New PGY2 feelings of quitting

[agedwhitecheddar]

Hoping to see others experiences. I’m a new PGY2 now about 2.5 months into ophthalmology residency. My program is demanding with front loaded call and consults for much of the year. Slowly getting some basic DFE skills and SLE down but just can’t shake off the feeling that I’m doing patients a disservice seeing them independently (with hit or miss attending oversight). I just feel stressed knowing sometimes that if I missed something on a DFE on call, that I may have missed something crucial for maintaining a patients vision.

I try to read as much as I can when home but it’s so difficult to spend all day worrying about ophtho and my inadequacies and then come home and read to only forget what I read because of how tired I am. I am also not sure the best way to study. I try to read about what I see, but also just do questions as I’m too tired to read BCSC

I just feel like I am doing the motions but not progressing as much. It really makes me second guess my decision of going into the field as the stress is starting to become overwhelming.

Wanted to hear others thoughts as I know this may be somewhat of a commonality amongst starting Ophthalmology residency.

---

Members don't see this ad.

 

[ESTJ245]

100% normal. I think it took me 6 months to even feel like I was starting to get the hang of it. And then I didn't truly feel comfortable until probably a few months into PGY-3. You will probably learn more practical things with just reading the Wills Eye Manual for things you see on call or see in clinic. Just keep pushing and learning!

 

[TheLesPaul]

I hated ophthalmology and wanted to quit. I then discovered oculoplastics which seemed more integrated with the rest of the medical field. I feel the OR is my real home. Wait until you start operating.

 

[airplanes]

Normal. It's steep learning curve early on for both knowledge and examination. Don't hesitate to ask questions or to have someone recheck. Most of time, you are not dealing with a sight threatening concern. Bring the patient back a little sooner if in doubt. You'll get there. You're very early on. Things should start clicking by winter and most residents are fairly comfortable come spring and towards the end of PGY2. Talk to your PD or a mentor if needed. We've all been through it, hang in there.

 

[LightBox]

Hang in there. And whenever you think that you might want to quit, ask yourself: "Would I really want to pursue a hospital-based profession?!?" Hell no!

Ophtho is amazing. Take it from someone >10 years out!

 

[Rhexis]

Stick with it. We've all been through it. It will get better before you know it. If you start over in another field you'll be feeling the same inadequacies there.

 

[RetinaDude]

It is stressful. Thinking back on my early years of training, I cringe at some of the situations I found myself knee deep with pts and feeling like I didn’t have a clue (I didn’t). Ophthalmology is an entire new language compared to the rest of medicine. It definitely takes a while to learn the skills. I recall feeling so damn frustrated because I just could not use a 78D lens. Sounds stupid, and I felt stupid, but I could not get the image to come in clearly to do an exam. Now, I’m a retinal specialist and I look back at it thinking “how could I have once been so stupid?” Feelings of inadequacy are normal. That steep learning curve is real, but once you get over it, you start to appreciate the cool things you get to see that no one else in medicine can see or understand.

 

[idkididk]

Hey I’m also a first year who’s definitely feeling the stress of it all. Studying with anki and Ophthoquestions, busy resident clinic, front loaded call schedule, 1.5-2hrs of didactics twice per week at 6pm, Grand rounds once a week, and getting involved in writing a review article. And trying to plan a wedding in the midst of it all lol. I don’t think I’ve ever had this much on my plate all at once.
An attending told me that all new ophtho residents go through a period of depression during the first 6 months, but after that something just clicks. I keep saying to myself, the seniors and the people who’ve graduated from this program all did it, there’s no reason to think I can’t do it.

 

[agedwhitecheddar]

Hey I’m also a first year who’s definitely feeling the stress of it all. Studying with anki and Ophthoquestions, busy resident clinic, front loaded call schedule, 1.5-2hrs of didactics twice per week at 6pm, Grand rounds once a week, and getting involved in writing a review article. And trying to plan a wedding in the midst of it all lol. I don’t think I’ve ever had this much on my plate all at once.
An attending told me that all new ophtho residents go through a period of depression during the first 6 months, but after that something just clicks. I keep saying to myself, the seniors and the people who’ve graduated from this program all did it, there’s no reason to think I can’t do it.

Hey I’m also a first year who’s definitely feeling the stress of it all. Studying with anki and Ophthoquestions, busy resident clinic, front loaded call schedule, 1.5-2hrs of didactics twice per week at 6pm, Grand rounds once a week, and getting involved in writing a review article. And trying to plan a wedding in the midst of it all lol. I don’t think I’ve ever had this much on my plate all at once.
An attending told me that all new ophtho residents go through a period of depression during the first 6 months, but after that something just clicks. I keep saying to myself, the seniors and the people who’ve graduated from this program all did it, there’s no reason to think I can’t do it.

Was trying to shoot you a DM, but feel free to message me! Seems like we’re in the same exact boat

 

[Ironfist]

1.) You're probably better than you think you are. You're learning a new language and the first phase of that process is feeling uncomfortable and self-conscious. You haven't seen or done enough to accurately gauge your own skills, but your attendings and senior residents have. At some point they collected enough data points to feel comfortable letting you examine patients on your own. What you're maybe not appreciating is how much more efficient they are at forming a differential, stratifying risk in terms of potential harm and deciding what they actually *need* to see immediately. (Hint: not that much.) Keep in mind that triaging eye patients is a job that is done by good technicians in a lot of places. Your job on consults isn't actually to make a diagnosis, though its nice, it's to get the patient stabilized and into the right clinic.

2.) You're coming from an intern year where you most likely made 0 actual decisions. Medicine interns function mostly as automata where everything is run by the upper level. It's uncomfortable going from that paradigm to one where you're triaging patients, processing information and enacting a plan. By the middle/end of this year you will be much more comfortable, but the only way to get there is to be forced to make uncomfortable decisions. I don't know who's supervising you, but I suspect that they're paying closer attention than you realize and intentionally letting you struggle a bit. Trust the process.

3.) You need to chill TFO. You're neurotic, that's good. But the level of responsibility is going to keep going up. I don't have advice. Do yoga or something.

 

[LightBox]

Ophthos are used to being the top dawgs at every level of training. So when you are suddenly on the lowest rung of knowledge, it can hit your ego significantly. Trust me, it gets a LOT better especially when you out in the real world living your best life as an attending/private practice owner.

 

[JMK2005]

ophthalmology is fun and rewarding on the other side of training. i remember it was really tough the first year.
it's still tough what you are going through now. hang in there.

 

[vannas]

I am a fellow PGY2 and I totally feel you. My program doesn’t really have didactics and I learn mostly by myself. It’s like being thrown into the ocean. I was assigned to see patients independently and missed a retinal detachment the other day. My senior said you could not miss this and I felt awful. How many retinal detachments have I seen really? I felt incompetent and lost my interest in ophthalmology. I was once so passionate. I am also thinking of quitting and switching to internal medicine. PM me and we can chat more.

 

[percyeye]

Optometrist here. Not here to debate Optometry vs Ophthalmology because obviously the training produces great clinical/surgical care, but I had a couple of classmates whose fathers were Ophthalmologists and they said they were jealous we got to sit in class for 2 years learning about the eye and practicing clinical skills before being thrown in with patients as he scrolled through our slides and textbooks. We even had some Glaucoma and Retina specialists to teach about those conditions which was nice. I think it did make a difference having a solid base of info before seeing things in person. It sounds very intense to be just thrown in there and learn on the fly while also learning the surgical side so props to ya'll.

 

[TheLesPaul]

I am a fellow PGY2 and I totally feel you. My program doesn’t really have didactics and I learn mostly by myself. It’s like being thrown into the ocean. I was assigned to see patients independently and missed a retinal detachment the other day. My senior said you could not miss this and I felt awful. How many retinal detachments have I seen really? I felt incompetent and lost my interest in ophthalmology. I was once so passionate. I am also thinking of quitting and switching to internal medicine. PM me and we can chat more.

We have all missed stuff as a PGY-2 (and beyond!). I spent my first day in clinic "correcting" people's notes from 'CNV' >> 'CMV'. I had never heard of choroidal NV and was fresh off of an ID rotation in my prelim medicine year. It is a different language and world and it takes a full year to acclimate.

 

[RetinaDude]

Optometrist here. Not here to debate Optometry vs Ophthalmology because obviously the training produces great clinical/surgical care, but I had a couple of classmates whose fathers were Ophthalmologists and they said they were jealous we got to sit in class for 2 years learning about the eye and practicing clinical skills before being thrown in with patients as he scrolled through our slides and textbooks. We even had some Glaucoma and Retina specialists to teach about those conditions which was nice. I think it did make a difference having a solid base of info before seeing things in person. It sounds very intense to be just thrown in there and learn on the fly while also learning the surgical side so props to ya'll.

I actually think you bring up a good point here. The MD/DO route prepares us to go into almost any type of medical field, except eccentric ones such as ophthalmology or ENT. At some residencies, they do send you to an intense “starter” course to acquaint you with the basics. I did not have that, and wish I did. Just like others, I missed critical problems at the start of my residency. Of course, it forced me to learn, and I never made that particular mistake again. Yes, it definitely made me a good clinician but I cringe at the costs of misdiagnoses in the process

 

[elementals]

We have all missed stuff as a PGY-2 (and beyond!). I spent my first day in clinic "correcting" people's notes from 'CNV' >> 'CMV'. I had never heard of choroidal NV and was fresh off of an ID rotation in my prelim medicine year. It is a different language and world and it takes a full year to acclimate.

BAHAHHA oh god i can just imagine the fallout

 

[DrRiker]

Hey I’m also a first year who’s definitely feeling the stress of it all. Studying with anki and Ophthoquestions, busy resident clinic, front loaded call schedule, 1.5-2hrs of didactics twice per week at 6pm, Grand rounds once a week, and getting involved in writing a review article. And trying to plan a wedding in the midst of it all lol. I don’t think I’ve ever had this much on my plate all at once.
An attending told me that all new ophtho residents go through a period of depression during the first 6 months, but after that something just clicks. I keep saying to myself, the seniors and the people who’ve graduated from this program all did it, there’s no reason to think I can’t do it.

Sorry to bump this thread. Saw that you are using Anki, I'm assuming the eyeguru deck or similar. Do you feel much need to reference BCSC while working through these decks?

 

[Doc320]

Hoping to see others experiences. I’m a new PGY2 now about 2.5 months into ophthalmology residency. My program is demanding with front loaded call and consults for much of the year. ...It really makes me second guess my decision of going into the field as the stress is starting to become overwhelming.

Definitely change to a different field IF there's a far superior field. I think there isn't one. Maybe if you have a $100 million business idea?

Even if one had a $100 million business idea, there are advantages to being a practicing doctor. You have the keys to the kingdom as far as knowledge. I know of at least 2 cases where a life was saved because the doctor relative had medical skills and 2 cases where a life was lost because of poor medical judgment by a non-doctor (and many dozen suspected lost lives). Non-doctors often have terrible medical judgment and make very bad medical decisions.

.. missed a retinal detachment the other day. My senior said you could not miss this and I felt awful. How many retinal detachments have I seen really? I felt incompetent and lost my interest in ophthalmology. I was once so passionate. I am also thinking of quitting and switching to internal medicine. PM me and we can chat more.

Don't feel bad. Think of why the error took place. Is it that you didn't know how to use the indirect? Is it that the patient was wildly shaking her head around because of dementia? Is it that you didn't know how to do scleral depression? Is it that your own glasses became foggy and you gave up too soon?

 

[docdoc2012]

Hoping to see others experiences. I’m a new PGY2 now about 2.5 months into ophthalmology residency. My program is demanding with front loaded call and consults for much of the year. Slowly getting some basic DFE skills and SLE down but just can’t shake off the feeling that I’m doing patients a disservice seeing them independently (with hit or miss attending oversight). I just feel stressed knowing sometimes that if I missed something on a DFE on call, that I may have missed something crucial for maintaining a patients vision.

I try to read as much as I can when home but it’s so difficult to spend all day worrying about ophtho and my inadequacies and then come home and read to only forget what I read because of how tired I am. I am also not sure the best way to study. I try to read about what I see, but also just do questions as I’m too tired to read BCSC

I just feel like I am doing the motions but not progressing as much. It really makes me second guess my decision of going into the field as the stress is starting to become overwhelming.

Wanted to hear others thoughts as I know this may be somewhat of a commonality amongst starting Ophthalmology residency.

When I was beating myself up as a first year, my favorite attending told me 'the eye cannot see what the brain does not know'. And I'll say the same thing to you.
You have a ton of information coming at you right now. You are trying to learn how to do a DFE. Frankly you probably don't even know all the normal variations of a fundus right now.
This is the discomfort of training. You will make mistakes. Patients may suffer, but because of system redundancies and safeguards hopefully not too much. You carry the guilt just long enough to learn how not to miss something a second time and then let it go.
There will be a point where everything just clicks. I didn't actually see or understand what dme or cme was until seeing the macula with a focal laser lens. I didn't understand truly how to scleral depress and how to angle your body until one day, it just clicked.
It will fall into place. Continue reading. Look at images. See as much as you can. Give yourself grace. And soon you won't remember what it was like not to know the eye