What if I don’t have what it takes to become a good anesthesiologist?

[Aripiprazole3]

So, I matched into Anesthesiology at my top choice program on Friday and I couldn’t be happier. During medical school I realised I didn’t really like any specific specialty until I did my gas rotation. I really enjoy basic sciences (step 1 250+) and I found the procedures so exciting (even though I still feel a bit insecure about doing them) so I thought it would be the best choice for me. After Match Day the excitement kinda wore off, impostor syndrome kicked in and now I’m second guessing myself.

I really love the acuity and OR setting and it was exciting to see the action when *** hit the fan and I really want to be that experienced one day. But I’ve never been in that position, so I don’t really know how I would react. What if I’m not a good fit? I’m usually very calm and don’t get stressed easily, but in situations where another life would depend on me, what if I lose it and don’t know what to do? Also I’ve done a few procedures during medical school, but I’m far from feeling confident or comfortable doing them. Does everyone master procedures with a lot of practice?
Does everyone feel like this before residency or am I overreacting?

I truly love the field and I will give my very best to learn and improve, so I would love to hear from other people’s experiences. Thank you!

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[Mman]

so you are basically like every other incoming intern. I would expect you to have poop stains on your scrubs at this point if you were in charge of keeping someone alive and the stuff hit the fan.

You have 4 years of residency to practice under fire and learn how to do it. Confidence eventually comes from having done things so many times it is second nature.

 

[Consigliere]

Jesus dude chill out.

 

[zizzer]

You'll be fine. Comfort will come with time and practice. You should be provided close supervision at first. Two tips to get more comfortable with time. Focus on being proactive vs reactive.

1. Consider things that could go wrong in general (hypoxemia, HoTN, power outage, etc.) and specific to the patient and procedures during your planning. Don't just prepare for a normal day or you won't end up being prepared. Knowing what to do leads to being comfortable, and this takes work. You're not expected to be there at the beginning of residency; that's what it's for.

2. After the first couple months in the OR (where you're just trying to learn the basics), approach things mentally as if you're the boss, and responsible for making the decisions. Now, I don't mean start making decisions and acting on them without going by your seniors and attendings, but at least challenge yourself to make a decision before just saying, "Here's the situation... what do you want me to do?" Every situation in which you are unsure of what to do should be viewed as a need for improvement before the end of residency. If you do that from the beginning, you'll be fine.

Regarding procedures, relax. They're learned skills. I will add, however, they take a bit of studying too. Watch some youtube videos. Ask others tips. Read old threads on SDN here. Procedures may feel weird at first, but soon they won't.

 

[BLADEMDA]

So, I matched into Anesthesiology at my top choice program on Friday and I couldn’t be happier. During medical school I realised I didn’t really like any specific specialty until I did my gas rotation. I really enjoy basic sciences (step 1 250+) and I found the procedures so exciting (even though I still feel a bit insecure about doing them) so I thought it would be the best choice for me. After Match Day the excitement kinda wore off, impostor syndrome kicked in and now I’m second guessing myself.

I really love the acuity and OR setting and it was exciting to see the action when *** hit the fan and I really want to be that experienced one day. But I’ve never been in that position, so I don’t really know how I would react. What if I’m not a good fit? I’m usually very calm and don’t get stressed easily, but in situations where another life would depend on me, what if I lose it and don’t know what to do? Also I’ve done a few procedures during medical school, but I’m far from feeling confident or comfortable doing them. Does everyone master procedures with a lot of practice?
Does everyone feel like this before residency or am I overreacting?

I truly love the field and I will give my very best to learn and improve, so I would love to hear from other people’s experiences. Thank you!

Okay. Here is some advice. Your Step score doesn't matter in a clinical situation. You know nothing and have no skills. Be humble. Keep your head down. Ask questions. work hard. Don't be lazy or arrogant... ever. This is a clinical field and there are many in your program with far lower scores who will likely outshine you. Get over it.

Now, if you follow the advice above and focus on learning the basics during PGY-1 and PGY-2 years by the time you reach PGY-3 you can be the star on the team. I emphasize TEAM because this is the type of specialty where you must get along with quite a few others to truly succeed. As for worrying about codes/critical situations you will learn to deal with them as well. As your knowledge and clinical skills grow so will your confidence.

 

[Aripiprazole3]

You'll be fine. Comfort will come with time and practice. You should be provided close supervision at first. Two tips to get more comfortable with time. Focus on being proactive vs reactive.

1. Consider things that could go wrong in general (hypoxemia, HoTN, power outage, etc.) and specific to the patient and procedures during your planning. Don't just prepare for a normal day or you won't end up being prepared. Knowing what to do leads to being comfortable, and this takes work. You're not expected to be there at the beginning of residency; that's what it's for.

2. After the first couple months in the OR (where you're just trying to learn the basics), approach things mentally as if you're the boss, and responsible for making the decisions. Now, I don't mean start making decisions and acting on them without going by your seniors and attendings, but at least challenge yourself to make a decision before just saying, "Here's the situation... what do you want me to do?" Every situation in which you are unsure of what to do should be viewed as a need for improvement before the end of residency. If you do that from the beginning, you'll be fine.

Regarding procedures, relax. They're learned skills. I will add, however, they take a bit of studying too. Watch some youtube videos. Ask others tips. Read old threads on SDN here. Procedures may feel weird at first, but soon they won't.

Thank you for the great advice!!

 

[Aripiprazole3]

Okay. Here is some advice. Your Step score doesn't matter in a clinical situation. You know nothing and have no skills. Be humble. Keep your head down. Ask questions. work hard. Don't be lazy or arrogant... ever. This is a clinical field and there are many in your program with far lower scores who will likely outshine you. Get over it.

Now, if you follow the advice above and focus on learning the basics during PGY-1 and PGY-2 years by the time you reach PGY-3 you can be the star on the team. I emphasize TEAM because this is the type of specialty where you must get along with quite a few others to truly succeed. As for worrying about codes/critical situations you will learn to deal with them as well. As your knowledge and clinical skills grow so will your confidence.

I only mentioned the step 1 score regarding basic sciences, because I liked studying them. Clinically I’m very aware that I know nothing. Thank you so much for the great advice!

 

[deleted171991]

All will be fine.

 

[nimbus]

The fact that you’re worried about being a good anesthesiologist is a good sign.

 

[deleted162650]

I’m usually very calm and don’t get stressed easily

It shows

 

[Planktonmd]

If anyone told you that you are supposed to be good at doing procedures on day one then they were lying to you!
You will suck for a few months... then you will learn... everyone does!
If a nurse can do it, then you should be sure as hell you can.
An average chimp can be taught to do anesthesia, trust me.

 

[deleted171991]

An average chimp can be taught to do anesthesia, trust me.

And many are.

Does this look familiar?

 

[dhb]

Just get a supervision job

 

[vector2]

What if I don’t have what it takes to become a good anesthesiologist?

Then you'll be just like the other bottom 25% of anesthesiologists

 

[deleted171991]

Then you'll be just like the other bottom 25% of anesthesiologists

Many go into pain, or critical care (those who can't make it even into a pain fellowship).

 

[Planktonmd]

Then you'll be just like the other bottom 25% of anesthesiologists

I would say that about 50 % of the current anesthesiologists don't have what it takes to be one!
Very sad... but it's true, trust me!

 

[BLADEMDA]

So, I matched into Anesthesiology at my top choice program on Friday and I couldn’t be happier. During medical school I realised I didn’t really like any specific specialty until I did my gas rotation. I really enjoy basic sciences (step 1 250+) and I found the procedures so exciting (even though I still feel a bit insecure about doing them) so I thought it would be the best choice for me. After Match Day the excitement kinda wore off, impostor syndrome kicked in and now I’m second guessing myself.

I really love the acuity and OR setting and it was exciting to see the action when *** hit the fan and I really want to be that experienced one day. But I’ve never been in that position, so I don’t really know how I would react. What if I’m not a good fit? I’m usually very calm and don’t get stressed easily, but in situations where another life would depend on me, what if I lose it and don’t know what to do? Also I’ve done a few procedures during medical school, but I’m far from feeling confident or comfortable doing them. Does everyone master procedures with a lot of practice?
Does everyone feel like this before residency or am I overreacting?

I truly love the field and I will give my very best to learn and improve, so I would love to hear from other people’s experiences. Thank you!

It's normal to be anxious/nervous. I still remember those feelings as a CA-1. But, trust in the system and your program to give you the opportunities/training/cases to become an outstanding Anesthesiologist. Have faith in yourself that you will work hard, stay focused and study/read as much as possible. Remember to be humble. Even the CRNA or orderly has something to teach you.

The last thing is you can never know it all. You can never be the best at everything. The goal is to start on this journey of learning and excelling that never ends. Be humble and learn from everyone around you. Ask questions and always question the dogma/status quo. You are always welcome to ask questions here or post anything that you just want to discuss.

 

[deleted171991]

Even the CRNA or orderly has something to teach you.

The orderly definitely. You did not have a stretcher-pushing course in medical school, that's for sure.

 

[Iso4ane]

The orderly definitely. You did not have a stretcher-pushing course in medical school, that's for sure.

Seriously, with all the different types of stretcher we have to push around, some are easier than others, and there are tricks to the others.

 

[deleted171991]

Seriously, with all the different types of stretcher we have to push around, some are easier than others, and there are tricks to the others.

Are you certified? Because I am...

 

[Iso4ane]

Are you certified?

As certified as any rickshaw driver is.

 

[nimbus]

Many go into pain, or critical care (those who can't make it even into a pain fellowship).

The converse is also true. Many great anesthesiologists would be terrible pain docs or intensivists.

 

[deleted171991]

The converse is also true. Many great anesthesiologists would be terrible pain docs or intensivists.

Blasphemy!!!

 

[Justice4all]

I still can't drive a bed to save my life. But back to the OP question.. I felt like I wasn't up to snuff until CA-2 year. I switched to anesthesia from a surgical specialty with no prior experience. I was between SOAPing radiology or anesthesia . Decided on anesthesiology and so far so good.1st year was rough. I felt like I wasn't good enough, but I kept reading,asking questions and asking for more cases even when sometimes my confidence took a hit. I remember blowing IVs left and right, struggling with regional to FOBs. Just keep your head up.
Only a few people were rockstars from inception. Just keep pushing and improving every day. Humility will take you places where talent will never get you.

 

[deleted697535]

I’m usually very calm and don’t get stressed easily, but in situations where another life would depend on me, what if I lose it and don’t know what to do?

You'll be grand. Loads of ppl in the same boat as you on here!
Myself included

 

[deleted875186]

Procedures come with repetition. I still remember my first central line and how terrible it went, now it’s second nature.

Clinical skills and decision making etc are what’s more important. My internal medicine prelim year was much harder of a transition than anesthesia.

 

[D P356]

Some days you will be unbelievably humbled by what is normally simple.
Max out on your attitude, preparation and effort. It will be hard, but keep grinding.

Is the cardiac surgeon of 30 years of practice going to look at you like you’re a ***** on your first month of cardiac? Oh, yes.

Will people be staring at you when you fail at getting your first IVs as a CA-1? Yeppers

Plenty of opportunities to be humbled in residency...and as an attending as I’ve experienced. You’re better off being humble from the start, because eventually you will be humbled.

attitude, preparation and effort daily. That’s what you can control.

 

[BLADEMDA]

I still can't drive a bed to save my life. But back to the OP question.. I felt like I wasn't up to snuff until CA-2 year. I switched to anesthesia from a surgical specialty with no prior experience. I was between SOAPing radiology or anesthesia . Decided on anesthesiology and so far so good.1st year was rough. I felt like I wasn't good enough, but I kept reading,asking questions and asking for more cases even when sometimes my confidence took a hit. I remember blowing IVs left and right, struggling with regional to FOBs. Just keep your head up.
Only a few people were rockstars from inception. Just keep pushing and improving every day. Humility will take you places where talent will never get you.

I remember working very hard at my weakest clinical skill. I made it my goal to become above average in that particular skill. It took me all of Residency and several years post Residency before I could confidently say that my weakness had become my strength.

My point is that these "skills" can all be mastered. Some only strive for mediocrity while others have a true desire to be a rock star. I thought the PROGRAM's job was to make me into a rock star but looking back i now know the program was simply there to produce mediocrity. It was up to the INDIVIDUAL to strive for, work for and reach for Rock star status.

There is truth to this statement: You get out of it what you put into it. I guess that is why I never bash "work horse" programs like Cleveland Clinic because they make sure that those who graduate have a minimum level of clinical skill. In the end, there is no substitute for case experience.

These days so many programs are "watered down" versions of what they should be; Residency is there to mold you into what you need to be not what you think the "minimum" is to get bye.

 

[Nivens]

Blade gave you some great advice re your Step score, but I'll take it one... step (sigh)... further. Try and forget everything you have accomplished to this point before your first day. I don't mean everything/what little you've learned, but just remember you and all of your classmates step on a scale on the first day of residency, with the weight of your papers and grades and accolades and pedigrees on your backs, and that scale is zeroed. It's a fresh start.

I say this because every year you see people who fail to recognize this, but remember that the reputation you build in the first 6 months becomes the lens through which everything you will do from then on is viewed. Develop a reputation as someone who works hard, is always prepared, and willing to stay late and help out despite not being on call, and that mistake you make as a CA2 or 3 will be waived off as a "great resident having a bad day". Complain about relief, miss important details, and fail to read about cases early on and you will struggle to recover from the label of "hopeless case". The people in the former camp tend to be favored for the best cases, better schedules, recruited for fellowships, etc.

I'm also going to go against the grain here and say that procedures matter. It never fails to amaze me the number of residents that show up on their first day of cardiac and have done zero preparation for the central line. I'm not saying you need to be able to do it independently, but you should be familiar with the steps, and for god's sake steal some suture and tie a few knots at home. I should not need to teach you how to instrument tie as a PGY3.. Similarly, if you have an epidural, read about the steps, know the layers you'll be going through in a midline vs paramedian approach. What's in a test dose? What are you testing for with it? I may adjust your entry point or angle, but the rest of the stuff you should already know coming in to your first procedure.

These things add up.

 

[abolt18]

Blade gave you some great advice re your Step score, but I'll take it one... step (sigh)... further. Try and forget everything you have accomplished to this point before your first day. I don't mean everything/what little you've learned, but just remember you and all of your classmates step on a scale on the first day of residency, with the weight of your papers and grades and accolades and pedigrees on your backs, and that scale is zeroed. It's a fresh start.

I say this because every year you see people who fail to recognize this, but remember that the reputation you build in the first 6 months becomes the lens through which everything you will do from then on is viewed. Develop a reputation as someone who works hard, is always prepared, and willing to stay late and help out despite not being on call, and that mistake you make as a CA2 or 3 will be waived off as a "great resident having a bad day". Complain about relief, miss important details, and fail to read about cases early on and you will struggle to recover from the label of "hopeless case". The people in the former camp tend to be favored for the best cases, better schedules, recruited for fellowships, etc.

I'm also going to go against the grain here and say that procedures matter. It never fails to amaze me the number of residents that show up on their first day of cardiac and have done zero preparation for the central line. I'm not saying you need to be able to do it independently, but you should be familiar with the steps, and for god's sake steal some suture and tie a few knots at home. I should not need to teach you how to instrument tie as a PGY3.. Similarly, if you have an epidural, read about the steps, know the layers you'll be going through in a midline vs paramedian approach. What's in a test dose? What are you testing for with it? I may adjust your entry point or angle, but the rest of the stuff you should already know coming in to your first procedure.

These things add up.

All of this x 1000.

Best advice given here IMO.

 

[BLADEMDA]

Blade gave you some great advice re your Step score, but I'll take it one... step (sigh)... further. Try and forget everything you have accomplished to this point before your first day. I don't mean everything/what little you've learned, but just remember you and all of your classmates step on a scale on the first day of residency, with the weight of your papers and grades and accolades and pedigrees on your backs, and that scale is zeroed. It's a fresh start.

I say this because every year you see people who fail to recognize this, but remember that the reputation you build in the first 6 months becomes the lens through which everything you will do from then on is viewed. Develop a reputation as someone who works hard, is always prepared, and willing to stay late and help out despite not being on call, and that mistake you make as a CA2 or 3 will be waived off as a "great resident having a bad day". Complain about relief, miss important details, and fail to read about cases early on and you will struggle to recover from the label of "hopeless case". The people in the former camp tend to be favored for the best cases, better schedules, recruited for fellowships, etc.

I'm also going to go against the grain here and say that procedures matter. It never fails to amaze me the number of residents that show up on their first day of cardiac and have done zero preparation for the central line. I'm not saying you need to be able to do it independently, but you should be familiar with the steps, and for god's sake steal some suture and tie a few knots at home. I should not need to teach you how to instrument tie as a PGY3.. Similarly, if you have an epidural, read about the steps, know the layers you'll be going through in a midline vs paramedian approach. What's in a test dose? What are you testing for with it? I may adjust your entry point or angle, but the rest of the stuff you should already know coming in to your first procedure.

These things add up.

The above post is coming from a Rock star Cardiac fellow. The dude is humble and an outstanding clinician who is well-liked by everyone who knows him.