When will I get good at this?

[Eidee]

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yea there may be no straightforward answer to this but as an intern doing my third ED month of the year I still feel that I'm slow, dumb and my suturing skills suck. there alwayss seems to be a thing or 2 i've left out of my differential or a small piece of hx that my attd wanted that I didn't have. on occasion i get patients who I have no idea wtf is going on.


please tell me things get better.

 

[margaritaboy]

yea there may be no straightforward answer to this but as an intern doing my third ED month of the year I still feel that I'm slow, dumb and my suturing skills suck. there alwayss seems to be a thing or 2 i've left out of my differential or a small piece of hx that my attd wanted that I didn't have. on occasion i get patients who I have no idea wtf is going on.

Then you are exactly where you should be.

If you were born knowing everything about EM, then they wouldn't have invented residency.👍

Sometimes residency teaches you lessons that are beyond simple differential diagnosis, procedures, or pathphysiology. There is something to be said for humility, open-mindedness, and knowing your weaknesses and limitations as well as your strengths.

Hang in there, work hard, and don't forget this time in your training. Develope your strengths, and address your weaknesses. Believe it or not, you are learning more than you think and are improving. You just don't know it yet.

 

[somedude98317]

Great Post!!!

 

[DrQuinn]

Agree with margarita.

It was around this point, when I was an intern, that I had my "six month review" with my PD. I flat out told him "I don't think I'm cut out for this. I'm not learnign anything, everyone around me seems to know more than I, and I just don't think I am cut out for Emergency Medicine." I'll never forget, he said
"Quinn, I felt the exact same way you did when I was in your shoes."

Its just something that happens around this time. Call it the intern blues. Call it second guessing your choice. Who knows.

But give yourself another 4-6 monhts. You'll come out of it. You'll realize you'er learning more than you thought you were. EMergency Medicine just kind of... "clicks" and you begin to REALLY learn it, actively. Right now, there is just so much information being thrown at you its hard to synthesize... "Kanavel's signs, hard signs of vascular trauma, nitro versus nitroprusside, preeclampsia labs, foul smelling lochia, pain out of proportion, pain on passive movement, jolt accentuation what the hell is that?!?! AUGH!" But come early PGY2 you'll feel much better.

Q

 

[yamaniakit]

I feel the same way...at times it just seems overwhelming. Hopefully the light will turn on eventually...at least slowly turning on with the dimmer switch.

 

[beyond all hope]

As a second year, I had one attending tell me "you just don't get it, do you?". Numerous bad evals, including one attending who I really liked and who liked me but said that I wasn't really cutting it with critical patients.

It's EXPECTED as an intern that you haven't gotten it yet. That is why internship exists. There are some interns who do just 'get it', but that is the exception and not the rule.

The fact that you are able to admit it means you're ready to learn. You'll learn more and faster than your colleagues who think they've mastered EM.

You're supposed to get it as a second year. It took me until third year. Those same attendings who gave me such bad evals changed their opinions of me as third year rolled around, and I got great letters and a great job out of residency.

Now I send residents home early when it's slow so I can see more patients myself. My last overnight I started out with four residents and started booting them out until I finished with one.

Sometimes I tell my residents and fellow attendings about those evals and they don't believe me. I almost called up my old residency to have them faxed over just to prove I wasn't making things up.

 

[EctopicFetus]

yea there may be no straightforward answer to this but as an intern doing my third ED month of the year I still feel that I'm slow, dumb and my suturing skills suck. there alwayss seems to be a thing or 2 i've left out of my differential or a small piece of hx that my attd wanted that I didn't have. on occasion i get patients who I have no idea wtf is going on.


please tell me things get better.

As a fellow pgy-1 i can tell you that there are some things I am good at.. truth is they are the same ones I was good at in med school. The majority of things Im just trying to survive thru. I feel dumb I feel like I often can only go to the next step in my eval and not 2 or 3 steps down like my attendings or upper levels can..

I spoke to one of my chiefs who (to me) is an awesome clinician. always knows what going on etc.. I was like "Chief, I feel like a *****, Im just hoping I dont really screw up." She said to me.. "Ectopic, everyday of my intern yr I would drive into work and think... I hope I dont kill anyone.."

Truth is EM is tough, so many different types of sick people with so many difft reasons of being sick.. I feel like ALL my 3rd yrs are real competent and good at what they do.. I also feel that once I get there I will be better at being a doc.

Keep plugging away, work hard, see as many patients as you can, try to read (which I think is the hardest thing), and try to pay attention at conference. We have good conferences here which are usually applicable to what we see.

Good luck... and like 2Pac said.. "keep your head up"

 

[GeneralVeers]

yea there may be no straightforward answer to this but as an intern doing my third ED month of the year I still feel that I'm slow, dumb and my suturing skills suck. there alwayss seems to be a thing or 2 i've left out of my differential or a small piece of hx that my attd wanted that I didn't have. on occasion i get patients who I have no idea wtf is going on.


please tell me things get better.

You want to feel dumb. Feeling dumb means that you are learning new things. When you feel like you know everything, then you should start to worry about your education.

 

[deleted109597]

You want to feel dumb. Feeling dumb means that you are learning new things. When you feel like you know everything, then you should start to worry about your education.

Amen. Even after residency you should feel like you learn something every day.

 

[FISKUS]

I agree - its a very normal for an intern to be overwhelmed... "not getting it".

However there is a small percentage "who never get it". I have seen seinor residents and even attendings who are in a persistant state of near panic and quite frankly, they are just not very good EM Docs.



As the pitchforks say..

Just because they have diagnoised you as paranoid does not mean they are not really out to get you

 

[BKN]

please tell me things get better.

We are EPs. We have to be at the third year level in every other specialty. How can you possibly do that in 3 years? It'll take you 6 years (30K visits) to get to be "good" and 12 years (60K) to be outstanding.

That's the good news. You'll learn something new in the ED every day for the rest of your life. You'll never be bored (and you know how EPs hate to be bored).

So halfway through year 1, you are concerned that you don't know much - fuggedaboutit.

BTW I had a resident who went from the 25th percentile to the 95th percentile between her 1st and 3rd year inservices. I asked her what her study program was. She just read about each of her patients at the end of the day.

 

[met19]

BKN is it really realistic to read on every patient that one might see every shift? I spoke to some interns at my home program who said if they read on one or two patients/shift they feel like they accomplished something.

 

[EctopicFetus]

BKN is it really realistic to read on every patient that one might see every shift? I spoke to some interns at my home program who said if they read on one or two patients/shift they feel like they accomplished something.

The advice from my attendings is to read on your 1-2 most "interesting patients".. This doesnt have to be a 80 page article..

FWIW I had a patient with "LAMs" syndrome spelled "LAMB" on the triage sheet.

I had NEVER heard of this.. I asked my attending about it and he just gave me the blank stare..

I looked it up prior to seeing the patient and then read about it afterward.. Does it make any difference in EM? Not for this disease.. but for others it will.

Keep working hard..

Reading on all the patients I see a day is not realistic for me..

 

[BKN]

BKN is it really realistic to read on every patient that one might see every shift? I spoke to some interns at my home program who said if they read on one or two patients/shift they feel like they accomplished something.

No, I don't think she read about every patient. I believe she did read every night, however.

And I don't think this is the only way to do it, but it worked for her.

 

[edinOH]

Heh...

I feel dumber now seven months into my attending career as I ever did as an intern/resident!

I agree with all the above posts.

 

[Eidee]

this is good to hear, thanks everyone

 

[The White Coat Investor]

Heh...

I feel dumber now seven months into my attending career as I ever did as an intern/resident!

I agree with all the above posts.

I'm so dumb I don't think I could pass the inservice if I took it this year. I swear I'm getting dumber every day!

The fun thing about being an attending is that you finally have time to do a lot of reading. Now I just have to work on the motivation!

 

[docB]

If you were born knowing everything about EM, then they wouldn't have invented residency.👍

Only Chuck Norris was born knowing everything about EM. Don't feel bed if you don't compare to Chuck. None of us do.

 

[DrQuinn]

The fun thing about being an attending is that you finally have time to do a lot of reading. Now I just have to work on the motivation!

I did really well for a while. I made it a plan to read Tintnalli's from cover to cover. I got stuck around page 600 or so. The phimosis/paraphimosis page is still staring at me on the coffee table. Everyday my wife asks me to hurry up and go to the urolithiasis chapter....

Q

 

[kungfufishing]

Only Chuck Norris was born knowing everything about EM. Don't feel bed if you don't compare to Chuck. None of us do.

I wasnt sure if this was true. I saw Chuck yesterday and asked him. He just round house kicked me in the face - some kind of metaphor?

 

[deleted109597]

I wasnt sure if this was true. I saw Chuck yesterday and asked him. He just round house kicked me in the face - some kind of metaphor?

You're lying. Nobody could have lived through that trauma.

 

[BMW19]

Dr. Quinn,

Perhaps I will learn from this and get baby Tintanelli's!!! Cover to Cover.....

BMW-

I did really well for a while. I made it a plan to read Tintnalli's from cover to cover. I got stuck around page 600 or so. The phimosis/paraphimosis page is still staring at me on the coffee table. Everyday my wife asks me to hurry up and go to the urolithiasis chapter....

Q

 

[Painter1]

yea there may be no straightforward answer to this but as an intern doing my third ED month of the year I still feel that I'm slow, dumb and my suturing skills suck. there alwayss seems to be a thing or 2 i've left out of my differential or a small piece of hx that my attd wanted that I didn't have. on occasion i get patients who I have no idea wtf is going on.


please tell me things get better.[/QUOTE ]

stole the words striaght out of my mouth. i too forget more than one detail my attendings on reflex wanted to know, worst i'll still miss to seek certain important findings on physical (e.g romberg in certain circumstances), and lastly, on more than a couple occassaions my face turns blank and resembles that of a lost puppy on being pimped.

i really hope this ends and i start feeling competent soon. CUZ IT SUCKS!

 

[WaZoBia]

i've been on SDN almost 6 years and this is by far the best thread ever. 👍

 

[EctopicFetus]

Only Chuck Norris was born knowing everything about EM. Don't feel bed if you don't compare to Chuck. None of us do.

Out of curiosity did Chuck train at In N Out? Or did he simply opt out of residency since he knew more about EM than anyone else? I tried a wikipedia search and somehow there was nothing on there.

 

[BKN]

Out of curiosity did Chuck train at In N Out? Or did he simply opt out of residency since he knew more about EM than anyone else? I tried a wikipedia search and somehow there was nothing on there.

I trained him. At the end he kicked me. but I survived, so I know that was his way of saying "Thanks, BKN".

 

[docB]

Chuck did know everything but he agreed to be trained for his own reasons. Don't question Chuck's reasons.

 

[edinOH]

I heard Chuck Norris once thrombolysed the clot in a STEMI patient with nothing but his cold stare followed by a round-house kick to the chest.

The patient lived and is now working on a cure for cancer.

 

[EctopicFetus]

I trained him. At the end he kicked me. but I survived, so I know that was his way of saying "Thanks, BKN".

Chuck did know everything but he agreed to be trained for his own reasons. Don't question Chuck's reasons.

I heard Chuck Norris once thrombolysed the clot in a STEMI patient with nothing but his cold stare followed by a round-house kick to the chest.

The patient lived and is now working on a cure for cancer.

Ive learned a lot today.. I hope i can channel a little chuck for the inservice!

 

[docB]

Ive learned a lot today.. I hope i can channel a little chuck for the inservice!

Chuck didn't take the inservice. He was nice enough to correct all the answers for the test writers. Then he kicked them.