When do you get good?

[neoexile]

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Question:

I'm honestly asking. When do you get good and feel like you know what you are doing in residency? At this point, I still feel like I'm not getting to the point where I need to be and at times, I still feel like I need to keep reading and practicing.

I'm getting frustrated that everytime I progress, that there is always something else I have to work on =_=. When do I get to feel like I'm competent?

 

[gutonc]

Well...I’m 7 years into my attending career after 6 years of residency/fellowship, and I feel pretty good at this point.

But just like you, every time I feel I’ve got something figured out, there’s something else to work on.

Welcome to being an adult.

The simple fact that you’re questioning yourself is a pretty good indicator that you’re right where you should be and are going to do just fine.

 

[neoexile]

Well...I’m 7 years into my attending career after 6 years of residency/fellowship, and I feel pretty good at this point.

But just like you, every time I feel I’ve got something figured out, there’s something else to work on.

Welcome to being an adult.

The simple fact that you’re questioning yourself is a pretty good indicator that you’re right where you should be and are going to do just fine.

I have too much anxiety everyday. I was about to leave yesterday, but I stayed back to make sure my notes were clean and that all the people I signed out too knew what we were doing with the patients and that nothing was missed that could potentially kill a patient............................

It's ridiculous how much you have to know and do before I can even consider going home =/

 

[Marasmus1]

I do not think there is such a thing as a competent intern. All interns are mistake prone and should feel incompetent. If an intern feels competent then I would worry about his patients life.

 

[NITRAS]

Not sure this helps, but I expect a “competent” intern to make an assessment, differential, and to know when to get help. Never going to be staff.

I’m pretty confident I’m not going to kill someone, but I’m still growing. The hardest transition for me was from going pgy3, where I felt the most comfortable, to Hospitalist in a bigger hospital. Really took me 18 to start to feel comfortable.

 

[Vandalia]

Question:

I'm honestly asking. When do you get good and feel like you know what you are doing in residency? At this point, I still feel like I'm not getting to the point where I need to be and at times, I still feel like I need to keep reading and practicing.

I'm getting frustrated that everytime I progress, that there is always something else I have to work on =_=. When do I get to feel like I'm competent?

About 30 minutes after the coffin closes at your funeral.

The feeling changes, but should never go completely away. If you ever get to the point where you feel invincible and know everything, quit. As an example, there is a story a pathologist friend of mine likes to tell about graduating residents (I am sure the story did not originate with him): On the last day of residency, the senior residents are confidently dictating reports and running the service. The next day, when those that remain are officially attendings, it becomes, "I think this is liver..., no maybe it is spleen... it might be normal, but then again...."

 

[jurassicpark]

Maybe by the end of your second or third year you should feel you are getting efficient at being a resident. Then you become an Attending and you feel lost. No matter how "tough" your program was, you will not have seen everything, the real world is tougher. You start the process all over again, getting "efficient" at being an Attending, but you will always be learning something new, a new path to master. And more importantly, new ways to be humbled after you start to feel you are getting good.

 

[pgy0246]

I began to feel comfortable half-way through my pgy-2, but I still occasionally miss stuffs.
As far as the internship, first 3 inpatient months is the most difficult; you feel like you are learning the new system, EMR, and hospital protocols.

What worked for me is that I spend 45 minutes to one hour each day after work to read, either Washington Manual (inpatients) or pocket medicine.

I initially focus on the high yield concepts (CHF, COPD, MI, AKI, A-fib), and going further and further into the more esoteric topics as I go into more comfortable.

But medicine is such a lifelong learning experience, and I am still learning new concepts and new guideline on a weekly basis, even I am just 4 months away from graduation.

 

[neoexile]

I began to feel comfortable half-way through my pgy-2, but I still occasionally miss stuffs.
As far as the internship, first 3 inpatient months is the most difficult; you feel like you are learning the new system, EMR, and hospital protocols.

What worked for me is that I spend 45 minutes to one hour each day after work to read, either Washington Manual (inpatients) or pocket medicine.

I initially focus on the high yield concepts (CHF, COPD, MI, AKI, A-fib), and going further and further into the more esoteric topics as I go into more comfortable.

But medicine is such a lifelong learning experience, and I am still learning new concepts and new guideline on a weekly basis, even I am just 4 months away from graduation.

I guess the biggest thing for me is "did I do everything I could to help my patients today? Did my patient's have a good experience? What could I do better?"

And the honest answer is "No I didn't do everything. I missed X, Y and Z. I needed help with this concept. My patients experience could have been better. And I need to improve. Yes, there are egos and bad personalities, but quite honestly, I need to keep training and step it up harder than yesterday."

Medicine is a tough field, but in a way, it's good for growth and you'll never stop learning. It changes you as a person.