Really stressed out about m3 year - feel like i am not approaching this correctly please help :(

[Premedneedsadvice]

Hi everyone. Apologies for the long post. I’ve been feeling really really down and anxious about how my year is going. 🙁

I started my clinicals this summer and things have just not been so great. Everyone talks about how this year is so amazing and how you learn so much. but i feel like most of my day is spent feeling anxious about what to do/where to be/what my role even is on a team.

i dont really have much responsibility. I follow 1-2 patients and write their progress notes, but for all bigger things the resident like already does them. For example, i wanted to prep the discharge for a patient but the resident did it before i could. Also i wanted to admit a patient, and told the resident that id like to learn how to do it.. but then they saw the patient without me and then walked me through their already written note. I also once tried to put in orders but the resident had already done it. Like.. i dont know how to ask to do things becasue i feel so annoying doing it!
I know residents are busy and i shouldnt be so upset, but it Has actually been super taxing. Every second of the day i feel like i wanna cry because i feel like im just taking up spAce. I dont think im learning and im worried im gonna suck for my sub Is and intern year.

Anyone have any tips for asking for more responsibility? I feel like ive been stuck with bad teams 🙁

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[TakotsuboOkazaki]

From what i’ve been able to gather, this is an absolutely normal third year experience. You are the inexperienced fly on the wall who happens to know a lot about translocations and CYP enzymes.

If your grades are what you want, then I would just try and study, learn what you can, and get through.

You summed it up here: “residents are busy and i shouldnt be so upset”.

 

[softball2344]

You don't have to worry about putting in orders and doing all of the discharge stuff yet, you will do that during your 4th year sub-i. At this point you should only worrying about getting better at taking histories, coming up with assessments and basic plans. And presenting all that decently. At my school 3rd years we expected to update the handoff and sometimes do the hospital course too but depends on institution. And I would work on taking on more patients - ideally 3-4 by the end of your medicine rotation. You should def be seeing admissions but sometimes you will end up kind of tag teaming since its hard for residents to send 3rd years alone when they want to get out as early as possible

 

[Redpancreas]

Hi everyone. Apologies for the long post. I’ve been feeling really really down and anxious about how my year is going. 🙁

I started my clinicals this summer and things have just not been so great. Everyone talks about how this year is so amazing and how you learn so much. but i feel like most of my day is spent feeling anxious about what to do/where to be/what my role even is on a team.

i dont really have much responsibility. I follow 1-2 patients and write their progress notes, but for all bigger things the resident like already does them. For example, i wanted to prep the discharge for a patient but the resident did it before i could. Also i wanted to admit a patient, and told the resident that id like to learn how to do it.. but then they saw the patient without me and then walked me through their already written note. I also once tried to put in orders but the resident had already done it. Like.. i dont know how to ask to do things becasue i feel so annoying doing it!
I know residents are busy and i shouldnt be so upset, but it Has actually been super taxing. Every second of the day i feel like i wanna cry because i feel like im just taking up spAce. I dont think im learning and im worried im gonna suck for my sub Is and intern year.

Anyone have any tips for asking for more responsibility? I feel like ive been stuck with bad teams 🙁

This is unfortunately common and there's no easy fix. The biggest injustice in clerkship education is that the ones who already have a good idea of what they're doing are the ones who get appreciated and taught the most while the ones who are clueless are chalked up as not useful and are just neglected. Task #1 is to do everything to avoid that "clueless" label which is more confidence and not saying something stupid than anything else. Frankly residents are under a great deal of pressure and empathy for the medical student is the last thing on their mind. The system's not holding them or the attending accountable for your education, but if that discharge summary isn't done by 11am the intern's getting chewed out when the nurse pages the team that the family is waiting.

I'm not going to lie to you and say there's a 10-step method to turn this around. There really isn't. Two things are likely contributing to your scenario.
1.) The institutional culture is not supportive of medical students.
2.) For whatever reason, you're not being perceived as useful.

Unfortunately there's not you can do about either of these things as reporting this to your clerkship director is next to useless and may actually backfire and clinical anticipation that would allow you to be more helpful isn't acquired overnight or by me telling you a few things. You may already be doing it but focus on what you can control which is your punctuality, clinical knowledge expected of a third year, attire, and professionalism. Avoid doing UWorld. There's plenty of time to do that later and it gives residents an excuse to not engage you. Be extremely observant of what the residents do. Carry a list with you. Always think why this? in your head. If you're intrigued by something that was done, write it down in one readily accessible place (back page of list). Look the answers up online before you allow yourself to start your routine when you get home. If you can't figure them out, ask a resident the next day (alluding to what you looked up yesterday) so your learning is somewhat active. If it's been 20 minutes and you're in a chair peering over the resident's shoulder, take an educated guess at what may be useful to do. Try a few times. If you really aren't having any luck pick a good time (not when the team's about to round) when the resident's in a good mood and tell them how you feel and ask what you can anticipate to make things easier and so you can learn more.

Honestly I have been in your shoes. It may seem frustrating but it shouldn't be an excuse to disengage. Hopefully this helps!

 

[IMG69]

Hi everyone. Apologies for the long post. I’ve been feeling really really down and anxious about how my year is going. 🙁

I started my clinicals this summer and things have just not been so great. Everyone talks about how this year is so amazing and how you learn so much. but i feel like most of my day is spent feeling anxious about what to do/where to be/what my role even is on a team.

i dont really have much responsibility. I follow 1-2 patients and write their progress notes, but for all bigger things the resident like already does them. For example, i wanted to prep the discharge for a patient but the resident did it before i could. Also i wanted to admit a patient, and told the resident that id like to learn how to do it.. but then they saw the patient without me and then walked me through their already written note. I also once tried to put in orders but the resident had already done it. Like.. i dont know how to ask to do things becasue i feel so annoying doing it!
I know residents are busy and i shouldnt be so upset, but it Has actually been super taxing. Every second of the day i feel like i wanna cry because i feel like im just taking up spAce. I dont think im learning and im worried im gonna suck for my sub Is and intern year.

Anyone have any tips for asking for more responsibility? I feel like ive been stuck with bad teams 🙁

Your gonna get a different experience every rotation. You won't think things could get any worse but they can and of course you can also get amazing docs who let you do everything. It's a coinflip. I would suggest finding a good nurse to teach you skills/procedures like ABG's etc but I don't think residents do this stuff in America, so its good to build these skills but could also be futile.

E.g Gen surg I did absolutely nothing but on ENT I essentially was the ENT, I would see all his patients before he did, otoscopy even dixie hallpikes etc form my ddx's and then he'd see them to confirm and he also let me assist in the OR, it was absolutely fantastic.

 

[TelemarketingEnigma]

It sounds like there might be a couple issues going on - your residents don't sound very supportive of learners, and I think perhaps you're focusing on some of the wrong things as a 3rd year (keep in mind I am also a 3rd year, so older folks may have better input)

Ideally, residents should bring you with them to see new admits, or send you alone to see the admit and then have you present to them. If an interesting case came in overnight, sometimes my residents would have me do my own H&P in the morning for the experience (even though the "official" one was already complete). It sounds like they aren't doing a good job including you in the team, which is absolutely frustrating and not your fault. sometimes you just need to do your best to be available and follow them around all day and tag along whenever they go places (ideally not the bathroom tho), so you don't miss them going to see a patient.

Make sure you're discussing expectations day one of each new rotation - clear expectations and structure can really help alleviate some of the anxiety about not knowing your role on the team. I find this conversation to be a good time to mention any goals I have for the rotation - I want to practice X, I hope to see a patient with Y, I've never had the opportunity to do Z...

As far as placing orders and doing discharge summaries, I really haven't done much of that as a 3rd year and perhaps focusing too much on those things is going to make you more frustrated. Rather than just trying to do it yourself, maybe ask the resident to talk you through it as they do it - the resident's main goal is to get their orders and notes done efficiently and accurately, and unfortunately as 3rd years we aren't always going to be the best at helping with that. They may not like the idea of having to wait for you to do it or correct any mistakes (especially with time sensitive things like many orders). Also, in some institutions students aren't even allowed to do all of these things. I think the most important part of third year is the clinical exposure, seeing actual patients and putting the book learning into practice. In terms of documentation, work on getting good at H&Ps and progress notes before worrying about discharge summaries IMO. You can also be helpful with things like checking in on patients after rounds, calling nurses, looking out for updates like new lab results, researching answers to clinical questions that come up on rounds, etc.

lastly, it's TOTALLY NORMAL to feel stressed and anxious as an MS3, i feel it allllll the time. your classmates are probably stressed and anxious too even if they don't always show it

 

[Matthew9Thirtyfive]

Med students can’t even place orders here. We write all the notes on our patients and do the hospital course summary though.

I’ve basically been just focused on getting as good as I can at gathering the info and processing it into a story with an assessment and plan, then being able to present that succinctly and clearly, then keeping up with my inpatients throughout the day so I can update the team whenever something is needed that I can’t do on my own.

 

[sliceofbread136]

Unfortunately when you are busy it takes more time to have someone else do something and then you have to follow it up. This is especially true when someone is new and there will have to be a lot of changes to what is done.

you’ll learn the scut like orders later, I wouldn’t focus on that. I would focus on doing thorough histories and physicals and start to nail down your process of narrowing down a differential. I’d also encourage you to start thinking of your patient’s by systems and how you will get them out of the hospital. Get a good morning routine to get all the information you need and to get it quickly.

 

[operaman]

You’re probably doing fine with a little room to improve. Some thoughts:

1) learning the EMR is an absolute waste of time. Well, learning how to do orders and whatnot is; learning to find the info you need is valuable now. Learning the admitting/ordering/discharging pattern is not that important yet and will be different everywhere.

2) you need to be following ALL the patients. Follow a few that are yours closely but be aware of everyone on the service. Take notes on rounds like the intern. Make the check boxes of what needs to get done. There’s never a need to ask what else you can help with; look at your checklist and find something undone that you can do.

3) learn how to present. This is arguably the most important aspect of your grade and pretty much how I judge students and residents. The ability to do an H&P and then synthesize that information and distill it down to its essence and communicate that clearly is a defining skill of a physician.

4) EMRs have basically neutered students’ ability to help with documentation. Things you can still help with: floor work, dressing changes, wound care, drain removal, NG removal, getting outside records, doing a good Med rec/calling pharmacies to see what’s been filled, following up scans and other tests by calling and getting updates, going to the reading room to review an important X-ray with radiology, helping transport your patient so things get done faster ( I still do this!). Look for things that don’t require a physician EMR login. These are just a few but these are tasks I still have to do even now so you’ll be helping AND learning skills you will use in practice.