May 10, 2013
MD/PhD Student
Hey guys,

A while back when I failed CS, I received practical/supportive advise from this place, really appreciated then, thought maybe I could reach out to this place once more. I know many here have gone through what I have gone through, some are now attendings, fellows, etc, successful in their careers, and above all treating patients with extreme satisfaction

Eventually I want to become one.

Quick introduction, I am PGY2 (just turned), at fairly prestigious IM program. I finished intern year with ups and downs like a lot of people, with performance evals about average overall, but without running into any difficulties from attendings or residents. Was fairly a smooth path until after quick week vacation finishing intern year, when I returned to start resident year, I received email from my associate PD that we need to talk. Long story short, one of the attending in my last rotation didn't think that I could be qualified to be resident, emailed the PD with similar request, my performance was questioned during the PD meeting and I was put on "pre-remediation stage". That is - to have continuous feedback with my clinic director, chief, not to have supervisory role until later in the year, and to ensure I develop necessary skills to become an independent resident till then.
Since, I have been struggling with confidence. When expressing my concerns to the primary PD, he was exceptionally nice and didn't think that with my enthusiasm, I would lack in any way once half way through the academic year, and he seemed less worried. However, I after receiving the news, I have had some "inner voice" channeling through my insecurities, telling me I was inadequate, my assessment and plan were wrong, casting doubt on even the simple cases. I realize there is definite psychologic process going on, perhaps a component of adjustment disorder with the recent stressor, but I am not sure exactly how to best overcome it except to face the fears and go with the best of my ability. I am certain that I am not the only one who have struggled with such anxiety in their journey to becoming a self-sufficient, competent physician.

To those who have underwent such hardship, how did you surmount it? How did you overcome self-doubt? What are practical ways to improve through such difficulty? I don't want this to ever be a set-back, but a boost to my learning curve which may have been lagging slightly behind.

I really want to get better..
Thanks SDN.


The Oncoming Storm
5+ Year Member
Oct 22, 2013
All of Time & Space
Are you currently getting some counseling?
I don't think it would hurt to go to your PCP or contact the Employee Wellness and get some counseling. See if there's someone in the community that is used to dealing with healthcare professional.

Do you have a friend from medical school who is a resident that you can confide in and talk about your day/week from time to time? Or a co-resident?

I'm just thinking having a doctor in training that you can *really* open up to and talk about the stresses and even cases in hindsight, can do a lot that's beneficial psychologically. I have a close friend from medical school and we do this for each other. It's nice to talk medicine with someone that's on the outside and on your side.

Some of the psychology in Adult Children of Alcoholics/Dysfunctional Families (check out their website and read the Laundry List to see if it applies to you). The only "requirements" for membership is an identification with the Laundry List and desire to recover from the effects of a dysfunctional family. That shoe might not fit you, I dunno. I found helped me sort of some of the psychology that was affecting me at work. Also, I found there were lots of successful professionals and healthcare workers at meetings.

Also, I like this website
For dealing with self esteem issues. I think self esteem is key for confidence. I wouldn't be surprised if all this had affected your self esteem.

Deep breaths. Really. The site I suggest above has some affirmations.

Otherwise, as you know, just trying to be as prepared as you can be, as systematic. Being responsive to feedback but try not to let less than tactful instruction hurt you.

It's OK to cry? Sorry, I wish I had more for you and I hope this helps you.


ASA Member
10+ Year Member
Sep 8, 2008
Attending Physician
You are hardly alone here. Adversity is something we have to deal with in medicine, and shots to your confidence happen from time to time regardless of your subspecialty - you might get named in a lawsuit, have a patient die in the ER, have a senior resident or attending chastise you, or have an airway emergency in the OR requiring tracheostomy.

Try to not let these things affect you too much personally, although they probably will. Talk it out with your friends and coworkers, and adopt an attitude of strength and determination. Make it your mission to prove that doctor wrong - excel in clinicals, care for your patients, and do well on in service exams.

Residency is full of ups and downs, and yearly transitions (PGY increases) naturally lend themselves to anxiety given increased workload, responsibility and thus pressure. Show you can handle it!
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10+ Year Member
Aug 14, 2006
Attending Physician
That's a *****y place to be in. You're most certainly not going to be evaluated equally on your merits and flaws herein out, since attention was brought to your weaknesses or perceived weaknesses. Given your anxiety, that's likely all you're going to focus on as well.

Don't. Try to spend equal time evaluating your strengths and enhancing them. Present them to your PD and others in an open way. Engage in a conversation about the things you do well, would like to do better, would like to know if your opinion matches theirs, etc. You need to create a dialog for yourself and your evaluators about everything you bring to the table and what's important to bring more of.

You can't avoid being put under the microscope. You do have some influence about where the microscope points.

Also, I would say that, being on the other end of things, professionalism counts more than anything else. As long as someone is competent enough to avoid serious harm, knowledge is not the most important thing. Many doing the pimping do not see it this way, but I do not think it is about assessing knowledge so much as evaluating investment in doing better. So many people who always get questions right are evaluated poorly in medical knowledge, and so many who often get them wrong are evaluated well. A demonstration of caring for your patient, thinking more deeply about something and understanding why it is important to do so, and willingness to sacrifice self-obligations when necessary are what carry you here. "I don't know, but I'll look it up" sounds like a fair response; I'd rather hear "I wish I had asked myself that -- it was bothering me that I was missing something."