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Quoted: Unprepared for residency?

Doodledog

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I have a question that I feel faces a lot of medical students. I went to a medical school that allowed us a variety of options in terms of clinical rotations. For some reason, most of my clinical rotations turned out to be very easy. I did have a few difficult inpatient rotations, but even so I felt that I have now forgotten most of what I have learned. Many of my rotations were outpatient family medicine rotations or stereotypical "tough" rotations that turned out to be easy (for instance for my surgery rotation my surgeon didn't work much so I just showed up for maybe 4 hours a day M-F).

What I know you probably will say is: "Everyone feels under-prepared for internship." Well, that may be the case, but I feel like I will be EXTRA-under-prepared due to my mostly easy clinical years. I feel like when I start internship, I will know nothing and look like a total idiot to my peers and attendings.

I did match in Family Medicine at a very competitive program. I attribute that to the fact that I have a great personality and am an excellent interviewee. Although I did well in pre-clinicals, I passed the boards with low scores. I have a 4.0 in my clinical rotations but I think that is because I had attendings who were easy-graders grading me.

I know aProgDirector once mentioned that he has seen students from some DO schools be under-prepared for internship. Well, I am very afraid I may be from the schools he was referring to.

Assuming that I am under-prepared for internship, how can I get prepared? Should I basically read books? What advice do you have? Thank you!

Okay, interesting question. First of all, I agree with the "everyone feels unprepared for residency" idea. In fact, almost everyone feels unprepared (or should at least) for becoming an attending. That's a big transition too.

Regardless, I accept that you feel especially unprepared. Even students with a solid clinical education in med school can feel "especially unprepared" for some rotations (e.g. critical care) and have a lot of concerns.

The amazing thing is that you, like almost all residents, will very quickly adapt. To me, the key is being truly ready to commit to residency. That means being prepared to do more than just your hospital time (80 hours isn't trivial, is it?) but also to briefly read about your patients using easily available material (e.g. UpToDate). Be honest in your first rotations about what you don't feel comfortable with (especially procedures) and accept that your first rotations will not feel great. But, the learning curve is incredible in internship and the overwhelming majority of interns quickly move to where they need to be.

Perhaps aPD or others have more specific suggestions or ideas?
 

Arch Guillotti

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I had some decent rotations in med school but there were also a few duds out there in DO-land. I know my clinicals were not on par with many allopathic places but I made the best of everything. Everyone is nervous to start internship. The ones who have problems are the ones that think they already know it all. I think that you will do fine.
 

shopsteward

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I'd second the advice about being open with your teachers right at the start. Teachers get satisfaction from seeing people learn, and it is easier for them to teach you, and for you to learn, if they understand at the start what you do and don't know. (If they are cross at the start about what you don't know, it will be more about your institution than you personally.)

The newer you are in any situation, the more leeway you have for asking stupid questions. So get your "stupid" questions in early, if you can. It will help that you will be at an institution which is new to you - a lot of your questions will be about acquiring "institutional" knowledge, rather than about possible gaps in your medical knowledge, so won't be stupid at all.

Good luck.
 

shopsteward

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I came across the extract below on a different thread, talking about what a med student needed to be able to do. If you can find the official version of the list of core competencies and check it for what you can and can't do, that would give you a solid understanding of where you are as against what will be expected of you when you start residency. If you do have deficits, you might be able to remedy them in the meantime, and if not at least you will be able to identify at the start of the residency the expected core competencies which you are not yet comfortable with and need extra help on.


"The list I was given-
1) Core Technical Competencies
-Venipuncture
-IV placement
-EKG
-NG tube insertion
-Urethral cath in male and female
-Urethral cath removal in male and female
-Dressing changes
-Obtaining peak flow
-Suture removal
-Throat Culture

2) Suggested Technical Competencies
-Admin of eye drops
-IM injections
-Subcut injections
-Heel and finger sticks
-Placement of non invasive monitors

3) Competencies requiring direct supervision
-Lumbar puncture
-Thoracentesis
-Paracentesis
-ABG
-Arterial stick

4) Other
-Neurological exam - standard and in patient in a coma
-Pelvic exam
-Pap smear
-Vaginal delivery
-Breast examination
-STD screening
-Assist in C-section
-Interpreting fetal sonogram and fetal heart monitor
-Assist in open abd gyn surgery
-Assist in laparoscopic gyn surgery
-Assist in vaginal gyn surgery
-Splinting
-GDS, MMSE, ADL/LADL assessment
-Suturing of laceration
-Airway management
-Central venous access
-Collection of DFAs
-Collecting blood culture

I believe these are the standards of the LCME or some sort of medical education committee."
 

dragonfly99

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I agree with Aprogramdirector. Why don't you try to get more clinical exposure now? For example, if you have the opportunity, perhaps a couple of weeks in both the ER and an ICU would be a good experience.
By the way, I think the list that someone has given above (of a bunch of procedures, etc.) isn't necessarily that relevant...you'll never do a lot of those procedures in many medical specialties.

You know that you are doing family practice, so you could approach some ob/gyns and/or fp's and see whether you could hang around and assist with some deliveries, etc.

I agree that if you only worked 4 hrs/day on a surgical rotation there probably wasn't a lot of learning going on. Maybe you can find a way to remediate some of that. I have to say that even when I worked 100 hrs/week on surgical rotations, I'm not sure about how much I actually learned, versus just being "scutted" and overly tired out a lot of the time.

I also agree w/some of the above comments about attitude and work ethic meaning a lot during internship. You may have a rough trip the first 6 months or so, versus some students who had a tougher 3rd year of med school and/or subI's. However, you will be able to overcome it. You just don't want to be in a situation where you are so underprepared that you hurt a patient...that is why I would say areas like ER and ICU are very important. Another thing I think could be an issue in placed like medicine wards or peds wards is that if you are used to not carrying very many patients at all, you will have to learn how to do H and P's faster while still handling your pages and putting in orders, etc. That is part of the learning for all interns but may be especially hard for you if you aren't used to doing very much work. Again,the only way I can think of to fix this is for you to volunteer for more work now...for example, volunteer to do a consult rotation and then see if you can handle writing up multiple consults/day.

Don't freak out too much though. Medicine is a marathon, not a sprint.
 

Gastrapathy

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I'd second the advice about being open with your teachers right at the start.

Good luck.
This is bad advice IMO. Don't paint a bullseye on your back.

How you can complete a "surgery" rotation where you worked 20 hours a week is beyond me. For all the DO vs MD threads, this is the ground truth.
 

shopsteward

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I'd second the advice about being open with your teachers right at the start.

This is bad advice IMO. Don't paint a bullseye on your back.

In case it wasn't clear, when I said the OP should be open with their teachers from the start, I was referring back to Tildy's comment -

Be honest in your first rotations about what you don't feel comfortable with (especially procedures)

What would be the alternative to an intern being clear about the limitations of their knowledge, e.g. of procedures? There are, notoriously, statistics whichevery year show increased mortality/morbidity in hospitals when newly qualified doctors start their training. Statistics can be disputed, but even so I would worry about the consequences both for the intern and for individual patients if someone who is underprepared tries to "wing it".
 

cpants

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In case it wasn't clear, when I said the OP should be open with their teachers from the start, I was referring back to Tildy's comment -



What would be the alternative to an intern being clear about the limitations of their knowledge, e.g. of procedures? There are, notoriously, statistics whichevery year show increased mortality/morbidity in hospitals when newly qualified doctors start their training. Statistics can be disputed, but even so I would worry about the consequences both for the intern and for individual patients if someone who is underprepared tries to "wing it".

Obviously you don't just wing it if you don't know what your doing. I wouldn't go up to the leadership and tell them you feel grossly unprepared. Just show up ready to work hard. If you are underprepared, they will figure that out on their own very rapidly. If you don't know what you are doing do not wing it. They tell you to do an ABG and you've never done it, just ask your senior resident to show you how. Now you know. Everyone is there to learn, and there is a culture of senior teaching junior.
 

MJB

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This is bad advice IMO. Don't paint a bullseye on your back.

How you can complete a "surgery" rotation where you worked 20 hours a week is beyond me. For all the DO vs MD threads, this is the ground truth.




You'd be shocked. I can't wait to start residency because some of my rotations haven't even been "less than stellar".
 
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