow thick skin. But, I would say if you're contemplating dropping out after 2 comments (only one of which was kind of unwarranted) as a M1, some of your M3 rotations are going to force you out of medical school if your skin is no thicker in 2 years.

 

[MetalGearFox]

Perhaps it is not you who is unfit for medicine, but those educators around you who are unfit to teach.

 

[tco]

MS1 has no bearing on anything.

Fixed.

 

[notbobtrustme]

MS1 has basically no bearing on anything worthwhile.

that's false. M1 is great for finding the one or two hot girls in your class. The rest? :shudder:

 

[Thyroxine]

that's false. M1 is great for finding the one or two hot girls in your class. The rest? :shudder:

Lots of hot girls in my med school - all of whom are already taken

 

[Textbookversion]

Lots of hot girls in my med school - all of whom are already taken

Give it time.

 

[oncomine]

agreed, it's almost a right of passage

 

[yesno]

I think some people are indeed "book smart" but "slow" when it comes to other things. I am m2 and doing very well in all my preclinical classes. But my school has a pass/fail clinical exam practical right before step1 and i am very worried about failing that... I think whether someone gives you such disparaging comments or not, you can decide for yourself if you are one of those people that "suck" or that person's comments were incorrect. But I also do not think it's a reason to quit. The time and money investment is just too great. And most other PROFESSIONS require the same set of "interpersonal" skills. I mightve been better off I went into some trade at 18. But now it's too late.

 

[sonofva]

the chief of surgery for my program runs a clinic each year for M4s right before graduation for those students who still cannot properly look in eyeballs or pick out the anatomic landmarks in an ear...so you're not alone. also, i skipped quite a few physical exam classes and i'm doing great on rotations...good educators will show you how to do things as they come up.

 

[PTPoeny]

You are doing fine. As an MS1 you should be unfit to be a doctor, you have only gotten through 1/8th of medical school! The rest of your medical school and residency career will be easier though if you are not thrown into a tailspin by silly comments. Not being able to find one femoral pulse on a newborn does not mean your fingers are numb, you just have to get used to the exam.

Talking to someone at your school is probably a good idea. Possibly even the small group leader who said that you make good contributions but are limited by how you make them. Ask for specific details, tell the person that you are going to work on this and try to do one thing differently each small group session. You also might look into seeing if there is a group like toastmasters where ever you live. This isn't really public speaking, but just speaking with confidence but a lot of the same principles apply.

 

[RockinRoll]

Lots of hot girls in my med school - all of whom are already taken

Give it time.

lol exactly be patient young one.

 

[RockinRoll]

In the last few weeks I have been seriously questioning whether I belong in medical school. I enjoy the material and I've been doing really well in my classes this year (not that it matters, true P/F school), but lately I have received some feedback that has made me question myself.

For example, I recently had a physical exam skills session where I could not for the life of me feel the femoral pulse on the newborn I was examining. The instructor chastised me and cautioned me against entering fields like IM where physical exam skills are essential. I'm sure I'm overreacting, but it seriously scared the **** out of me. I can study as much as I want, but I can't make my fingertips more sensitive or whatever.

Two weeks ago, in small group, my facilitator said that I made excellent contributions, but that they were negated by the way that I delivered them because I so obviously had low self-esteem. She told me that 3rd and 4th year, this will be mistaken for stupidity and/or incompetence. I have always had low self-esteem and knew it could be a problem in medical school, but this facilitator so blatantly called me out (and even mocked me in front of my classmates) that it's making me think 1) my low self-esteem will prevent me from doing well in 3rd/4th year, and 2) my low self-esteem can't handle the criticism I am sure to get during the clinical years. This incident has seriously sent me into a tailspin (unreasonable, I know) of self-doubt and misery. This makes me think I probably lack the coping skills to deal with rotations.

I also have a leadership role requiring me to regularly volunteer in our student clinic, and I passionately hate it. I always knew primary care wasn't for me, so it's not that shocking, but it's just another factor that's really making me question myself. It might just be the patient population I'm working with or the fact that I'm so new at everything, but I feel incompetent/desperate/miserable during and after clinic. I sort of enjoy interacting with patients, but I HATE giving pelvic exams or doing blood draws, especially while the patient is screaming in pain the whole time. 🙁

I don't want to drop out of medical school. I like what I'm learning and it's not like there's something else I'm qualified to do right now, or even really something I'd rather be doing. But my experience in clinic and my feedback is making me wonder if I'm even capable of finishing medical school, let alone having a career in medicine. If I'm too incompetent or have too weak of an ego or whatever, I probably should drop out, right? I have no debt. Have I just been unlucky with two bad comments in the last month? Or is this a warning sign? I'm also on the young side at 22 if this makes a difference. Thanks.

I'm even worse than you lol it's honestly not a big deal just chill. If you get stressed out some more find a boy, if you can't find a boy then hit me up. I'll give you my numbah and I'll call, follow you to the mall.

 

[CodeBlu]

Seriously? Your faculty/staff sound absolutely horrible.

My advice? Stand in your bathroom and look at yourself in the mirror for 10 seconds. Walk away. Then do it for 20 seconds. Then do it for 1 minute.

Get comfortable with yourself. Look yourself in the eyes. You are in medical school for a reason. You're clearly intelligent. Pull it together. You've got it made. Don't let a few idiots ruin this for you.

And seriously? Physical exam skills? REALLY??????

Femoral pulses are notoriously hard to feel in an infant. Lots of fat and stuff. You're gonna be just fine. I promise.

 

[NickNaylor]

Can't feel the femoral pulse? Gunna be a bad doctor.

OP, my advice is to get over the feelings of inadequacy you're feeling now as it's likely that you will feel them in the future. As long as you're working hard and doing your best to learn as much as you can, you will be fine. I don't think anyone expects a pre-clinical student to do anything perfectly the first time, especially physical exam skills. Sounds like you just had a terrible teacher who lacks tact.

Sent from my SAMSUNG-SGH-I717

 

[D elegans]

The comment from the doc about your not feeling the femoral pulse is absolutely absurd

 

[Unzbuzzled]

In the last few weeks I have been seriously questioning whether I belong in medical school. I enjoy the material and I've been doing really well in my classes this year (not that it matters, true P/F school), but lately I have received some feedback that has made me question myself.

For example, I recently had a physical exam skills session where I could not for the life of me feel the femoral pulse on the newborn I was examining. The instructor chastised me and cautioned me against entering fields like IM where physical exam skills are essential. I'm sure I'm overreacting, but it seriously scared the **** out of me. I can study as much as I want, but I can't make my fingertips more sensitive or whatever.

Two weeks ago, in small group, my facilitator said that I made excellent contributions, but that they were negated by the way that I delivered them because I so obviously had low self-esteem. She told me that 3rd and 4th year, this will be mistaken for stupidity and/or incompetence. I have always had low self-esteem and knew it could be a problem in medical school, but this facilitator so blatantly called me out (and even mocked me in front of my classmates) that it's making me think 1) my low self-esteem will prevent me from doing well in 3rd/4th year, and 2) my low self-esteem can't handle the criticism I am sure to get during the clinical years. This incident has seriously sent me into a tailspin (unreasonable, I know) of self-doubt and misery. This makes me think I probably lack the coping skills to deal with rotations.

I also have a leadership role requiring me to regularly volunteer in our student clinic, and I passionately hate it. I always knew primary care wasn't for me, so it's not that shocking, but it's just another factor that's really making me question myself. It might just be the patient population I'm working with or the fact that I'm so new at everything, but I feel incompetent/desperate/miserable during and after clinic. I sort of enjoy interacting with patients, but I HATE giving pelvic exams or doing blood draws, especially while the patient is screaming in pain the whole time. 🙁

I don't want to drop out of medical school. I like what I'm learning and it's not like there's something else I'm qualified to do right now, or even really something I'd rather be doing. But my experience in clinic and my feedback is making me wonder if I'm even capable of finishing medical school, let alone having a career in medicine. If I'm too incompetent or have too weak of an ego or whatever, I probably should drop out, right? I have no debt. Have I just been unlucky with two bad comments in the last month? Or is this a warning sign? I'm also on the young side at 22 if this makes a difference. Thanks.

You will make an excellent pathologist.

 

[Bluesclera]

I would always get nervous before my MS1 clinical skills exams because we had to ask questions and perform clinical tests that made absolutely no sense to me. my preceptors would just say that we need to just focus on the movements and as we learn the material it will make more sense. I completely agree and hate this statement. Because initially it is just a movement or test that we ask the patient to do but without the appropriate context it doesnt make sense and I feel like I'm just messing around without doing anything meaningful. Absolutely hated first year clinical skills...

Second year was awesome because I realized that 1) I need to practice my clinical skills and learn why I am doing it 2) I found youtube videos that teach everything I need to know (https://www.youtube.com/playlist?list=PLC7A2A3A140D0391B very good for the History part)

3) I was learning the associated pathology that linked the clinical skill and question with a pathological finding.

I wouldnt worry about what other people say, focus on what you want out of yourself. How do you see yourself in 10 years? what would make you happy today? are you teaching residents and doing clinical research? or are you private practice/ more clinical? w/e and dont forget the other parts of your life outside of your career: how is your family? do you have a family? how many kids? so answer these questions make a better picture of what makes you happy and then apply those values throughout your day.

Also remember that you are in charge of your happiness, if someone tells you that you are a complete failure, then its up to you to accept that comment or brush it off and say well based on my past experience I dont agree with that (in your mind of course).

And finally, find a mentor that matches with the picture you have of yourself (The one that fits with what would make you happy). where ever this person is make an attempt to make him/her your mentor and learn from them and have them guide you. Also know that you can have multiple mentors who can guide you in different aspects of your life.

Take care!

 

[wuhsabee]

Don't beat yourself up about the physical exam, which is going by the wayside w/ all the labs and imaging available.

Some physical findings are just impossible to make, especially in our society of 300 lb and up patients. Just like girls sometimes fake orgasms, I sometimes fake thyroid exams 'Oh yes, I feel that right thyroid nodule', fake pelvic exams 'Oh yes, I feel the ovaries and they are normal in size', and of course you have to fake abdominal exams 'Oh yes, based on my percussion the liver is approximately 10 cm in length'.

This was awesome.

Sent from my Nexus 4 using Tapatalk

 

[Ogenki]

Don't beat yourself up about the physical exam, which is going by the wayside w/ all the labs and imaging available.

Some physical findings are just impossible to make, especially in our society of 300 lb and up patients. Just like girls sometimes fake orgasms, I sometimes fake thyroid exams 'Oh yes, I feel that right thyroid nodule', fake pelvic exams 'Oh yes, I feel the ovaries and they are normal in size', and of course you have to fake abdominal exams 'Oh yes, based on my percussion the liver is approximately 10 cm in length'.

lol, that's terrible. I just admit I couldn't feel a thing (not to the patient)

 

[PxNegative]

Two questions:

1) Are you a girl?
2) Are you pretty?

@GalenAgas - While you may have been well-intentioned, those comments are sexist and unhelpful. Asking if she's female seems like you're implying that she's just being hysterical (though maybe you were trying to comment on sexism that still exists in academic medicine?). Asking if she's attractive seems like you're implying that either 1) she's ugly and so her low self esteem is justified or 2) she's pretty and so she clearly only got as far as she has based on her looks and is now finding that she really can't cut it (or maybe this was a meta-commentary on the fact that women are still judged in these ways?).

that's false. M1 is great for finding the one or two hot girls in your class. The rest? :shudder:

@notbobtrustme - This, too, is sexist and unhelpful, even if you meant it tongue-in-cheek.

In the last few weeks I have been seriously questioning whether I belong in medical school. I enjoy the material and I've been doing really well in my classes this year (not that it matters, true P/F school), but lately I have received some feedback that has made me question myself.

OP- Sounds like you may be suffering in part due to "impostor syndrome." Seriously, I'm not making it up–google it. It's really common among grad students, and med students as well. Basically, you've got to force yourself to realize that the self doubts you're experiencing are incredibly common, even among people who go on to be leaders in their fields. I'd bet some of the people you look up to in medicine experienced this at some point in medical school.

For example, I recently had a physical exam skills session where I could not for the life of me feel the femoral pulse on the newborn I was examining. The instructor chastised me and cautioned me against entering fields like IM where physical exam skills are essential. I'm sure I'm overreacting, but it seriously scared the **** out of me. I can study as much as I want, but I can't make my fingertips more sensitive or whatever.

OP- As others have mentioned, you should not judge yourself too harshly because of one exam or even because you aren't learning the skills as fast as you'd like or as fast as your peers–in fact, I'd bet half the time your peers just fake it and say they can find a newborn's pulse even though they can't. By being honest to yourself and instructors, you're setting yourself to learn the skills better and be a better doctor in the long run. Also, if an instructor chastised you that harshly and suggested it had implications for your career prospects, they have no place being instructors. You don't want to make waves, but consider leaving anonymous feedback to an appropriate office about the instructor's behavior, as long as you're confident it can't/won't come back to you. Also, while you can't make your finger tips more sensitive, you can learn how to feel with them. Think about listening to heart sounds. It takes practice to learn how to process all the auditory information, to distinguish between different types of sounds, especially when they overlap in frequency &/or timing. Your ears aren't any more sensitive, but you are better at hearing. Same goes for feeling pulses.

Two weeks ago, in small group, my facilitator said that I made excellent contributions, but that they were negated by the way that I delivered them because I so obviously had low self-esteem. She told me that 3rd and 4th year, this will be mistaken for stupidity and/or incompetence. I have always had low self-esteem and knew it could be a problem in medical school, but this facilitator so blatantly called me out (and even mocked me in front of my classmates) that it's making me think 1) my low self-esteem will prevent me from doing well in 3rd/4th year, and 2) my low self-esteem can't handle the criticism I am sure to get during the clinical years. This incident has seriously sent me into a tailspin (unreasonable, I know) of self-doubt and misery. This makes me think I probably lack the coping skills to deal with rotations.

OP- As others have said, this facilitator was probably well-intentioned and did give good advice, but it was inappropriate for her to embarrass you in front of your classmates like that. Maybe she was trying to make sure the whole group heard her self-esteem advice, but she should have given your advice in private and explained the general advice some other time when it wouldn't obviously be in response to you. Having low self-esteem totally sucks and it's understandable that these things could send you into a tailspin, especially if you're used to performing better than most classmates and rarely getting anything but positive feedback. But, the instructor is right that you've got to improve your self-esteem now while the consequences are comparatively minor, so you don't have the problems she described in your clinical years. Maybe I belong at a "hippie granola school," but I think everyone deserves to have high self-esteem. You'll be much happier and you'll perform better if you're able to work on this.

Get counseling
This can't be emphasized enough. There are plenty of reasons why you might be reluctant to do this–maybe you think it's an admission of weakness or failure to need counseling, maybe you don't think it'll help or that you have time for it, maybe you are afraid of future colleagues finding out you sought counseling and how that could affect your career prospects. None of them is strong enough to argue against seeking help now. Plus, most of them are overblown, anyway. Everyone goes through rough patches and virtually everyone who makes it through them gets outside help in one form or another. Maybe they have a strong support system from family or friends. Maybe they had a great mentor. Maybe they sought counseling. It's a strength, not a weakness, to face your limitations, to admit that it's probably better to have some help than to blindly go it alone. It's a little corny, but you've already sought help here–if you can do that, you're strong enough to get help from professionals who will be much better at this than we are. Counseling can and does work and it can save people's careers and even their lives. They can refer you to a psychiatrist, as needed, since you may be suffering from depression or something else that can be effectively treated or managed with medications on top of counseling. Your privacy concerns are valid, but I guarantee you that a good percentage of your classmates are already seeing counselors &/or psychiatrists. See if your school has any counseling services that are specifically for medical students and that are isolated from the rest of your institution in order to safeguard your privacy (my school has this and I've heard of others that do, too). If not, see about going to a private practitioner whose medical records are totally separate from your school's. In the end, they can't legally hold it against you even if they did find out, and the potential benefits far outweigh the risks.

I also have a leadership role requiring me to regularly volunteer in our student clinic, and I passionately hate it. I always knew primary care wasn't for me, so it's not that shocking, but it's just another factor that's really making me question myself. It might just be the patient population I'm working with or the fact that I'm so new at everything, but I feel incompetent/desperate/miserable during and after clinic. I sort of enjoy interacting with patients, but I HATE giving pelvic exams or doing blood draws, especially while the patient is screaming in pain the whole time. 🙁

OP- This is a lot more complicated, but you should really examine why you got involved in the first place if you already knew you hated it (not criticism per se, since this is really common). See if there are other leaders who could replace you if you left. As long as it wouldn't have serious consequences for the clinic and as long as you talk to the appropriate people beforehand to ensure a smooth transition, you might seriously consider stepping down. You don't have to put it on your CV and it won't kill your match prospects to have done one less (none?) extracurricular during your first year. You might decide to just grin and bear it and that's fine, too. It might even "build character" as is so often said about putting up with a bunch of crap you can't stand.

I don't want to drop out of medical school. I like what I'm learning and it's not like there's something else I'm qualified to do right now, or even really something I'd rather be doing. But my experience in clinic and my feedback is making me wonder if I'm even capable of finishing medical school, let alone having a career in medicine. If I'm too incompetent or have too weak of an ego or whatever, I probably should drop out, right? I have no debt. Have I just been unlucky with two bad comments in the last month? Or is this a warning sign? I'm also on the young side at 22 if this makes a difference. Thanks.

OP- Even if you are incompetent now, you can still learn. Please, please, please look into "impostor syndrome." You're almost certainly judging yourself and your abilities too harshly and not noticing that many of your classmates are probably also struggling. It may even seem like you're the only one struggling and that everyone knows it. They don't. Just as you don't notice that they're struggling, so, too, do they fail to notice your struggles. Sure, some are sailing through, but most aren't and almost everyone will struggle as you are now at some point during their medical education. Also, because you're probably too hard on yourself, you may be interpreting the criticism as being harsher than was actually intended by the facilitators. I'm not denying your experience or feelings, though.

You do need to develop a thicker skin, but the best way to do this is to build self-esteem so that you can be confident in yourself to the point that criticism like you've experienced recently can't shake it. The best way to do this, especially while in the middle of medical school, is to seek counseling.

PM me, PRN.

You'll make it. Best wishes.


__________________
MD Class of 2016!

 

[Druggernaut]

Both of these incidents have happened with women though. It occurred to me that female physicians might "eat their young" just like nurses do, but I'd also like to think I'm at a kindhearted hippie granola school where things like that don't happen.

That could be part of it. Even cattiness aside, women are treated differently. Patients assume male techs are doctors, while the actual female physicians and PAs get called nurse, and my female classmates are usually assumed to be in nursing school when they say they're medical students.

I worked in a really sharp psych professor's lab as an undergrad, and I remember him giving feedback to the top grad student there after she gave a presentation to us. When you're not confident about the material, the pitch of your voice goes up. People pick up on that. Men can get away with it more, since they have deeper voices to begin with, but women don't have as far to go until they get squeaky. It sounds petty, and maybe even uncontrollable, but I think one of the best skills a medical student can have is the ability to "fake it until they make it." For example, if you go to start an IV on a patient and your voice is as shaky as your hands, they're not going to have faith in you, and you're less likely to succeed. But if you can sound confident and keep your quivering hands out of sight, you have a better chance of a good outcome, which will in time will lead to actual confidence and stop your hands from shaking.

Look at what you're doing that tells people you're not confident, and take steps to eliminate it. And as a side note, your fingertips are probably just about as sensitive as everyone else's'. You just need to practice so you can recognize and process what it is you're feeling.

Don't beat yourself up about the physical exam, which is going by the wayside w/ all the labs and imaging available.

Some physical findings are just impossible to make, especially in our society of 300 lb and up patients. Just like girls sometimes fake orgasms, I sometimes fake thyroid exams 'Oh yes, I feel that right thyroid nodule', fake pelvic exams 'Oh yes, I feel the ovaries and they are normal in size', and of course you have to fake abdominal exams 'Oh yes, based on my percussion the liver is approximately 10 cm in length'.

Be careful with this, though. A program director told us a story about catching a student saying a certain finding was normal, when it was totally obvious (to the point that no matter how bad at the physical exam, a student couldn't miss it if they'd checked) there was an abnormality. The student fessed up after being called out, but he was dead in the water already. Bad eval, no chance of interview.

OP- This is a lot more complicated, but you should really examine why you got involved in the first place if you already knew you hated it (not criticism per se, since this is really common). See if there are other leaders who could replace you if you left. As long as it wouldn't have serious consequences for the clinic and as long as you talk to the appropriate people beforehand to ensure a smooth transition, you might seriously consider stepping down. You don't have to put it on your CV and it won't kill your match prospects to have done one less (none?) extracurricular during your first year. You might decide to just grin and bear it and that's fine, too. It might even "build character" as is so often said about putting up with a bunch of crap you can't stand.

I disagree with this, unless it's so hard on you that you're really stressing out about going there. If that's the case, seek counseling. But if you're not comfortable with the PE, or any other skill or procedure, you need to do as many as you can. You're not going to get better if you run away from it.

 

[Armadillos]

I skipped the whole thread, but from the OP it seems like your essentially concerned that you feel incompetent at being a doctor. Thats why we go to medschool, instead of just getting an MD once we are accepted.

If you dont frequently feel incompetent during medschool, then you probably have super bad self awareness. Also it seems like they are expecting more from you on physical exam stuff than most medschools do for MS1s so I wouldn't be worried. I think some of this "early clinical experience" stuff gives many people unreasonable expectations of what they are actually (or should) be capable of doing.

 

[MD Odyssey]

Just like girls sometimes fake orgasms...

They do this? Seriously? Damn. There went my self-esteem.