Hi everyone:
PGY-3 general surgery resident here. By way of background, I am at a large academic program that is probably recognizable to some on this board. I enjoy surgery and being a resident. In general I get along with almost everyone I work with and like my job. But more days than not I go home feeling like absolute crap. Why? Mostly because I feel behind my classmates in terms of technical skills. I know objectively this isn't true because I've seen my ranking in comparison to my class and I fall almost right in the middle, maybe a little below the median. Some cases I feel comfortable doing completely by myself (lap appy, lap ventral hernia for example), but others I continue to require a lot of direction and redirection (lap chole, lap inguinal herniae). I know in my mind this is most likely a numbers issue and that tincture of repetition will cure. It's just hard not to think "Man, I'm in my third year, shouldn't I just be getting this stuff by now? Am I cut out to do this job? Why is it so easy for other people in my class?" The insane part is, I've never seen anyone else from my class operate. I just assume I'm behind because I hear what the ancillary staff and other residents say about them.
Maybe I just need to chill out and trust the process. Five year program for a reason kind of a thing. Anyway, I'll hang up and listen.
I didn't have the time yesterday to adequately respond to this.
I think a number of your thoughts/anxieties/concerns resonated with me based on where I was early in third year. If I had to venture a guess, probably resonate with a lot of surgical trainees.
A couple of big points:
1. I would guess that most of your peers feel the same as you do. "Imposter syndrome" is very common, and their outward veneer of ease is likely just that. Conversely, if they do think it's easy, they are idiots. A little dose of humility about your current skill level (provided it doesn't paralyze you with anxiety) is a good thing.
2. PGY3 is, especially at big academic programs, a thrown to the wolves kind of year. Prepare yourself mentally for that.
3.As above, to some degree you should trust the process. You get a lot of time, experience, and repetition between now and graduation.
4. However, if you listen to the old farts and the literature, there are concerns that "the process" is inadequate. Which I took to mean, I had to be as driven and responsible for my own learning as possible. I took a number of steps to try and do this, a few of which I have detailed below:
(a) Start a journal. I always kept a sticker book, but I bought a bigger journal and now I put the sticker in the corner, and then I write about a page or two of case notes. I am a terrible artist but I will also occasionally sketch things out (like how to set up a low colo-anal hand-sewn anastomosis, etc) since I find the sketching helps my kinesthetic learning style. I felt like one of the hardest transitions of PGY3 year was from focusing on simply what my hands were doing (i.e. put needle in here, twist wrist, have needle come out there) into focusing on the "big picture" of the case and the steps to expose, make progress. The journal helped me in that regard. It's also really nice to have now, since I make a lot of little notes about how certain attendings like to do things - so when I go back to a service I haven't been on in a while I can still look smooth.
(b) Actively solicit feedback. I can't tell the number of times I've come out of a case where I felt stressed the whole time, or something went wrong, or I thought I was inefficient, and the attending just grunts "good job" then disappears. And then the end of the month eval says something cursory like "always a pleasure to have on service". And yet, I have found that if I actively seek things out from them - either during or after the case, or even by going to their office and meeting - they give much more meaningful insight.
(c) And along with soliciting feedback...take it. I had one of the transplant attendings tell me to work on my hand-tying with 6-0s. At first I was cranky, and thought it was just that he was doing a case with me when I was super tired and post-call and blah blah blah. After I got over the ego hurt, I stole a bunch of 6-0 from the sim center and tied knots all the time for the remainder of the month.
(d) READ VORACIOUSLY. I tried to read intern year. Second year it fell off the map. Third year I really pushed myself to read more. Not reading Sabiston's or Greenfield's as much, but focusing more on operative texts. Try to actively read, thinking through steps in the case or your prior experiences doing a similar operation and how it did/did not line up with the textbook.
(e) Plan out the case yourself. Look at scans, look at the patient's note. Think in detail about what you would do, with no attending there. Rehearse it in your head the night before. Then in the case, ask the attending why they are doing it a particular way. Try to understand what they are thinking rather than just following along with the flow of the case.
(f) Set your own learning goals...and then share them. Tell the attending what you think you need to work on. Ask permission to do it. Say you're doing a lap chole...ask if you can gain the initial access and decide where to place all the ports yourself. A good attending will let you do it, and then let you struggle during the case so that you realize you placed your working port too high or too low or whatever. Or maybe your learning goal is more complex.
TL;DR: It's normal to feel stress about your operative skills at this point in the game. Don't beat yourself up, but focus on your own learning and take charge of it.
