Is it normal to feel bad after 1st year?

[Chads2]

Year 1 is done. I am happy with my performance etc. but I just feel like s@!$. I have learned a ton but I feel like everything evaporated two weeks into the summer.

Oh and as always....back to the OP. First of all, what’s up, A-Fib? I’m Chads2 and we of course need to get to know each other. You’ll eventually know what that means, if you don’t know already.

So first of all, training works. At least, for the majority of us. An MS1 looks at an MS2 and wonders how it is they know so much information about useful things like antibiotics as opposed to the minutiae of the Krebs cycle. An MS2 looks at an MS3 and wonders how they will ever see real live patients. An MS3 looks at an MS4 and says “OMG, you’re practically a doctor!” And an MS4 feels like an intern has “arrived” and will often start by calling them Dr (Lastname), until they get annoyed and say “look, it’s just Chad.” And so it goes.

Again, something I say often...you feel lost now because you now have enough knowledge to know what you don’t know. But the same things that got you this far are the same things that will propel you to continue to succeed where others wouldn’t even dare to try.

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[Chads2]

comments like "Oh, X is on break, Y is on break, Z is not there either so... I am in charge!" (they mean themselves)

“Uneasy is the head that wears the crown.”

“With great power comes great responsibility.”

“You come at the King...you best not miss.”

 

[Localnative]

This is more of a rant than a question but any input is welcome...

Year 1 is done. I am happy with my performance etc. but I just feel like s@!$. I have learned a ton but I feel like everything evaporated two weeks into the summer.
I am working in an ED as a tech. I did that before med school as well. It's daunting to see that people who started with me are done with their 9 month RN program and are doing real stuff and make stupid comments like "Oh, X is on break, Y is on break, Z is not there either so... I am in charge!" (they mean themselves) and when I point out that Dr. P is still there they say that "They don't count..." That's just frustrating.

I feel like I know more things than before starting med school but still am not able to "act" appropriately - like we had a 56h baby come in in resp. distress and I still wasn't able to tell if the baby looks fine or dead just by looking. Still can't tell if the baby looks mottled or not. Please tell me this will come one day!

We had an altered older gentleman brought by EMS and one of the nurses decided to play with me and asked me "What do you think is wrong with this guy?" I didn't know that she wanted a whole differential and told her that it could be thiamine deficiency. In fairness, he looked like a long-time alcohol user, had nystagmus etc. She looked at me like I am an idiot and started spewing "Well, it could be a stroke, hypoglycemia, high ammonia..." I could've told her the same if I wasn't put on the spot like that. Still - not proud of myself for saying what I said. When I brought it up to the doc, the doc asked "Is this like the Wernicke's thing?" They said they've never ever seen it in real life. The school tried to make us super sensitive to that like "You will for sure see it a lot of times!" WTF? I don't know what to think anymore...

I know that I still have more time but reading through SDN a few days ago, I started freaking out about clinical rotations (year 3). How am I supposed to do well if the grading is subjective? I can work hard etc. no problem, but I am just freaking out! Do I just trust the process?

Just drowning here... help.

TLDR but skimmed

you sound smart and self sufficient
You will do well in the wards
Don’t beat yourself up. There are those who welcome change whether professional or personal and those that feel anxious about change. Nerves fried before the start of every rotation.
you know where you place yourself among your peers. You are further along in that evolution of 2nd level thinking that will make you a truly great clinician whether you use mostly your brain in your craft or rely more on manual dexterity.
it’s a state of mind. I still get nervous about stepping into an operating room if there is a more complex case I have to tackle.
be calm and rock on. Give your adrenal glands a bear hug. They luv ya.
M
Class of 2008 UMich

 

[zeppelinpage4]

Man I just finished residency and STILL feel bad! That’s not to discourage you more, just to say what you’re feeling is normal and you’re not alone. Each new stage of training is a new challenge and hurdle.

Medicine is hard as hell, it’s a lot to learn and impossible to know it all. Add in lots of difficult ****ty people and the fact that the training process has numerous real flaws at just about every level and it just becomes a ****ty demoralizing experience.

Best advice, Try to tune out the people around you, and just do your best. Focus on what you’re learning and go easy on yourself. I still struggle but I’m also amazed at how much I know compared to 7 years ago. The stuff that’s important to know, you’ll see over and over again and know it well. The less common stuff, you’ll have resources to look up and colleagues to run things by. You’ll always have things to learn but you’ll be surprised with how much you learn/know with time too.
Best of luck.

P.s. I trained in pediatrics, knowing a truly sick child or baby from a well one isn’t always easy or straightforward. I didn’t really feel comfortable with it until my 3rd year of residency after multiple blocks working the ED, PICU, and floor, making my share of mistakes/looking stupid and having to ask senior residents and attendings for guidance. There’s nuances that you really have to be careful not to miss and it’s not always straightforward. So don’t beat yourself up on that.

 

[RRRozzi]

I’m about to start OMS-1 but I’ve been an RT for years, and I will tell you that the only way to look at someone and get a feeling as to whether they’re fine, crashing or dead is experience. You and I will not get the amount of exposure needed in those situations until maybe yes 3 & 4 and then really residency will be where the training is. This is OK!
Being a physician is a lot different than a nurse or an RT. Yes there’s hands on things they might know better while we’re still training, but there is so much more that we will understand about how the body works and will respond to treatment once were further along in training. Don’t be frustrated, anticipate your future breadth of knowledge and look forward to how much stronger your clinical abilities will be because you took the long route to learning! Don’t fret, that 6th sense will come in time.

 

[BarbaraOrtho]

Do the best you can but try not to beat yourself up over not getting 6/6 Honors.

I wouldn't even sweat the nurses tbh. You'll be making at least 3x their salary, so let them have their petty battles. I would have just looked the nurse dead in the eye and said "haven't a ****ing clue".

Exactly!!! Don't let nurses make some quiz on you! With the time and experience you'll see that all will come instantly from the heart. It's an automatic response to what you've retained so far and also what you've seen. Relax!

 

[sylvester500]

This is more of a rant than a question but any input is welcome...

Year 1 is done. I am happy with my performance etc. but I just feel like s@!$. I have learned a ton but I feel like everything evaporated two weeks into the summer.
I am working in an ED as a tech. I did that before med school as well. It's daunting to see that people who started with me are done with their 9 month RN program and are doing real stuff and make stupid comments like "Oh, X is on break, Y is on break, Z is not there either so... I am in charge!" (they mean themselves) and when I point out that Dr. P is still there they say that "They don't count..." That's just frustrating.

I feel like I know more things than before starting med school but still am not able to "act" appropriately - like we had a 56h baby come in in resp. distress and I still wasn't able to tell if the baby looks fine or dead just by looking. Still can't tell if the baby looks mottled or not. Please tell me this will come one day!

We had an altered older gentleman brought by EMS and one of the nurses decided to play with me and asked me "What do you think is wrong with this guy?" I didn't know that she wanted a whole differential and told her that it could be thiamine deficiency. In fairness, he looked like a long-time alcohol user, had nystagmus etc. She looked at me like I am an idiot and started spewing "Well, it could be a stroke, hypoglycemia, high ammonia..." I could've told her the same if I wasn't put on the spot like that. Still - not proud of myself for saying what I said. When I brought it up to the doc, the doc asked "Is this like the Wernicke's thing?" They said they've never ever seen it in real life. The school tried to make us super sensitive to that like "You will for sure see it a lot of times!" WTF? I don't know what to think anymore...

I know that I still have more time but reading through SDN a few days ago, I started freaking out about clinical rotations (year 3). How am I supposed to do well if the grading is subjective? I can work hard etc. no problem, but I am just freaking out! Do I just trust the process?

Just drowning here... help.

“It's daunting to see that people who started with me are done with their 9 month RN program and are doing real stuff and make stupid comments like "Oh, X is on break, Y is on break, Z is not there either so... I am in charge!" (they mean themselves) and when I point out that Dr. P is still there they say that "They don't count..." That's just frustrating.”

If you ER is anything like mine, nurses are in fact responsible for (“in charge” of) a lot of the operational and logistical success of the team. Yes, docs are the leaders of medical decision-making, but nurses have lots of responsibility too. Your nurse co-worker was either alluding to this, or being playfully dismissive of the doc’s role simply because, well, s/he is a doc and is OBVIOUSLY in charge.

Don’t take this component to hard. You’ll be good!

 

[longhaul3]

I have noted that “signout” rarely involves what a patient is treated for / how a patient is being treated. As a young attending, I asked a nurse how she knew what was going on with a patient. She said she got it from the night nurse in signout. I asked who that nurse got it from...and she said, the day nurse who signed out to her. So I asked...did anyone in that chain ever speak to a doctor or read a doctor’s progress note.

It was the first time she’d ever read a doctor’s progress note.

But, in the process of doing that, she learned where to look and how to know more about her patients.

That's how you get the 1am page about how your progress note says ambulate TID but the patient actually ambulated QID, just want to make you aware

 

[calivianya]

That's how you get the 1am page about how your progress note says ambulate TID but the patient actually ambulated QID, just want to make you aware

Or four separate phone calls at 4AM as individual critical labs come back, instead of waiting for all of the lab results to come back to consolidate them into one call.

But for real I’ve never met a nurse who didn’t read the physician’s progress notes - at least the H&P and the most recent one, if not a full chart dive. Since many (not all) physicians are crap communicators, it’s often the only way to figure out what the plan for the patient is. I have trouble believing there’s a nurse anywhere who has *never* read a progress note.

 

[Chads2]

I have trouble believing there’s a nurse anywhere who has *never* read a progress note.

I have been in this same teaching hospital since before the EMR. At the time of the transition, the veteran nurses gave up on trying to read the bloated notes and they never taught the new nurses to do so. It has improved since that time.