Venting: poor performance and low mood

[tiramisu1]

I have been dreading to go to rotations. I feel stuck. I'm not doing well in my performance. I have difficulty focusing and memorizing. I feel like I don't have motivation to improve. I do love rotations, I love seeing patients, I do have motivation to improve, but I'm not strong enough, and it just makes me want to give up. I am afraid of going out and socialize and interact with people. I will screw it up somehow, will make people think negatively about me, will make people think that I'm not a good person. I feel paralyzed. My mind would transport me elsewhere, I would imagine myself being somewhere else in the past that's more comforting and not in the present moment.

Problem #1: Lack of motivation. Multiple attempts to improve my study habits have failed. Problem #2: Feeling like I don't belong. I'm introverted and not good with socializing. I don't feel like I belong. I don't think I'm gonna be a good doctor working in a team-based environment. I think in groups I will be singled out at best and bullied at worse - and it would probably be my fault because of my personality and my incompetence. This makes me reevaluate whether I want to be a doctor or not.

The price is too big to pay to try to be good at it - as in, the price paid by the school for my training is just not worth it for someone who will end up being so incompetent like me (I have a scholarship too). I think people are disappointed and frustrated at me. Imagine taking double the time and effort and materials to train me, only for me to still be incompetent. I don't have any good excuse - I'm just simply don't have the natural caliber to do this. I love learning about diseases and I want to treat patients so much but I don’t think my patients, my colleagues or my superiors will trust me in the future.

I have failed multiple shelf exams, need to retake some of them, and now feeling discouraged for the upcoming shelf exams. Sometimes I feel "what for?"

I show up. I do show up, early, earlier than peers who do better than me. I do go for extra sessions. I do proactively take several actions to improve my performance. I tried hard in order to be able to say that I've tried. Still, I can't ever have the same knowledge as my peers. I would sit in a teaching session and my peers would be able to say things that I cannot. They would know little facts that I don't know. And the teachers told me straight up they can see that my knowledge is inferior than my peers. They don't know that I do show up early and do the extra work... maybe it'd be more embarrassing if they know. I know I'm doing something wrong compared to my peers, but I've tried and tried and nothing changes and I ran out of fumes.

I think I’m posting this not to ask “how to improve my study strategies” - that’s a separate issue. I guess the point of this post is the mindset aspect - how do I help myself when I don't even have the motivation? How do I keep going when my future as a doctor is so bleak?

The question is not “how do I regain my motivation?” - I know that my productivity ebbs and flows, and that it will regain itself at some point. That much is known. My question is when failure is so much more probable, so much more realistic... what do you even do? What will I do with my future? Do research instead? What realistically less demanding jobs that I can do after I finally able to scrape through and graduate from medical school? I know that I will be an incompetent doctor, I know my supervisors and colleagues will hate having me, I’m taking so much time and resources by being a slow turtle. What if it’s for the better good that I just don't attempt at all?

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[operaman]

Sorry to hear you’re having a rough time out there. I’ll offer a few thoughts:

1) your peers don’t know squat either. Even the top medical students show up as interns on July 1st not knowing which way is up. I promise your peers are struggling to keep up too and will also be idiots on July 1st just like we all were.


2) beware the wisdom of crowds effect. Put enough peers in a room and it will seem that they all know more than you, and collectively they do. In truth, most probably have little tiny areas they’ve studied more recently or discussed on rounds the day before - add all that up and it will seem that everyone is smarter. If you split them all up into individuals, they’re a little more mortal. You will never be smarter than a room full of peers. The good news is that you don’t have to be.

3) one core issue is you need to learn how to study for shelf exams. Generally that means practice questions and it means a lot of them. My rule was to complete two full question banks per shelf. That would ensure I’d seen just about everything they could test me on. Get the shelf prep dialed in and you’ll feel better not being under the gun so much.

4) you don’t need to be the smartest doctor. Not only do you learn most stuff in residency, but you can tailor your practice later to whatever you like. And you have other docs to lean on. Even within my own specialty there are partners of mine who are better than me at certain things, so I just send those patients to them. I’m good at the niche of things I do well and they send those patients to me. There are plenty of practice options down the road where you can find a scope you’re comfortable with, and simply refer the rest to others.

5) find a good faculty mentor. You need someone in person who can help you. I often see students like this and it’s not usually a knowledge issue so much as a mindset and pattern recognition one. Usually they’re so focused on that last 10% of minutiae that they neglect the 90% of what’s pretty easy. If you’re failing shelves I suspect this may be part of your story too. Part of getting good at medicine is accepting that you will be wrong at least 10-20% of the time. Focus on getting that 80% of easier stuff. Learn the patterns that get you there most of the time and accept that occasionally the pattern will fail you. Figuring this out is best done in person, so if you can find a good faculty mentor it might be helpful. Ask around- your admin surely knows who some of these folks are and can connect you.

 

[Hollow Knight]

Have you considered being evaluated for ADHD/anxiety/depression? My mental heal slowed me down a lot in third year because I refused to acknowledge it/ didn’t have the self awareness. Talking to someone isn’t going to hurt you. Sometimes just working harder isn’t the answer.

Also, please keep in mind that a lot of the exams you take in med school have very little if anything to do with practicing medicine. It’s kind of amazing. People don’t expect interns to know hardly anything nowadays. The point I’m trying to make is that I’ve met many attendings and residents who scraped by the exams who are awesome doctors because being a doctor is not much like taking a multiple choice test. You need to pass and get out, but a higher class rank or step 2 does not correlate to clinical outcomes.

DM me if you want to talk mental health stuff or study strategies (I’m not a gunner.) but it sounds like you don’t believe in yourself. You got into medical school, you’re an incredibly smart and hardworking person. It’s probably a strategy or mental healthy thing more so than an ability thing.

 

[tiramisu1]

Thank you very much for the words of encouragement 🙏 I will keep these in mind.