New Intern, feeling absolutely useless and stupid

[osprey099]

I just started PGY1 today in categorical medicine and my first work day was a 28hr ICU shift. I felt completely useless, didn't where anything was, had 0 knowledge of anything, and had to ask my senior residents for help with everything. Every time a nurse paged me, even for really small things, I would just freeze and ask my senior resident what to do. I felt more useless than a 3rd year med student and I'm freaking out. I also basically did nothing my 4th year of medical school. I honored medicine 3rd year and honored my 3 medicine sub-i's but at the beginning of the year (last may, june, july) and pretty much did absolutely nothing the rest of the year. I feel like I don't know any of the basic knowledge or anything at all. Is this normal? When do interns start picking things up?

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[Mass Effect]

When do interns start picking things up?

Not on their first day. Time to exercise some self-compassion and give yourself a break.

 

[Perrotfish]

1) Yes this is normal

2) Read on the things you didn't understand.

3) Don't ask the senior what to do. Tell him what you want to do and why, and then let him tell you that you are wrong. You will be wrong, initially you will be wrong almost 100% of the time, but you have to try.

 

[Postictal Raiden]

I just started PGY1 today in categorical medicine and my first work day was a 28hr ICU shift. I felt completely useless, didn't where anything was, had 0 knowledge of anything, and had to ask my senior residents for help with everything. Every time a nurse paged me, even for really small things, I would just freeze and ask my senior resident what to do. I felt more useless than a 3rd year med student and I'm freaking out. I also basically did nothing my 4th year of medical school. I honored medicine 3rd year and honored my 3 medicine sub-i's but at the beginning of the year (last may, june, july) and pretty much did absolutely nothing the rest of the year. I feel like I don't know any of the basic knowledge or anything at all. Is this normal? When do interns start picking things up?

Oh God, you are describing what I'm exactly going through. If it wasn't for my senior residents answering every stupid question I have and guiding me through the whole thing, I'd be doing nothing but converting oxygen to carbon dioxide.

 

[FistLength]

1) Yes this is normal

2) Read on the things you didn't understand.

3) Don't ask the senior what to do. Tell him what you want to do and why, and then let him tell you that you are wrong. You will be wrong, initially you will be wrong almost 100% of the time, but you have to try.

Bolded best advice. Ideally you have some kind of plan, even if it is pathetic, before going to the senior.

 

[engineeredout]

Your seniors know this is coming, and would much rather have you ask too many questions, then to order something or try to handle something without knowing what you were doing. Every other PGY1 is currently going through what you are (and honestly, the ones who don't show it are either faking it, or they truly think they know everything which is MUCH worse).

It's painful but it will get better. Look at your 2nd year residents and remember that they were in the exact same position you were a year ago.

 

[ToKingdomCome]

This is me. I feel so terrible. I''m on a consult service right now. I have literally gotten every knowledge base question wrong since I started. My A/P's in my notes need improvement. This week I put a wrong order in and have felt really terrible. It wasn't a catastrophic error by any stretch but Thankfully, it was caught and modified.

 

[Postictal Raiden]

Two weeks in and here are some of the things I'm struggling with:

1. giving a concise yet thorough presentation to my attendings. I either focus too much on the details and end up losing their attention, or focus on the story and forget to give the pertinent details.

2. my A/P needs improvement

3. feeling confident enough put in simple orders like diet, DVT ppx, prn pain meds without referring to my seniors

4. knowing what all those acrynoms and abbreviations stand for (DAPT, MPOA, next gen, ANC, etc...)

5. having time/energy/interest to read at night

6. EMR

7. knowing my way around the hospital

8. untying my scrubs

9. staying away from calorie dense food in the cafeteria

10. staying hydrated

 

[rokshana]

Two weeks in and here are some of the things I'm struggling with:

1. giving a concise yet thorough presentation to my attendings. I either focus too much on the details and end up losing their attention, or focus on the story and forget to give the pertinent details.

2. my A/P needs improvement

3. feeling confident enough put in simple orders like diet, DVT ppx, prn pain meds without referring to my seniors

4. knowing what all those acrynoms and abbreviations stand for (DAPT, MPOA, next gen, ANC, etc...)

5. having time/energy/interest to read at night

6. EMR

7. knowing my way around the hospital

8. untying my scrubs

9. staying away from calorie dense food in the cafeteria

10. staying hydrated

about right...though remembering to go to the bathroom was on my list.
it will get better and you will be amazed at how much you learn in a month.

 

[lulu09]

Two weeks in and here are some of the things I'm struggling with:

1. giving a concise yet thorough presentation to my attendings. I either focus too much on the details and end up losing their attention, or focus on the story and forget to give the pertinent details.

2. my A/P needs improvement

3. feeling confident enough put in simple orders like diet, DVT ppx, prn pain meds without referring to my seniors

4. knowing what all those acrynoms and abbreviations stand for (DAPT, MPOA, next gen, ANC, etc...)

5. having time/energy/interest to read at night

6. EMR

7. knowing my way around the hospital

8. untying my scrubs

9. staying away from calorie dense food in the cafeteria

10. staying hydrated

1. I think interns really start getting good at this about halfway through intern year, some only as a PGY-2 or even later. It's a skill but also highly dependent on the presenting resident and also the attending being presented to. TBH a few of my peers who graduated this year still never figured out that you don't present in X manner to Y attending and Z attending requires a X manner presentation...etc. In the beginning though, just do your best to each and every attending and don't worry about these nuances. Less is more. If attendings want a certain piece of info, they'll ask you for it.

2. Whose doesn't?

3. This is literally simple repetition and has nothing to do with how good you are. After you've admitted 100 patients it will be second nature.

4. See above.

5. Honestly I wouldn't worry about reading outside of the hospital for like the first 1-3 months of intern year. Focus on surviving first -- you're actually learning a huge amount as you go and as you do admissions in the hospital. I found the stuff I looked up frantically before presenting to an attending / my senior as an intern to be more than enough for the first year of residency.

6. A neverending mystery, truly.

7/8/9/10. Good luck!! My buddy lost, not gained, 15 lbs his intern year

 

[atom18]

I just started PGY1 today in categorical medicine and my first work day was a 28hr ICU shift. I felt completely useless, didn't where anything was, had 0 knowledge of anything, and had to ask my senior residents for help with everything. Every time a nurse paged me, even for really small things, I would just freeze and ask my senior resident what to do. I felt more useless than a 3rd year med student and I'm freaking out. I also basically did nothing my 4th year of medical school. I honored medicine 3rd year and honored my 3 medicine sub-i's but at the beginning of the year (last may, june, july) and pretty much did absolutely nothing the rest of the year. I feel like I don't know any of the basic knowledge or anything at all. Is this normal? When do interns start picking things up?

I feel EXACTLY the same way. Just started my preliminary IM year. Everything you said fits me exactly. And I also had a really cush 4th year and feel like I no longer know anything at all!

 

[DOFOSHO]

this time next year you'll look back and laugh at yourself.

 

[osprey099]

I just started PGY1 today in categorical medicine and my first work day was a 28hr ICU shift. I felt completely useless, didn't where anything was, had 0 knowledge of anything, and had to ask my senior residents for help with everything. Every time a nurse paged me, even for really small things, I would just freeze and ask my senior resident what to do. I felt more useless than a 3rd year med student and I'm freaking out. I also basically did nothing my 4th year of medical school. I honored medicine 3rd year and honored my 3 medicine sub-i's but at the beginning of the year (last may, june, july) and pretty much did absolutely nothing the rest of the year. I feel like I don't know any of the basic knowledge or anything at all. Is this normal? When do interns start picking things up?

It's almost 3 weeks in now and I am still feeling completely dumb. I was asked on rounds about the differential and workup for GI bleed and my brain could not generate anything. I feel so stupid. Reading feels like it just enters one ear and goes out the other because it's so hard to retain info when I'm sleep deprived and tired. Any advice on how to retain knowledge and what resources to use? I have just been reading step up to medicine and watching onlinemeded videos

 

[alishamur]

oh guy, you are not the only one. sometimes I think I'm the most stupid person ever, feel like I change my job in a few months... that all is too much for me

 

[rokshana]

It's almost 3 weeks in now and I am still feeling completely dumb. I was asked on rounds about the differential and workup for GI bleed and my brain could not generate anything. I feel so stupid. Reading feels like it just enters one ear and goes out the other because it's so hard to retain info when I'm sleep deprived and tired. Any advice on how to retain knowledge and what resources to use? I have just been reading step up to medicine and watching onlinemeded videos

up to date, period.

 

[DrMcCoyDO]

In the same boat, buddy. I feel dumber now than when I was a third year. One of my seniors tells me that it’ll start getting better about halfway through the year.

 

[Perrotfish]

It's almost 3 weeks in now and I am still feeling completely dumb. I was asked on rounds about the differential and workup for GI bleed and my brain could not generate anything. I feel so stupid. Reading feels like it just enters one ear and goes out the other because it's so hard to retain info when I'm sleep deprived and tired. Any advice on how to retain knowledge and what resources to use? I have just been reading step up to medicine and watching onlinemeded videos

How sleep deprived are you? How many hours of sleep per night? Are you getting any exercise? Was the GI bleed question on a post call day?

What resources do you have access to? Do you have up-to-date access? Do you own Harrison's or the Harrison's question book? Do you own the MKSAP?

Have you gotten any formal feedback from your seniors or attendings yet? If so how do they think you are doing? If not do you have any scheduled?

 

[bizdr]

I just started PGY1 today in categorical medicine and my first work day was a 28hr ICU shift. I felt completely useless, didn't where anything was, had 0 knowledge of anything, and had to ask my senior residents for help with everything. Every time a nurse paged me, even for really small things, I would just freeze and ask my senior resident what to do. I felt more useless than a 3rd year med student and I'm freaking out. I also basically did nothing my 4th year of medical school. I honored medicine 3rd year and honored my 3 medicine sub-i's but at the beginning of the year (last may, june, july) and pretty much did absolutely nothing the rest of the year. I feel like I don't know any of the basic knowledge or anything at all. Is this normal? When do interns start picking things up?

I felt the same way. But you will learn more clinically in this first year, than all 4 years of med school. It will feel so different after this year!

 

[Psych_hopeful]

I KNOW EVERYTHING IN MY FIRST YEAR!!!!!!!!!!!

...is what I wish I could say . Nope, I still try hard though and do my best to learn from my seniors. Im honestly glad that for the most part, our residency is full of chill guys and gals or else I'd be screwedddddd. I totally need my seniors to bail me out like 95% of the time XD

 

[Redpancreas]

I just started PGY1 today in categorical medicine and my first work day was a 28hr ICU shift. I felt completely useless, didn't where anything was, had 0 knowledge of anything, and had to ask my senior residents for help with everything. Every time a nurse paged me, even for really small things, I would just freeze and ask my senior resident what to do. I felt more useless than a 3rd year med student and I'm freaking out. I also basically did nothing my 4th year of medical school. I honored medicine 3rd year and honored my 3 medicine sub-i's but at the beginning of the year (last may, june, july) and pretty much did absolutely nothing the rest of the year. I feel like I don't know any of the basic knowledge or anything at all. Is this normal? When do interns start picking things up?

I heard a senior once told his intern to walk around the hospital, explore, report back in 2 hours telling him what he learned. This seems less ludicrous now.

 

[Perrotfish]

A friend told me a senior told his intern to walk around the hospital, explore, report back in 2 hours telling him what he learned. This seems less ludicrous now.

They should just do the match a few months earlier, and then make everyone do a sub-I wherever they matched so they can at least learn where the bathrooms are before they start Intern year.

 

[kabooya]

+1. I'm in the same boat. The most I've had to carry was 6 patients, but I have such a hard time not mixing up their details. I get we're all in the same boat, but a few of the interns I've worked with are able to memorize all these patient's stories or come up with A&P's and solid justification for their plans. I try to not compare myself with them, but man, some of them really have their stuff together. I can't wait for it all to make sense.

Also, has anyone ever tried NEJM Resident 360? I just heard about it and am wondering if I should invest time in that instead of UpToDate (for now).

 

[Postictal Raiden]

so I get a page. Pt is being from an outside hospital and will be admitted to our hospital for a higher level of care. I spend more than an hour trying to make sense of the things I'm reading on the chart. Attending comes in, spends 5 mins clicking through the chart and suddenly has a better understanding/plan for this pt.

this is my life everyday.

 

[geripalgal]

so I get a page. Pt is being from an outside hospital and will be admitted to our hospital for a higher level of care. I spend more than an hour trying to make sense of the things I'm reading on the chart. Attending comes in, spends 5 mins clicking through the chart and suddenly has a better understanding/plan for this pt.

this is my life everyday.

Its possible that the attending already spoke with the transfering attending (prior to accepting transfer).

 

[geripalgal]

Its easier to remember the history and details for patients who you personally took the history from and followed (vs, picked up from another doc)

If its not your patient: read the h&p, read the most recent progress note, and if thats not enough the most recent consultant note for a summary to the situation so far.

Figure out how to put labs in your EmR in a trend view. Whats changing? And whats relevant to monitor? Electrolytes in CHF, wbc in infection, etc

Write down the pertinent info on a cheat sheet - theres a couple available online, or make up your own. Dont worrry about memorizing at this time.

Are you having trouble with assessment? Or the plan. If its assessment, then you really need to think about how you are taking your history. If its plan - use uptodate, pocket medicine, or similar resource to generate a plan. Eventually most of these plans will become second nature.

Then more you see, do, and read, the easier this will get.

 

[hallowmann]

so I get a page. Pt is being from an outside hospital and will be admitted to our hospital for a higher level of care. I spend more than an hour trying to make sense of the things I'm reading on the chart. Attending comes in, spends 5 mins clicking through the chart and suddenly has a better understanding/plan for this pt.

this is my life everyday.

You get better at it, but they will still be faster basically every time.

 

[rokshana]

Its possible that the attending already spoke with the transfering attending (prior to accepting transfer).

no its because he is the attending and has been a doctor for at least 3 years more than the 6 weeks that the OP has been an intern.

 

[smq123]

so I get a page. Pt is being from an outside hospital and will be admitted to our hospital for a higher level of care. I spend more than an hour trying to make sense of the things I'm reading on the chart. Attending comes in, spends 5 mins clicking through the chart and suddenly has a better understanding/plan for this pt.

this is my life everyday.

That's ok. Some day (sooner than you think), that will be you. It just takes practice.

 

[Redpancreas]

Can we change this thread name to Official Intern Support Thread 2018-2019? I feel we could all benefit.

 

[okcinternal]

The beginning is always the hardest... stay strong and push through.

 

[Psych_hopeful]

The beginning is always the hardest... stay strong and push through.

Felt like crap today. I was slammed with patients and was forgetting key values in my presentations. My attending was nice and gave me a slight scolding, but still, I hate the fact that after doing well for several days, I just started to mentally quit or cut corners when I shouldn't.

Still learning basics. I'm glad that I have a senior (seriously).

 

[deleted875186]

so I get a page. Pt is being from an outside hospital and will be admitted to our hospital for a higher level of care. I spend more than an hour trying to make sense of the things I'm reading on the chart. Attending comes in, spends 5 mins clicking through the chart and suddenly has a better understanding/plan for this pt.

this is my life everyday.

It’s more about the attending having seen the same pathology many times over. By the end of intern year you’ll have taken care of so many CHF patients, PNA, AMS, etc that you’ll be able to remember the important details and disregard in your mind the irrelevant stuff. Trying to memorize all the details of a patient I think is nearly impossible, especially if taking care of 10 patients, and especially if there’s high turnover, that’s why there’s a medical record.