Am I just dumb?

[TiredMedStudent08]

I'm over 3rd year. Im on my inpatient medicine rotation. It's the worst feeling in the world to wake up so early and to feel incompetent the entire day. That's when work sucks when you go in knowing your day is going to be terrible. For me it's the morning part when we round that is the worst. Whenever I get pimped I'm able to answer the question 25% of the time. Also, I will rarely make it past the first question. People describe pimping as asking serious of questions until you crack.. I crack on the first question lol. Example today during rounds in front of 3 interns, two residents, one Sub-I, and attending.

We were talking about a patient who had a bleeding stomach ulcer so in that context the resident asked me...

Resident: So if someone comes into the ED and is actively bleeding, what is the first thing you do?
Me: Umm you give anti-coagulation...?
Resident: No you wouldn't give anti-coagulation if someone is bleeding. (Me in my head: Oh duh, you want them to stop bleeding).
Me: 5 seconds of me going ummm and everyone staring at me adding to my anxiety...You scope them?...
Resident: Scoping them would be good but what's the first thing you check?
Me: Awkward 5 second pause again...umm blood pressure?
Resident: Right!
Intern: You're thinking too hard.
Attending then explains why you need to check their pressure and vitals first...
Me: Nodding my head and feeling stupid af..

I know feeling stupid is common in 3rd year but I feel I just take it to a whole new level. Idk how I passed step 1 and how the usmle thinks Im on my way to becoming a doctor lol. I don't feel so bad when I get tough pimp questions wrong or very specific questions wrong... But questions like this related to patient crashing or they phrase the question as "What is the main/most important/first thing you do?"... and I struggle so hard to come with the answer as in this case which was to check vitals... I feel insanely stupid. Also in front of a group I literally will always blank out for the most simple questions. If you pimp me 1 on 1 I tend to do much better and I don't mind getting all the questions wrong in that situation and learning.. I've never really had social anxiety before.. I've been around 25-30th percentile of my class, which is around the percentile where my step 1 score is. And so far only received passes on my rotations. My mcat and gpa were pretty high coming into med school so I felt I could always rely on my intelligence.. but med school has made me feel like I don't belong here. Anyway, just needed to vent and wondering if anyone has felt similar..

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[TheOther]

Whenever I get pimped I'm able to answer the question 25% of the time.

Me too, fam. Me too.
It sucks to suck.

 

[Crayola227]

I'm over 3rd year. Im on my inpatient medicine rotation. It's the worst feeling in the world to wake up so early and to feel incompetent the entire day. That's when work sucks when you go in knowing your day is going to be terrible. For me it's the morning part when we round that is the worst. Whenever I get pimped I'm able to answer the question 25% of the time. Also, I will rarely make it past the first question. People describe pimping as asking serious of questions until you crack.. I crack on the first question lol. Example today during rounds in front of 3 interns, two residents, one Sub-I, and attending.

We were talking about a patient who had a bleeding stomach ulcer so in that context the resident asked me...

Resident: So if someone comes into the ED and is actively bleeding, what is the first thing you do?
Me: Umm you give anti-coagulation...?
Resident: No you wouldn't give anti-coagulation if someone is bleeding. (Me in my head: Oh duh, you want them to stop bleeding).
Me: 5 seconds of me going ummm and everyone staring at me adding to my anxiety...You scope them?...
Resident: Scoping them would be good but what's the first thing you check?
Me: Awkward 5 second pause again...umm blood pressure?
Resident: Right!
Intern: You're thinking too hard.
Attending then explains why you need to check their pressure and vitals first...
Me: Nodding my head and feeling stupid af..

I know feeling stupid is common in 3rd year but I feel I just take it to a whole new level. Idk how I passed step 1 and how the usmle thinks Im on my way to becoming a doctor lol. I don't feel so bad when I get tough pimp questions wrong or very specific questions wrong... But questions like this related to patient crashing or they phrase the question as "What is the main/most important/first thing you do?"... and I struggle so hard to come with the answer as in this case which was to check vitals... I feel insanely stupid. Also in front of a group I literally will always blank out for the most simple questions. If you pimp me 1 on 1 I tend to do much better and I don't mind getting all the questions wrong in that situation and learning.. I've never really had social anxiety before.. I've been around 25-30th percentile of my class, which is around the percentile where my step 1 score is. And so far only received passes on my rotations. My mcat and gpa were pretty high coming into med school so I felt I could always rely on my intelligence.. but med school has made me feel like I don't belong here. Anyway, just needed to vent and wondering if anyone has felt similar..

I thought you were reviving the last thread like this.

Take some time reading on SDN. You're not special.

The exchange you describe sounds entirely within the range of an average 3rd yr med student response.

 

[Nyatar]

Knowing that you suck is good, it's not a good feeling but it will keep you questioning your performance and getting the best out of you. You need to have a critical thinking in medicine, especially when it is about you, so don't make much drama of it, try to improve and always look upon the ones who are better than you.

 

[evilbooyaa]

Always start with basics. Anytime you're asked about urgent treatments, always start with the easiest thing first. H&P. Vitals. etc.

 

[Reveler]

You're a 3rd year. Even if you choose a 3-year residency, that still means that you have 4+ years of clinical training before anyone asks you to go about your doctoring alone. It's all part of the process. As a 4th year, I'm shocked at how much I remember and how my approach to patients has changed throughout the past year and a half of rotations. And I totally sucked when I started 3rd year. I had great grades/stats, but I always wanted to like check a dsDNA, give someone a monoclonal antibody, order an MRI as the first step. Stupid ****, honestly, but it's all part of the process.

 

[TypeADissection]

It's important to remember in context the purpose of pimping. It's to rid you of needless self esteem. Cheers.

 

[quesarasara]

Some days are just like that

 

[CherryRedDracul]

And so far only received passes on my rotations. My mcat and gpa were pretty high coming into med school so I felt I could always rely on my intelligence.. but med school has made me feel like I don't belong here. Anyway, just needed to vent and wondering if anyone has felt similar..

Passes on all your rotations so far?

Also the name "TiredMedStudent08" ... how much sleep are you getting? If you aren't getting enough quality sleep, you will have trouble thinking on your feet.

 

[Eagles6389]

OP, I've felt this way on just about every rotation so far and so have a lot of my M3 classmates.

You kind of have to step back and think "hey, I've been doing this for two and a half years, with only the last 6-7 months actually being outside of the classroom. Of course I'm not going to know nearly as much as the doc who has been in his/her specialty for the last 10+ years."

It's also tough because as MS3 students, you're often that person in the room with the least amount of clinical knowledge or experience. During general surgery, the scrub techs know each surgical procedure well, know what each surgical instrument is etc, and there you are holding a clamp or holding the camera with no idea whats going on.

It's also unfortunate that during a lot of rotations, there's no defined role for the medical student. Some preceptors have the time to teach, while others have a hectic enough schedule where there's no time to teach a med student a procedure or let the med student see the patient first.

I'm trying to take the mentality of "learn what you can, focus on residency, and realize that if you don't get to do X,Y, and Z procedures during the rotation, or the preceptor sucks, it's a small loss in the grand scheme of things."

 

[IM APD]

I smiled at your post b/c it is universal (I've seen a bunch of 3rd years rotate through my service) and I like the reflective insight. You have the next 3 years to look and act like you were just placed here from outer space. Take advantage! The worst thing you can do is "fake it till you make it". Ask questions, don't be afraid of showing people you don't know what you're doing. Better now than when you're a PGY-2 or higher and it actually becomes a problem Fight on!

 

[Oso]

Like several others have said, it's 'normal' to feel this way. You've been doing clinical medicine for a few months, switch fields every few weeks, and work alongside people who have been doing this for years (many attendings have been doing this for longer than I've even been alive).

It's also good to remember that everyone learns at different paces. I feel like I didn't really get the gist of things until halfway through m3 year, meanwhile some students were killing it before the first rotation was even over. Whatever, just focus on yourself, as long as you're at least passing then you're good. Just try to get better. And you will be amazed by how far your clinical reasoning will have improved by the first few months of M4 year.

In regards to pimping, I've also never been good at coming up with an answer in 2 seconds. I just need more time. The key for me is to just view it as low stakes -> if I get it wrong then oh ****ing well, at least I've learned something or recognized a weak area. Try not to get too discouraged.


Also, for when you get pimp questions wrong:

Good luck!

 

[deleted707454]

Are there any guides to help with each rotation? e.g. A book of questions you will likely be pimped with?

in aviation, you are required to take written, practical, and oral exams as part of your certification process. There are books that are all about mastering the oral exam. I wish there was books for medical students' clinicals

 

[Coupd'Cat]

Ah, this brings back memories. Don't worry OP, you are not even close to being alone.

Something I learned was that it was my job to feel dumb, because that feeling was also the feeling of learning. It's tough, because you're learning 1) the medicine and 2) how a hospital works--which is an entirely different amorphous blob of things to figure out.

What I didn't realize until now, a year later on my sub-I, is that the process actually did teach me things. It'll be gratifying when you can turn back and feel at least more competent than you were a year before. Looking at our MS3s now on the team, I think blanking on a question can often be forgiven (and often times is expected) especially if overall you show interest in what's going on clinically and willingness to read/improve on things. Which in itself is kind of hand-wavy, so I apologize.

As for shelf scores, unfortunately they do contribute a large part to your rotation grades. I had to reevaluate how I studied (went from flashcards/outlines to full-on narrative mini-textbooks) and how often (1-2 hours after work to 4-5 hours everyday) about half way through 3rd year, but it paid off. What's been your study method so far, and do you feel comfortable changing it?

 

[Durty-Trixxx]

Don't worry --- about 99% of all MS3's feel exactly like you do

The main purpose of pimping is to "get your feet wet" about how life will be as an intern/resident. Pimping is never fun and residents/attendings love to pimp the wise-ass 3rd years who think they know everything --- they need to be humbled. Like others already mentioned, 3rd year pimp questions will usually be about the basics so most of the time "vitals, H&P, ROS, basic DDx" will save your ass on questions. By the time you are a 4th year you will be better at handling rounds so then you can start worrying about more detailed questions.

3rd year is a big adjustment from classroom to a clinical setting so it's perfectly normal to feel out of place. Nobody really expects much out of M3's --- so just focus on basic survival like showing up on time, looking interested, asking questions, working hard, etc. Pass the shelf exams and move on to 4th year where it gets easier.

 

[operaman]

Yeah this is a totally normal MS3 experience. This is how you will learn clinical medicine. Everyone knows exactly what you’ve been taught so far because we all went through the same thing. You would probably be able to talk intelligently about stomach histology, pathology, physio, etc. because that’s what you’ve been taught. The pimping about practical things you do is a vital next step in your learning.

And trust me, plenty of interns have gone to see that same bleeding patient in the ED and got distracted by other things and completely forgot to look at vitals. You can tell this when you ask them and they respond with some variation on, “I believe the patient in currently stable.” I know I’ve forgotten to look before and so has everyone else. If a little pimping misery sears this on your brain and spares you a mistake 18 months from now when you’re the intern, I’d say it’s worh it.

 

[joeDO2]

Expectations are low MS3 year. You're not supposed to know the answers to all the questions. Use those experiences to get better. You won't realize it but gradually every week, every month, you will get better. When they stop asking you questions, that's when to worry. Questions mean someone thinks you're teachable.

 

[mimelim]

Just wait until you get something wrong and someone gets seriously hurt or dies as a result. Getting pimping questions wrong sucks and I don't think it is a very effective teaching method, but on the spectrum of sucky things in this profession, at least on my odyssey it doesn't even crack the top 10.

All I can say is learn from this. Learn, learn, learn.

- Learn as much medicine as possible, so that you have as few weekends like I did. (Fresh arm bypass went down and after 8 hours in three OR cases, I still don't understand why or what I could have done differently, I keep telling myself, 'the outflow was poor', but it feels like a cop out in the face of someone losing their arm.)
- Learn how it feels to be pimped and decide for yourself if you should do it when you are in a position to choose the teaching method.
- Learn to work with and in front of others. While you may be better 1 on 1, medicine is not a 1 on 1 sport and there will always be eyes watching.

While it applies to my field likely more than others, my PD says at least once a week, "This is a humbling sport." and he is far from wrong.

 

[neoexile]

I'm over 3rd year. Im on my inpatient medicine rotation. It's the worst feeling in the world to wake up so early and to feel incompetent the entire day. That's when work sucks when you go in knowing your day is going to be terrible. For me it's the morning part when we round that is the worst. Whenever I get pimped I'm able to answer the question 25% of the time. Also, I will rarely make it past the first question. People describe pimping as asking serious of questions until you crack.. I crack on the first question lol. Example today during rounds in front of 3 interns, two residents, one Sub-I, and attending.

We were talking about a patient who had a bleeding stomach ulcer so in that context the resident asked me...

Resident: So if someone comes into the ED and is actively bleeding, what is the first thing you do?
Me: Umm you give anti-coagulation...?
Resident: No you wouldn't give anti-coagulation if someone is bleeding. (Me in my head: Oh duh, you want them to stop bleeding).
Me: 5 seconds of me going ummm and everyone staring at me adding to my anxiety...You scope them?...
Resident: Scoping them would be good but what's the first thing you check?
Me: Awkward 5 second pause again...umm blood pressure?
Resident: Right!
Intern: You're thinking too hard.
Attending then explains why you need to check their pressure and vitals first...
Me: Nodding my head and feeling stupid af..

I know feeling stupid is common in 3rd year but I feel I just take it to a whole new level. Idk how I passed step 1 and how the usmle thinks Im on my way to becoming a doctor lol. I don't feel so bad when I get tough pimp questions wrong or very specific questions wrong... But questions like this related to patient crashing or they phrase the question as "What is the main/most important/first thing you do?"... and I struggle so hard to come with the answer as in this case which was to check vitals... I feel insanely stupid. Also in front of a group I literally will always blank out for the most simple questions. If you pimp me 1 on 1 I tend to do much better and I don't mind getting all the questions wrong in that situation and learning.. I've never really had social anxiety before.. I've been around 25-30th percentile of my class, which is around the percentile where my step 1 score is. And so far only received passes on my rotations. My mcat and gpa were pretty high coming into med school so I felt I could always rely on my intelligence.. but med school has made me feel like I don't belong here. Anyway, just needed to vent and wondering if anyone has felt similar..

I'm okay with this. You should make a flash card of "A patient comes in to the ED with active bleeding. What is the next step?" where the answer is "Check vitals, especially blood pressure first".

The thing is you need to build these pathways in your mind so that you know what to do in order to manage a patient. You aren't gonna learn anything if you just forget this and pass this off as "pimping". Honestly, make a flash card, anki, write a note, whatever you have to do and then review it everyday.

You'll be a beast if you do.

 

[Crayola227]

I'm gonna say flashcards are not the right answer for this

that's sorta the point of pimping - it's a different type of recall, and it more closely mirrors what you need to do for recall going forward. Just let it happen.

"Vitals are vital" is what I was told the first time I was a ******* about vitals, and it's always stuck with me and became my forever guiding reminder where to start on assessing a patient. There's a reason why in any printout or presentation of PE, it's the first set of data listed. Checking vitals is almost never the wrong answer for the first thing to do. I've put a lot of smiles on a lot of faces with that naive answer to a number of pimping questions. So learning that is easy, the stuff after is definitely more difficult.

Algorithms are useful at this stage, so that kind of "flashcard" could be good.

 

[neoexile]

I'm gonna say flashcards are not the right answer for this

that's sorta the point of pimping - it's a different type of recall, and it more closely mirrors what you need to do for recall going forward. Just let it happen.

"Vitals are vital" is what I was told the first time I was a ******* about vitals, and it's always stuck with me and became my forever guiding reminder where to start on assessing a patient. There's a reason why in any printout or presentation of PE, it's the first set of data listed. Checking vitals is almost never the wrong answer for the first thing to do. I've put a lot of smiles on a lot of faces with that naive answer to a number of pimping questions. So learning that is easy, the stuff after is definitely more difficult.

Algorithms are useful at this stage, so that kind of "flashcard" could be good.

Indeed, those are the type of flash cards I'm referring to. You start with a vignette and you slowly add more information to it and make multiple flash cards of the same vignette so that you learn the full algorithm.

Something like

Question: "You see a person on the ground on the street. What is the next step?"

Answer: "Tap on shoulder and ask: hey are you okay?"

Question: "You see a person on the ground on the street. He is nonreactive to verbal stimuli. What is the next step?"

Answer: "Check for chest rise"

Question: "You see a person on the ground on the street. He is nonreactive to verbal stimuli and is not breathing. What is the next step?"

Answer: "Activate emergency response system"

Etc.

That's what I would do to build that mental pathway. But there are multiple ways to do this without flash cards. I just like my method.

 

[Durty-Trixxx]

The thing is you need to build these pathways in your mind so that you know what to do in order to manage a patient. You aren't gonna learn anything if you just forget this and pass this off as "pimping". Honestly, make a flash card, anki, write a note, whatever you have to do and then review it everyday.

This is a good point --- it's good to know the answers to questions you've already been pimped on --- it shows you're paying attention and interested in patient care.

Medicine is mostly about repetition --- so learning the common treatment pathways early means you can focus on the more esoteric stuff later (and for boards)

 

[Hadoken92]

how are we the same person?

 

[deleted815127]

I'm over 3rd year. Im on my inpatient medicine rotation. It's the worst feeling in the world to wake up so early and to feel incompetent the entire day. That's when work sucks when you go in knowing your day is going to be terrible. For me it's the morning part when we round that is the worst. Whenever I get pimped I'm able to answer the question 25% of the time. Also, I will rarely make it past the first question. People describe pimping as asking serious of questions until you crack.. I crack on the first question lol. Example today during rounds in front of 3 interns, two residents, one Sub-I, and attending.

We were talking about a patient who had a bleeding stomach ulcer so in that context the resident asked me...

Resident: So if someone comes into the ED and is actively bleeding, what is the first thing you do?
Me: Umm you give anti-coagulation...?
Resident: No you wouldn't give anti-coagulation if someone is bleeding. (Me in my head: Oh duh, you want them to stop bleeding).
Me: 5 seconds of me going ummm and everyone staring at me adding to my anxiety...You scope them?...
Resident: Scoping them would be good but what's the first thing you check?
Me: Awkward 5 second pause again...umm blood pressure?
Resident: Right!
Intern: You're thinking too hard.
Attending then explains why you need to check their pressure and vitals first...
Me: Nodding my head and feeling stupid af..

I know feeling stupid is common in 3rd year but I feel I just take it to a whole new level. Idk how I passed step 1 and how the usmle thinks Im on my way to becoming a doctor lol. I don't feel so bad when I get tough pimp questions wrong or very specific questions wrong... But questions like this related to patient crashing or they phrase the question as "What is the main/most important/first thing you do?"... and I struggle so hard to come with the answer as in this case which was to check vitals... I feel insanely stupid. Also in front of a group I literally will always blank out for the most simple questions. If you pimp me 1 on 1 I tend to do much better and I don't mind getting all the questions wrong in that situation and learning.. I've never really had social anxiety before.. I've been around 25-30th percentile of my class, which is around the percentile where my step 1 score is. And so far only received passes on my rotations. My mcat and gpa were pretty high coming into med school so I felt I could always rely on my intelligence.. but med school has made me feel like I don't belong here. Anyway, just needed to vent and wondering if anyone has felt similar..

So I want to take the time to share with you my Internal Medicine Experience in a few sentences, we were working in groups of 4 people. The attending thought he was god's gift to humankind and would shout at us and if you screwed up the pooch that day, god help you! he would ask one of us to close the door and then shout to the point that we would shake in fear. One particular day, I made a mistake (really it was him sort of skipping over information that I had already given him) he shouted at me in front of the whole ward full of staff members. Next day, I had staff members coming to me and telling me hope i had a better day today.

It got to the point, that I actually thought about stopping 3rd year, studying more and then come back and do it again with him next year. I would come home each day and cry, and each evening, I would mark one day down in my calendar. I got terrified to the point, I never wanted to speak again in front of him.
So here is what I did:-

1. I contacted previous students in that rotation. It's halfway through third year curriculum for us. I am sure someone in your class has done IM before, if they have worked with this attending or resident before ask them what they are like, what kind of questions do they pimp you more on?
In my case, students from past two years told me his behavior was exactly like that with them, if not worse.

2. Try and talk to the resident one on one, be somewhat diplomatic in your approach, "Dr. X, I am really interested in improving my game, improving as a student, whatever phrase you feel is apt, and can you give me some tips or feedback". First, they will appreciate you being all professionals, second it makes it seem like you want to improve your game not that you are struggling.

3. Don't worry IM is like that for the majority of us, except a special few. I ended up passing that rotation with an HP and that's not something that has happened a lot in the hx of that rotation in the past seven years. Till the time, you can show improvement, a modicum of independence w/developing a plan and working with your pt and a mildly decent personality, smile and all. Then you should be fine.

 

[Psai]

When I was a medical student I was pimping the residents and attendings. Uphill both ways.

 

[Crayola227]

if he is quite literally shouting then you should go to your school's admin and let them know

that is totally inappropriate and unprofessional

If I wanted to be overly dramatic I would say a violation of most of our oaths to pass on what we have learned (wait, that's Yoda) and treat our colleagues as our brothers and sisters

 

[Durty-Trixxx]

if he is quite literally shouting then you should go to your school's admin and let them know

that is totally inappropriate and unprofessional

I did a general surgery rotation with an attending who LOVED to have shouting matches with students and residents in front of everyone, as well as nurses, surg. techs, radiology techs, etc. The only people he didnt shout at were senior department attendings who held power over him. A bunch of us med students and even some surgery residents formed an ad hoc committee to formally complain to our med school and try and get him removed from the surgery teaching service and even fired but they didnt budge. He was just a "Hell Rotation" that many of us had to endure and then tell war stories about afterwards that we survived it.

I found out about 3 years after I rotated with him that he got sued by a surg. tech over a nasty incident in the OR and lost the case and about $2 million in punitive damages. He was fired from the university hospital as well. Justice always gets served to these pompous blowhard egomaniacs.

 

[Crayola227]

I did a general surgery rotation with an attending who LOVED to have shouting matches with students and residents in front of everyone, as well as nurses, surg. techs, radiology techs, etc. The only people he didnt shout at were senior department attendings who held power over him. A bunch of us med students and even some surgery residents formed an ad hoc committee to formally complain to our med school and try and get him removed from the surgery teaching service and even fired but they didnt budge. He was just a "Hell Rotation" that many of us had to endure and then tell war stories about afterwards that we survived it.

I found out about 3 years after I rotated with him that he got sued by a surg. tech over a nasty incident in the OR and lost the case and about $2 million in punitive damages. He was fired from the university hospital as well. Justice always gets served to these pompous blowhard egomaniacs.

A long hx of documenting complaints is often part of it
Good for you guys.

 

[FistLength]

I was the exact same third year. It was embarrassing. The best thing you can do is read a little every night. If they ever ask a question about an acute event, think ABC's always, and then move from there.

 

[MightBeACylon439]

After doing my inpatient IM rotation with residents I realize why IM isn't among the competitive specialties.

It isn't because its in the lower paying spectrum (hospitalists are doing pretty well these days), its not because its easy (the knowledge base required is among the largest of all specialties), and its not because of the hours.

It's because its a thankless, soul crushing, and all around terrible experience. IM isn't competitive because no one wants to do it.

 

[Crayola227]

After doing my inpatient IM rotation with residents I realize why IM isn't among the competitive specialties.

It isn't because its in the lower paying spectrum (hospitalists are doing pretty well these days), its not because its easy (the knowledge base required is among the largest of all specialties), and its not because of the hours.

It's because its a thankless, soul crushing, and all around terrible experience. IM isn't competitive because no one wants to do it.

It isn't for everyone.

 

[siliso]

If it makes you feel any better, as someone who likes teaching medicine, these are expected and endearing sort of foibles for an MS3. And when I ask a question you don’t know the answer to, I am happy because it’s an opportunity to teach. If you know all the answers already, what are we there for?

If you’re finding you can’t retain what is being taught from day to day (like you don’t remember next time that vital signs come first and it’s important to start by distinguishing a life threatening bleed from a slower one), you may want to talk to your staff or resident or other mentor about learning strategies. But no you’re not dumb, you made it this far, you’re just an MS3.

 

[rlbk]

Knowing that you suck is good, it's not a good feeling but it will keep you questioning your performance and getting the best out of you. You need to have a critical thinking in medicine, especially when it is about you, so don't make much drama of it, try to improve and always look upon the ones who are better than you.

I find that the times when I feel stupid or embarrassed by forgetting something, it actually helps my learning because I remember things better--you never forget that embarrassment that's engraved into your brain

 

[scpod]

Like someone already mentioned, learning medicine is all about repetition. I probably admitted 150 DKA's as an intern. The last 75 were done in my sleep.

The best thing I ever heard was from an attending on my first inpatient medicine rotation during third year of medical school. I thought I knew what I was doing after I took step 1, then came the medicine rotation that made me feel like a total idiot. He said, "Look, you probably only read about this 3 times during your first two years of school. By the time you finish rotations you will have read about it 30 times. By the time you finish residency you will have read it 300 times. You WILL get it eventually. Just keep learning."

 

[Durty-Trixxx]

The best thing I ever heard was from an attending on my first inpatient medicine rotation during third year of medical school. I thought I knew what I was doing after I took step 1, then came the medicine rotation that made me feel like a total idiot. He said, "Look, you probably only read about this 3 times during your first two years of school. By the time you finish rotations you will have read about it 30 times. By the time you finish residency you will have read it 300 times. You WILL get it eventually. Just keep learning."

That is pretty much 97% of learning clinical medicine in a nutshell.

I've always maintained that you can take an intellectually-curious, hard-working person off the street at age 18 and make him/her a competent physician by age 21 or 22, at least as a primary care or ER doc. Just make them skip all the classwork, force them to study a couple hours every night for boards, and take non-stop clerkships with their final year being nothing but inpatient IM, outpatient FM, and some ER and peds thrown in and I guarantee they will be as good as any board-certified FM or IM doc you ever met fresh out of 7+ years of intense medical education and training.

 

[Waldeinsamkeit]

I have not given up on pimping, but "reframed" it, so to speak. I know I will be absolute **** on pimping. But, I also know that the attendings ask me the same questions all the time (particularly true in surgery, where they not only ask you the same questions, but tell the same jokes as well). Anyway, I made it a goal for my third year to never miss the same question twice, and that has actually been within my grasp. I usually make a note after I get asked the question, then make a notecard once I am home. This leads to some moments of entering "god-mode" on rotations (this is when either a new attending asks you the same questions as a different attending does or the same attending asks you the same questions and forgot about it). This happened a few times and it always feels great, even if artificial
The only weird thing is, no one wants my notes. I don't get it. I make quizlets of the different rotations of all the questions I was pimped on, and no one is interested. Medical students just confuse me 98% of the time.

Anyway, my second time rule has been how I have tried to cobble together the shards of my confidence during MS3.

I'm over 3rd year. Im on my inpatient medicine rotation. It's the worst feeling in the world to wake up so early and to feel incompetent the entire day. That's when work sucks when you go in knowing your day is going to be terrible. For me it's the morning part when we round that is the worst. Whenever I get pimped I'm able to answer the question 25% of the time. Also, I will rarely make it past the first question. People describe pimping as asking serious of questions until you crack.. I crack on the first question lol. Example today during rounds in front of 3 interns, two residents, one Sub-I, and attending.

We were talking about a patient who had a bleeding stomach ulcer so in that context the resident asked me...

Resident: So if someone comes into the ED and is actively bleeding, what is the first thing you do?
Me: Umm you give anti-coagulation...?
Resident: No you wouldn't give anti-coagulation if someone is bleeding. (Me in my head: Oh duh, you want them to stop bleeding).
Me: 5 seconds of me going ummm and everyone staring at me adding to my anxiety...You scope them?...
Resident: Scoping them would be good but what's the first thing you check?
Me: Awkward 5 second pause again...umm blood pressure?
Resident: Right!
Intern: You're thinking too hard.
Attending then explains why you need to check their pressure and vitals first...
Me: Nodding my head and feeling stupid af..

I know feeling stupid is common in 3rd year but I feel I just take it to a whole new level. Idk how I passed step 1 and how the usmle thinks Im on my way to becoming a doctor lol. I don't feel so bad when I get tough pimp questions wrong or very specific questions wrong... But questions like this related to patient crashing or they phrase the question as "What is the main/most important/first thing you do?"... and I struggle so hard to come with the answer as in this case which was to check vitals... I feel insanely stupid. Also in front of a group I literally will always blank out for the most simple questions. If you pimp me 1 on 1 I tend to do much better and I don't mind getting all the questions wrong in that situation and learning.. I've never really had social anxiety before.. I've been around 25-30th percentile of my class, which is around the percentile where my step 1 score is. And so far only received passes on my rotations. My mcat and gpa were pretty high coming into med school so I felt I could always rely on my intelligence.. but med school has made me feel like I don't belong here. Anyway, just needed to vent and wondering if anyone has felt similar..

 

[kitsunepixie]

Very normal; see it as a learning opportunity. Some day, you will be seeing patients and making decisions on your own with no safety net, and being afraid of "pimping" will seem quaint and cute. Your mind going blank when just asked about a bleeding patient...what about when you are actually face-to-face with one? You need repetition to stay calm under pressure. Don't take it personally and think of any nugget of information that you learn as something that you can use to help a future patient. It's also amazing how much there is that ISN'T in a textbook or journal article. Case in point, when I went to Kenya and met Dr. Leland Albright, who wrote a tome about Pediatric Neurosurgery, he said he was still seeing things every day that he had never seen before.

 

[Matthew9Thirtyfive]

This happened a few times and it always feels great, even if artificial

It's not artificial. You didn't know something, went home and learned it, and now you know.

 

[kitsunepixie]

The only weird thing is, no one wants my notes. I don't get it. I make quizlets of the different rotations of all the questions I was pimped on, and no one is interested. Medical students just confuse me 98% of the time.

I made my own notecards and didn't want pre-made ones. Part of the learning process for me was actually making them.

 

[sliceofbread136]

I think the moral behind this pimping sessions is that for any chief complaint that walks through the door the first thing is to make sure your ABCs are stable. Everything else can wait.

My answer would actual have been check their mental status and how well they are maintaining their airway

 

[Waldeinsamkeit]

I made my own notecards and didn't want pre-made ones. Part of the learning process for me was actually making them.

Yeah, but it’s not about learning, it’s about knowing what they will ask you ahead of time...

 

[Oso]

Yeah, but it’s not about learning, it’s about knowing what they will ask you ahead of time...

It's about learning ... that you're probably not gonna get Honors if you're not getting a lot of pimp questions right (not actually sure if I'm joking or not)

 

[Waldeinsamkeit]

It's about learning ... that you're probably not gonna get Honors if you're not getting a lot of pimp questions right (not actually sure if I'm joking or not)

I think you interpreted my statement wrong. Essentially discounting the virtue of getting forgotten questions correct the second go round. Also, have not been swimming in honors by any means.

 

[Oso]

I think you interpreted my statement wrong. Essentially discounting the virtue of getting forgotten questions correct the second go round. Also, have not been swimming in honors by any means.

I was kidding. I do agree with what you're saying

 

[Nantchokani]

Am also in 3rd year,hopefully finishing this May.My first rotation was internal medicine and it was rough.Had rounds which were ending at around 1 pm most of the time for my round team and afternoon classes would start at 2 pm,with evening for reading and assignments.The ward rounds though tiresome but are a great way to know what you know,what you think you know and what you completely have no idea about.Everyday try to go through and read about cases and questions you had that day,it sure helps. If you have a IM pocket book don't forget to carry it with you and try to at least read a topic (common cases in your setting ) and how to manage them,before you know it you would have mastered them.Ward rounds can be intimidating to someone shy or just not used to being vocal and that can make one feel down(mostly this is me) but try as much as possible to speak up,It's better to get it wrong while a student than a doctor.Now am doing my pediatric rota and I wish I could say it's easy but I can confidently say that am better now that I started.So trust the process,it's hard but at the end it's there to make us better.

 

[khrd2]

I had IM as my first rotation as well in the spring. Compared to the other MS3 I felt really dumb because he always got the pimping Qs right and was actually very smart. Attendings loved him and it made me feel really terrible. I completely lost my confidence and it hindered my performance for the rest of th rotation. I ended up with an average eval and I am still working on gaining confidence. At the end of the rotation several nurses and employees told me how much they appreciated my kindness and compassion towards my patients. My residents patted me on the back on my last day (literally). Yeah you may feel dumb but patients don’t care about that. If you truly care about your patients they will see that. You can look up anything on your smartphone these days. Even as an attending. So yeah I’ve learned to shake it off and not care about what attending think. I know myself and it trust myself. And that’s all that matters.

 

[2PINZ]

Thought I'd share my experience as well in case anyone else searches for advice when dealing with feeling like an idiot in front of preceptors. I'm lurking after royally choking today and I can't stop thinking about how badly I bombed.

I'm in my 3rd yr and have been going to a vascular surgery outpatient clinic because I'm really interested in vascular. 98% of what I've seen there involve dialysis access in the arm, carotids, abdominal aorta, and vessels below the abdominal aorta. So I've been doing my due diligence in terms of reading up on our patients, pathology, diagnosing, imaging, etc.

Today, my attending at the end of our shift points at a carotid duplex result and asks what I would suspect if the left vertebral artery flow was found to be retrograde? I said it'd be a steal phenomenon, but for whatever reason totally blanked on the anatomy of vessels off the aortic arch! Even worse, he tried hand holding me to the anatomy of the left vertebral and I kept bombing.

I think I'll have this knot in my stomach for several days. It sucks because after showing interest, writing up a case report, scrubbing into the OR in my non-rotation time....to not know something that basic just killed me - especially after telling my attending I'm interested in vascular.

It's embarrassing - but as mentioned above, although making mistakes like that will probably not land you stellar reviews, all I can really do is not let that happen again.

 

[AliBabaMD]

Rotations are subjective based on location, your attending and the resident team.

Don't be too hard on yourself. You are doing great. PM me if I can help further or follow me on here. AB

 

[TheOther]

Reporting back nearly a year later. Just finished my interview trail.

I have to say: trust the process. Keep putting yourself out there. Offer to see as many patients as you can, say yes to procedures when asked if you know how to do them (even if you don’t — then use your med student Jedi tricks to get them to talk you through it), and see every uncomfortable moment as an opportunity to grow. Keep being good to yourself. Have positive self-talk.

I finished up an FM sub-i last month and had stellar feedback. Got maybe 80-90% of my pimping questions right.

Keep on keepin on.

 

[Crayola227]

Reporting back nearly a year later. Just finished my interview trail.

I have to say: trust the process. Keep putting yourself out there. Offer to see as many patients as you can, say yes to procedures when asked if you know how to do them (even if you don’t — then use your med student Jedi tricks to get them to talk you through it), and see every uncomfortable moment as an opportunity to grow. Keep being good to yourself. Have positive self-talk.

I finished up an FM sub-i last month and had stellar feedback. Got maybe 80-90% of my pimping questions right.

Keep on keepin on.

I just saw this, and it's worth bumping just for me to note, DO NOT LIE, EVER. As if an attending or resident physician isn't smart enough to be able to tell you have no idea how to do a procedure when you say you do but you really don't.

Overstating your knowledge and experience puts patients at risk in the fast paced environment of patient care, when one is trying to delegate responsibility and supervision appropriately. This is totally unacceptable and if I thought a med student had bull****ted to me when I am asking to determine what they can know how to do, believe me there would be consequences.

This isn't like when you're asked if you can page someone but have no idea how but can reasonably expect to ask someone or a nurse how to do something menial. Or you've been taught in an OSCE how to do a musculoskeletal exam and you don't feel confident but are asked if you can do one. In that case the answer is yes.

You should always answer truthfully, "I have never done that," "I don't know how," "I've only seen two," "I have never sutured a patient before but I have practiced in suture lab on pig's feet," or "No I have not placed a central line but I have watched videos" followed up with "I'm eager to try/assist/learn/help."

I just can't even that you would lie like this. I would try to get you in the maximum amount of trouble there is for this. Being caught out in an actual lie of any kind can insta-fail a rotation if not get you canned.