Struggling in 3rd year - 1st rotation

[PugnaciousF]

I am really struggling in my first rotation (I'm currently on the 2nd week) in internal medicine - inpatient speciality (I don't want to say the name).

Both attendings that circulate through are notoriously hot tempered (one is simply vicious). And frankly, I don't know a lot of the clinical medicine or questions they relentlessly pound me with. Worse, I'm with a much older 3rd year who has extensive clinical experience (think PA/paramedic etc). This means that every damn day, the attending goes after me first, second... and third with question sets. I dread rounds. I have been reprimanded and yelled at everyday.

On a positive note, everyone else on my team is awesome. They try to prepimp me for rounds by suggesting questions etc. This has actually been semi-effective, and we regularly discuss the topics have been repeated in the past or on someone's day off. The resident and intern are people I would probably be good friends with outside of the medical environment - just great people. They're all patient and great teachers. The fellows is also an all star. I also like the patient care, even the mean and crabby, "I am going to sue you" types. None of that bothers me, it's all really engrossing and interesting. But I have big confidence issues about my competency right now. I also do the scut work if it's available, but my rez and intern are way too nice to give it to me (so I find ways to help them in other ways - ie doing their presentation research etc)

My school is fairly generous with it's grading but I am concerned b/c of my two nazi attendings. Suppossedly, my grade comes from eveyrone - intern/res/fellow and attending, but I don't necessarily buy it. Also, my alarm never went off on my 7th day (power failure) and I showed up 20 mins late to rounds. I am normally on time to 1.5 hr early.

IM isn't my dream profession or anything, but I want to keep the door open.

Help?


I'm not the type that freaks out, at least, I don't think so, but I am starting to do that a little. Everyone tells me third year doesn't matter blah blah blah b/c I have no responsibility but I sure feel like I'm digging myself a really big hole.

And on another note... I have found this process insanely draining from an emotional standpoint. I've seen 3 people die or who are dying in the past several days and several others who will be there shortly. A few days ago I had to flat out excuse myself from rounds after being near the family who lost their loved one. I know this process isn't about me, but I feel that I am not functioning well in the system.

---

Members don't see this ad.

 

[Medstudentquest]

I am really struggling in my first rotation (I'm currently on the 2nd week) in internal medicine - inpatient speciality (I don't want to say the name).

Both attendings that circulate through are notoriously hot tempered (one is simply vicious). And frankly, I don't know a lot of the clinical medicine or questions they relentlessly pound me with. Worse, I'm with a much older 3rd year who has extensive clinical experience (think PA/paramedic etc). This means that every damn day, the attending goes after me first, second... and third with question sets. I dread rounds. I have been reprimanded and yelled at everyday.

On a positive note, everyone else on my team is awesome. They try to prepimp me for rounds by suggesting questions etc. This has actually been semi-effective, and we regularly discuss the topics have been repeated in the past or on someone's day off. The resident and intern are people I would probably be good friends with outside of the medical environment - just great people. They're all patient and great teachers. The fellows is also an all star. I also like the patient care, even the mean and crabby, "I am going to sue you" types. None of that bothers me, it's all really engrossing and interesting. But I have big confidence issues about my competency right now. I also do the scut work if it's available, but my rez and intern are way too nice to give it to me (so I find ways to help them in other ways - ie doing their presentation research etc)

My school is fairly generous with it's grading but I am concerned b/c of my two nazi attendings. Suppossedly, my grade comes from eveyrone - intern/res/fellow and attending, but I don't necessarily buy it. Also, my alarm never went off on my 7th day (power failure) and I showed up 20 mins late to rounds. I am normally on time to 1.5 hr early.

IM isn't my dream profession or anything, but I want to keep the door open.

Help?


I'm not the type that freaks out, at least, I don't think so, but I am starting to do that a little. Everyone tells me third year doesn't matter blah blah blah b/c I have no responsibility but I sure feel like I'm digging myself a really big hole.

And on another note... I have found this process insanely draining from an emotional standpoint. I've seen 3 people die or who are dying in the past several days and several others who will be there shortly. A few days ago I had to flat out excuse myself from rounds after being near the family who lost their loved one. I know this process isn't about me, but I feel that I am not functioning well in the system.

Sorry to hear about that, but yes doing IM first is pretty tough because you don't really know anything yet. A few questions-are these two attendings the same ones you'll have for the entire thing? Do they have a say in your grade? I mean even though they may be nasty, if they don't affect your grade, then there is no need to worry. For my little for school, you can generally choose your graders. Sometimes attending evals are required but not always. So I would try to figure that out first. Also if you are changing team soons with new attendings, then I would not worry about it too much.

It takes a while to get used to rotations, so you should probably be a little more patient with yourself. Try to know your patients well, be prepared to present them, try to anticipate things that might be asked.

 

[PugnaciousF]

One of the two attendings must have a say in the grade. I know who I am choosing already b/c while he yells at me everyday, I know he is trying to teach me something (I do believe he is a good man who cares about his patients and making good future docs). The other one is simply satan and clearly enjoys hazing others and I believe is on some sort of probation for harrassing interns and residents.

 

[Medstudentquest]

One of the two attendings must have a say in the grade. I know who I am choosing already b/c while he yells at me everyday, I know he is trying to teach me something (I do believe he is a good man who cares about his patients and making good future docs). The other one is simply satan and clearly enjoys hazing others and I believe is on some sort of probation for harrassing interns and residents.

Do you have both of these people for the entire duration of the clerkship? What does he yell at you about-things you forgot, answers you don't know, what exactly? You should maybe talk to him and ask how you can "improve" and maybe he'll see that it's not that you dont care or whatever but that you are just starting out. Does the other M3 get yelled at as well? Do you get to work with other attendings too or just these 2?

 

[Top Gun]

Don't let them get to you. Remember, you're just starting out, so you're not expected to know everything yet. Whenever the one attending yells at you in order to teach you something, just keep whatever he said in mind for your next presentation/pimp session.

 

[nutcancer]

OP - this is 3rd year, you just have to tough it out like the rest of us. Just pray every night that the trouble your having now will be balanced by happiness in other rotations. I hate to say it but this is the real world. Keep your head up everyday and never show any weakness. Smile every single day even if you're miserable. I think what you need to is ask for feedback from the attendings to really gauge where you're at. This will be key for you.

 

[Medstudentquest]

OP - this is 3rd year, you just have to tough it out like the rest of us. Just pray every night that the trouble your having now will be balanced by happiness in other rotations. I hate to say it but this is the real world. Keep your head up everyday and never show any weakness. Smile every single day even if you're miserable. I think what you need to is ask for feedback from the attendings to really gauge where you're at. This will be key for you.

I have to ask-how did you come up with that handle? :|

 

[PugnaciousF]

Attending 1 (aka Satan):

Asks me very specific questions:
Ie - Equations... (alveolar gas equatoin, winter's rule etc. ARDS related questions, pharm mechanisms, etc - I'm not on pulm btw. They're just all over the place. A lot of the pharm is not taught in med school but I'm strong there so I try to get him to sneak in the class of drug, since adequate in pharm. His questions are just too specific. He terrorizes everyone though, including the residents. Nobody gets the questions right.

Attending 2.
He just stays on top of me in general. Not listening (he's foreign and we have an intern who whispers her presentations), I've solved this by literally jamming my head next to the intern when she presents and asking him to repeat things. He asks really broad poorly worded questoins.. that have easy answers. I just don't know where he's going with them. When the rez sits down and asks me the same question worded in a normal way, I do well.

I talked to a consultant today from another department and shesaid getting yelled at by these two people is par for the course. They do it to everyone... but I'm like this big stupid target that gets ragged on constantly. I also get yelled at for saying I don't know (in fact, I think I'm not allowed to answer I don't know evne if I have never heard of the drug, the study, etc).

 

[PugnaciousF]

Don't let them get to you. Remember, you're just starting out, so you're not expected to know everything yet. Whenever the one attending yells at you in order to teach you something, just keep whatever he said in mind for your next presentation/pimp session.

My memory of conversations/events are really sharp. I'd LOVE to have concepts repeated. They aren't. I don't see how these sessions are productive for anyone? Nothing is really repeated and I'm chastised for not knowing what is "obvious" and not "reading". I want to throw my giant binder of highlighted journal articles at the attending every time they pimp me. *not really of course, but you get the idea*

And nutcancer, hmmm, sacking it up? Gee, That idea never crossed my mind. This is the first time I've ever considered going back to the phd track. Apparently, I'm one step from a murderer every time I step on the wards with my insanely inept knowledge of medicine. 😀

 

[nutcancer]

i needed to come up with a new alias. nut and cancer were the first two things that popped up in my mind.

 

[Medstudentquest]

Attending 1 (aka Satan):

Asks me very specific questions:
Ie - Equations... (alveolar gas equatoin, winter's rule etc. ARDS related questions, pharm mechanisms, etc - I'm not on pulm btw. They're just all over the place. A lot of the pharm is not taught in med school but I'm strong there so I try to get him to sneak in the class of drug, since adequate in pharm. His questions are just too specific. He terrorizes everyone though, including the residents. Nobody gets the questions right.

Attending 2.
He just stays on top of me in general. Not listening (he's foreign and we have an intern who whispers her presentations), I've solved this by literally jamming my head next to the intern when she presents and asking him to repeat things. He asks really broad poorly worded questoins.. that have easy answers. I just don't know where he's going with them. When the rez sits down and asks me the same question worded in a normal way, I do well.

I talked to a consultant today from another department and shesaid getting yelled at by these two people is par for the course. They do it to everyone... but I'm like this big stupid target that gets ragged on constantly. I also get yelled at for saying I don't know (in fact, I think I'm not allowed to answer I don't know evne if I have never heard of the drug, the study, etc).

That kinda sucks. IM attendings/residents are not supposed to be evil. For sure OB and maybe surgery, but most IM people are nice. I suggest you try to change teams if you can if you feel you can't tolerate it, or determine whether the team stays the same. Sometimes they change, and you can just tough it out for now. It's hard getting good evals from people who are naturally just evil, because no matter what you do, it won't be good enough. If you can't change teams, or if your teams don't change (don't residents change every month??), then you have to figure out a way to get more comfortable with the attending.

 

[MeowMix]

I think you are taking it too seriously as a test of your competency. This is no more than a big hazing ritual, just like boot camp.

My experience in third year was that no one actually expected me to know the answers to all those questions. It is just a style of interaction that passes for teaching on these rotations. I rarely knew the answers to pimping questions and still did very well in my evals on many rotations. You are being tested on your ability to reason toward an answer, and most of all to keep your composure under pressure, and to follow up on things you do need to learn instead of chasing the esoteric. Do not take it personally, and do not take it as a measure of your suitability for the profession. Above all, do not get wrapped up in worrying about the attending's eval. Be professional and polite, and whatever will happen will happen.

Of course, it is difficult to have any sense of right and wrong in your first 2 weeks of third year. Just know that eventually you will feel more comfortable. The first two weeks of any rotation often suck.

Now, death and dying. I recommend processing by talking to other people. Preferably other med students with good personal experience with the dying, or your resident/intern if they have time. Palliative care docs are fantastic for this. Not your significant other, unless they are unusual; it's too much for most of them. Read about dying, keep a journal, do whatever you need to do to keep processing this instead of overloading and shutting down, and know that sometimes shutting down is the only way to deal with the overwhelming crappiness of it all.

 

[lumbering]

Damn...I feel sorry for you pugnacious. My attending is continuously stressed out and often short with me, but I can tell that she genuinely wants me to learn and enjoy the rotation.

Her pimping falls into three categories...

1) Easy basic science questions that I can answer (25%)
2) Easy clinical questions that I can guess at (25%)
3) Impossible clinical questions that I don't know but am not really expected to know (50%).

I dread the thought of having to deal with sadistic arrogant attendings who couldn't care less about me. Yikes!

 

[PugnaciousF]

Yeah. The level of pimping questions is way over a normal 3rd years head.

I spoke to the chief residents and the person in charge of IM rotations today. Initially they just thought I was a crazy/hyper anxious med student and then I told them who my two attendings were and there's an awkward pause and a "yeah, thats really is a bad environment" acknowledgement.

I'm starting to have GI problems from the stress - IBS/crazy heartburn etc that lasts ONLY in the morning during rotatoins. It's pretty ridiculous.
I'm glad this rotatoin is short. 🙁

It's obvious the environment is killing any chance of me getting the most out of my time on the wards. My brain is usually so scrambled after our 3-4hr rounds that I scut work is a welcomed site. It's honestly the highlight of my days + the conferences.

 

[ChildNeuro]

I am really struggling in my first rotation (I'm currently on the 2nd week) in internal medicine - inpatient speciality (I don't want to say the name).

Both attendings that circulate through are notoriously hot tempered (one is simply vicious). And frankly, I don't know a lot of the clinical medicine or questions they relentlessly pound me with. Worse, I'm with a much older 3rd year who has extensive clinical experience (think PA/paramedic etc). This means that every damn day, the attending goes after me first, second... and third with question sets. I dread rounds. I have been reprimanded and yelled at everyday.

On a positive note, everyone else on my team is awesome. They try to prepimp me for rounds by suggesting questions etc. This has actually been semi-effective, and we regularly discuss the topics have been repeated in the past or on someone's day off. The resident and intern are people I would probably be good friends with outside of the medical environment - just great people. They're all patient and great teachers. The fellows is also an all star. I also like the patient care, even the mean and crabby, "I am going to sue you" types. None of that bothers me, it's all really engrossing and interesting. But I have big confidence issues about my competency right now. I also do the scut work if it's available, but my rez and intern are way too nice to give it to me (so I find ways to help them in other ways - ie doing their presentation research etc)

My school is fairly generous with it's grading but I am concerned b/c of my two nazi attendings. Suppossedly, my grade comes from eveyrone - intern/res/fellow and attending, but I don't necessarily buy it. Also, my alarm never went off on my 7th day (power failure) and I showed up 20 mins late to rounds. I am normally on time to 1.5 hr early.

IM isn't my dream profession or anything, but I want to keep the door open.

Help?


I'm not the type that freaks out, at least, I don't think so, but I am starting to do that a little. Everyone tells me third year doesn't matter blah blah blah b/c I have no responsibility but I sure feel like I'm digging myself a really big hole.

And on another note... I have found this process insanely draining from an emotional standpoint. I've seen 3 people die or who are dying in the past several days and several others who will be there shortly. A few days ago I had to flat out excuse myself from rounds after being near the family who lost their loved one. I know this process isn't about me, but I feel that I am not functioning well in the system.

Yeah, it is nice that your school adknowledges that the attedings are out of line, some other schools try to play with your mind and tell you other stuff, but having seen alot there are definitely some attendings who purposely ask a question you could normally answer in a convulated, grammatically and logically incorrect way, they have a need to be mean to students and residents because they don't enjoy medicine or being a doctor, in a decade they will be lying in the ICU bed after a massive anterior MI. Never excuse yourself from rounds though, that will make you a target, I try to do about 10-15% more than what I am asked, it helps in the end because there are many students only try to skate by with doing 90% of that asked of them, don't be that students, I had to really warn a super-lazy student today.

 

[Medstudentquest]

Yeah, it is nice that your school adknowledges that the attedings are out of line, some other schools try to play with your mind and tell you other stuff, but having seen alot there are definitely some attendings who purposely ask a question you could normally answer in a convulated, grammatically and logically incorrect way, they have a need to be mean to students and residents because they don't enjoy medicine or being a doctor, in a decade they will be lying in the ICU bed after a massive anterior MI. Never excuse yourself from rounds though, that will make you a target, I try to do about 10-15% more than what I am asked, it helps in the end because there are many students only try to skate by with doing 90% of that asked of them, don't be that students, I had to really warn a super-lazy student today.

Are you a resident Childneuro? In what specialty?

 

[ChildNeuro]

Are you a resident Childneuro? In what specialty?

Not yet!

 

[LuckyBambooGirl]

Ask your attending and residents if there are any books they recommend for reading. That's what I did because I am on surg onc right now and the questions my attending asks are much more specific that what is in our required surgery text. He recommended a big fat book that our library has. Reading sections of that has really helped for his pimping. Also, another thing that increased my confidence was the fact that if me or the other student cannot answer his question, it goes to the intern, then the second year, then the chief resident, etc. The fact that the upper levels cannot always answer his questions made me feel better about getting questions wrong. Since your attending is hard on every one, I really would not sweat it too much. Just try to get through the rotation, do your work, smile and don't worry about your grade too much since everyone else seems to like you! You will be fine!

 

[Frijolero]

I am really struggling in my first rotation (I'm currently on the 2nd week) in internal medicine - inpatient speciality (I don't want to say the name).

Both attendings that circulate through are notoriously hot tempered (one is simply vicious). And frankly, I don't know a lot of the clinical medicine or questions they relentlessly pound me with. Worse, I'm with a much older 3rd year who has extensive clinical experience (think PA/paramedic etc). This means that every damn day, the attending goes after me first, second... and third with question sets. I dread rounds. I have been reprimanded and yelled at everyday.

On a positive note, everyone else on my team is awesome. They try to prepimp me for rounds by suggesting questions etc. This has actually been semi-effective, and we regularly discuss the topics have been repeated in the past or on someone's day off. The resident and intern are people I would probably be good friends with outside of the medical environment - just great people. They're all patient and great teachers. The fellows is also an all star. I also like the patient care, even the mean and crabby, "I am going to sue you" types. None of that bothers me, it's all really engrossing and interesting. But I have big confidence issues about my competency right now. I also do the scut work if it's available, but my rez and intern are way too nice to give it to me (so I find ways to help them in other ways - ie doing their presentation research etc)

My school is fairly generous with it's grading but I am concerned b/c of my two nazi attendings. Suppossedly, my grade comes from eveyrone - intern/res/fellow and attending, but I don't necessarily buy it. Also, my alarm never went off on my 7th day (power failure) and I showed up 20 mins late to rounds. I am normally on time to 1.5 hr early.

IM isn't my dream profession or anything, but I want to keep the door open.

Help?


I'm not the type that freaks out, at least, I don't think so, but I am starting to do that a little. Everyone tells me third year doesn't matter blah blah blah b/c I have no responsibility but I sure feel like I'm digging myself a really big hole.

And on another note... I have found this process insanely draining from an emotional standpoint. I've seen 3 people die or who are dying in the past several days and several others who will be there shortly. A few days ago I had to flat out excuse myself from rounds after being near the family who lost their loved one. I know this process isn't about me, but I feel that I am not functioning well in the system.

Pugnacious, you sound like a down to earth, empathetic, and interested dude. I think the advice given earlier was right on track. Don't interpret the hazing as any indication of your competency. If you already knew the answers to their questions what would be the point of school? The fact that you love the patient interaction, are genuinely interested in the material, and can empathize with patients speaks volumes as to what kind of doctor you'll likely become. Just chill out a little, don't take things to heart so much, and make a note of the type of attending you don't want to be in the future. Things will get better, and you'll get more accustomed to that style of "teaching". Good luck man, I'm certain things will work out for you.

As an aside, childneuro, I would love to hear how the "warn a lazy student" situation went down. It's hard for me to picture a scenario in which the involved student didn't get immediately irritated and tell you to eff off. But that's just me.

 

[PugnaciousF]

It's all very frustrating because at no point am I really allowed to speak to my attendings directly (I mean one I clearly wouldn't ever talk to anyway). It is clearly a speak only when yelled at process with either anyway.

In the past week, I decided I really couldn't handle my rotation alone, so I talked to the rotation coordinator and the chief residents of the program. They were very supportive and acknowledged the difficult position I was in with my attendings. Each acknowledged that this is not a normal situation, and not a very benign place to start my medical rotation.

So the good news is that they contacted the fellows who I think has actively intervened on my behalf. She seems to realize that I'm in fact, a third year medical student who does not understand the first thing about clinical medicine! I'm personally terrified of rocking the boat in any capacity but it seems my situation is slightly improved. She has actively taken me aside and tried to teach me the basics of IM care and for once, I feel like I'm filling in some of the gaping blanks in my head.

As far as the attending goes, he is yelling at me less, though I can still tell he is always disdainful of my performance,answers,presentations, etc. If she leaves to get water etc, he immediately pimps me. Old habits are hard to break I guess. I will say, the style has changed from brow beating and yelling to a more toned down pedantic style. And that is something I am very thankful for.

Finally, I was told that my behavior was misinterpreted by my attending (the sane one). He assumed I was not doing work and was lazy and indifferent to the rotations. As I suspected, I was being compared to the other 3rd year who has over a decade of previous experience (almost exclusively in the IM subspecialty I'm in). I mean he's really light years ahead of me as far as clinical care goes and yet, I am willing to bet I beat him on the USMLE (though I get the impression the last 2 years of knowledge is completely meaningless now!). Apparently, all my effort in desperately trying to maintain a calm demeanor without showing emotion was effective - in getting me yelledat everyday. It's been misinterpreted into the fellows/attending thinking I'm indifferent.

I don't think this is the case anymore and I finally had an open and honest discussion with teh fellows that makes me feel like I'm not totally and utterly alone. We'll see what follows..

thank you all for the advice..

ps - i "worked" a 30 hr shift with my rez just to see what its like... bombed my presentations but it was a great overnight experience

 

[DoctorPhud]

.

 

[jennyboo]

Hope you're doing better in your rotation; here is the encouragement I would offer.

1. Focus on the shelf exam. As you know, you don't need to honor this rotation; you do need to pass it. You can pass this rotation with some negative evaluations that will go in your record, but they most likely won't be transcribed into your Dean's letter (they tend to gloss over the negatives and copy the positives verbatim anyway). However, you won't pass if you flunk the shelf. The main purpose of the clinical rotations is not, as some believe, to earn brownie points, kiss a$$ and get glowing evaluations. It's to study the assigned topic and pass the shelf. Extra time is better spent studying than observing in the hospital. In my medical school, we had people barely show up for a clinical rotation and still honor it because they aced the shelf.

2. Don't focus excessively on evaluations. As a medical student, I was way stressed about what residents and attendings thought of me during rotations. You've been told that what they think has some sort of major effect on the outcome of your residency applications and your career. Now that I'm a resident, I have realized that the truth is, 1) we don't expect you to know anything at all, and 2) 90% of students fall into the category of "average" no matter how much or how little medical facts they know, and the remaining 10% either stand out because they are really fun/enthusiastic/ask appropriate questions, or because they are extraordinarily lacking in social skills and come off as arrogant and rude. Note that the best medical students actually DON'T answer all the questions correctly! It is hard to consistently get top evaluations, it is also hard to get bottom evals. You can get a great residency with mostly average evals (mine were almost all average and sometimes not very well written -- I read them!). Don't try to people-please -- just be polite and focus on learning the medicine.

3. Say "I don't know" with confidence. Do not hedge. Saying "I don't know" gets you off the hook and allows the attending to move on to another person.