Too sensitive for the wards?

[Apply Pressure]

I never thought I would ever in a million years be the one to feel like this..... but this is medical school, so I suppose anything is possible.

I'm having a difficult time dealing with the rigors of 3rd year. We started just about 3.5 weeks ago (I'm on a fairly, but not the most difficult rotation) and I feel like I've emotionally been on a downward spiral ever since. The craziness started when I received my below-average board scores not too long ago and was shocked to see how I did. Now, I feel like I increasingly take criticism poorly.... like my peers, interns, residents, and attendings are attacking my abilities if I don't know something they ask about when they put me on the spot. I understand that this is all part of the "game" (i.e. pimping), but geez it really does work to make you feel like an idiot/lose your self-esteem. Especially if you get something wrong that is a relatively easy question.

It's possible that I'm now under additional pressure because I feel like I need to redeem my step 1 performance and internally prove that I'm better than it..... but I think I just need some help to toughen up and not take things so personally all the time. I can admit that I've never been the most amazing student, but until recently, I had always thought of myself as at least reasonably intelligent.

This whole scenario is increasingly killing my self-confidence, thus making it difficult to recall information/be at ease to answer more questions. It's like each day I'm lacking more confidence about my abilities.. and we all know how important having confidence/positive reinforcement is in academic/clinical performance. In short, my environment is helping to reinforce the notion that I may be a total idiot/not worthy of a career in medicine.

Any advice for my situation?

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[Rendar5]

Well, to start with, rethink what it is to be pimped. You need to realize that if you're getting everything right that you're pimped on, something's wrong. You're not supposed to get everything right, you're supposed to learn when you get something wrong. I basically just learned to blurt answers out, whether I was confident in them or just guessing. Sometimes I'd get crazy answers outta random chance and look good, but plenty of times I gave the wrong answer, but I at least looked enthusiastic.

As for the rest, I never made other students look bad, and helped em out plenty, and received help myself plenty of times.

So yeah, suck it up, and realize that you don't need to be the sharpest tool in the shed for 3rd year. Just know ur pt's, be enthusiastic, learn from mistakes, and do the best u can.

 

[persia]

Ah, my friend. Welcome to the weirdness that is third year. Again, I say welcome.

You clearly have a fine set of working emotions, ones that can tell you 'hey! something is not right here!' and you will be right. Some people do well in this environment, but it is not for everyone. If it is not for you, just know that this environment is not how it works in the community or in your own private practice one day. The pimping is well, maybe not the best way to teach especially in the beginning. Once you start to know things, try and see if you can think of is as an opportunity to 'think out loud.' In the right hands, pimping can be alot of fun, but that means when the person is wellmeaning and are not just trying to torture you. Think of it like watching jump rope or ice skating, it looks like fun but how to you get in there? you just jump in and do your best. If you don't like, then try and find ways to deal with it that work for you. It should get better as you learn more and gain more confidence over time. You will also learn some awesome tricks for protecting yourself and deflecting potential pimp questions, but this comes with time.

One thing to think about is that somewhere in the comments you hear is something someone is trying to say to maybe be helpful. In other words, what can I learn from these comments? Sometimes, you can even say to the person later, what did you mean when you said blah, blah. That can help you feel more in control and sometimes, too the person later can make more sense than when you are on rounds and feel embarrassed. Also, try practice saying: thanks for the feedback, that was really helpful. Or even lame comments like, 'ok, that was awesome!' or whatever. After a while it will feel more natural.

In the end, trust your instincts and listen to your gut. Protect yourself as best you can and when in doubt just smile and be friendly. Don't ever say anything you wouldn't want to see in tomorrow's newspaper, and if someone hassles you figure it is their problem, and walk away. Be kind, don't ever screw with anyone, be professional and don't let down your own integrity. When in doubt, go for a walk or sit in the bathroom for a few minutes. It will pass, it will all pass and things will get better. Just know that you are ok, even if you don't like the process.

 

[futuredo32]

I never thought I would ever in a million years be the one to feel like this..... but this is medical school, so I suppose anything is possible.

I'm having a difficult time dealing with the rigors of 3rd year. We started just about 3.5 weeks ago (I'm on a fairly, but not the most difficult rotation) and I feel like I've emotionally been on a downward spiral ever since. The craziness started when I received my below-average board scores not too long ago and was shocked to see how I did. Now, I feel like I increasingly take criticism poorly.... like my peers, interns, residents, and attendings are attacking my abilities if I don't know something they ask about when they put me on the spot. I understand that this is all part of the "game" (i.e. pimping), but geez it really does work to make you feel like an idiot/lose your self-esteem. Especially if you get something wrong that is a relatively easy question.

It's possible that I'm now under additional pressure because I feel like I need to redeem my step 1 performance and internally prove that I'm better than it..... but I think I just need some help to toughen up and not take things so personally all the time. I can admit that I've never been the most amazing student, but until recently, I had always thought of myself as at least reasonably intelligent.

This whole scenario is increasingly killing my self-confidence, thus making it difficult to recall information/be at ease to answer more questions. It's like each day I'm lacking more confidence about my abilities.. and we all know how important having confidence/positive reinforcement is in academic/clinical performance. In short, my environment is helping to reinforce the notion that I may be a total idiot/not worthy of a career in medicine.

Any advice for my situation?

You are intelligent- you are a third year med student.

This is your first rotation. You are transitioning from second year where you had to answer questions based on multiple choice on material that you studied to third year where the pimp questions are based on a very broad range of information and only a few seconds to answer the question. You are still a student with a long way to go in your training. This is the time for you to be learning, not the time where you should be an expert(otherwise, there'd be no need for third year, fourth year or a residency). Don't be so hard on yourself.

There are some books that may help with classic pimp questions (Surgical Recall really saved me on my general surgery rotation). Other than that, I'd just suggest to pick a topic or a few topics to read about every night. Maybe the information you learn won't specifically be asked by your attendings or residents, but it's still useful information.

Some attendings and residents are really good about giving students praise where praise is due. Others don't really acknowledge good work done by students. But if you are able to look objectively at yourself as you progress through rotations, you will probably be able to look back at how far you have come and how much you have learned.

 

[elwademd]

as stated above, the recall books can definitely be of help.

also, how do you answer (or alternatively not answer) pimping questions. it took me a bit of time to realize that some people actually know some stuff, and other people don't truly answer the question but try, and others don't know the answer and don't try.

i was one of those students who didn't try to answer questions with bs, i figured you either knew the answer or you didn't. my mentor had to point out that in order to play the game, you need to show what you know.

if you really pay attention on rounds/pimp sessions, you'll notice that some people don't actually answer the question. but they do give some insight. they may start of by saying what they do know about the subject, and then give what seems to be an educated guess. this is probably the best way to answer questions on rounds. try to avoid "i don't know".

as far as your step 1 score goes, you're on the wards. there are plenty of students around the country, and perhaps at your school, who didn't do so hot on step 1 and therefore are not on the wards. look at it that way, and then maybe its not so bad.

synopsis:
get a recall book for the rotation you're on
always show what you know when answering
thank God (or whatever higher being/power/spirit you believe in... or not) you passed step 1 and get to continue on the wards

 

[Law2Doc]

This whole scenario is increasingly killing my self-confidence, thus making it difficult to recall information/be at ease to answer more questions. It's like each day I'm lacking more confidence about my abilities.. and we all know how important having confidence/positive reinforcement is in academic/clinical performance. In short, my environment is helping to reinforce the notion that I may be a total idiot/not worthy of a career in medicine.

Any advice for my situation?

Roll with it. It's fine to have less confidence about your abilities at this stage, because honestly you have none yet. To some extent you get trained better by having your self-confidence ripped to shreds, learning new defense mechanisms, and building it back up again. The concept is that to some extent a student needs to be broken down so he can be built up again with the right attitudes/approach. You don't learn to be a doctor in the classroom, you learn it by being an apprentice to a demanding taskmaster.

Pimping itself is not problematic, you can generally handle questions you don't know by offering to look it up. Many residents/attendings feel the need to berate you when you don't know stuff, and for that you need to just grin and bear it. The whole point of this exercise is to learn, and whatever you don't know, you make sure you know by the next time. That means preparing daily. As folks have mentioned, there are good books for every rotation.

Med school tends to be frustrating to some because they have gone through many years of classroom stuff where they were constantly praised and suddenly get to the clinical years and learn they don't know squat. You get ridden hard and sometimes verbally tongue-lashed because at some point down the road you are going to be alone on the wards making decisions with people's lives at stake. You will get better at rotations, will get a new and more justified confidence. It will take time. Until then, roll with it.

 

[AmoryBlaine]

Unfortunately having a thick skin is vital for success in medicine -- you will develop it as the year wears on.

Think about it, you're never going to know everything and you're always going to get stuff wrong. People are always going to forget how hard this stuff is to learn and belittle you for not knowing obscure facts. Fortunately most of these people are complete losers so you can laugh hysterically in your mind as you think of how pathetic they are.

 

[nightowl]

Just chiming in to say I know how you feel. I am typically visibly nervous before rounds, a good friend of mine described me today as "a little frantic". I just hate the feeling that I'm not going to know what questions they are going to ask. Even though people say to read, it's impossible to read the entire book and therefore know everything they might ask you. (or maybe close to everything ) I think it's great to read, and I do that, but I still feel stupid at least once every single day, if not all the time! I've come to the conclusion that it's not only helpful, but absolutely imperative, to grow a thick skin to survive on wards! the thing is, it's going to at least be this bad for pretty much all of residency, so might as well adapt

As far as Step I, I didn't do fantastic either, but I know people who made lower scores than me and outshine me on rounds daily. So just know that your step I score DOES NOT predict how awesome your going to be on rounds. I'm shy and tend to keep my mouth shut unless I know an answer or am put on point, but I'm trying to be more outgoing and just give it my best guess. Good luck and know you're not the only one. We will survive!

 

[gbwillner]

Why so serious?

Really, my advice depends on your sex. If you are a guy, I would say "walk it off" etc., learn how successful students deal with the pressure and demands of the service. I noticed that the best students in the clinic were always the most confident ones that never took everything so seriously. If you don't know something you don't know it- who cares- it probably wasn't so important anyway. If it was, now you know- no sense beating yourself up over it. If you DO know something, say it like you mean it. You confidence will go a long way.

The only reason I mention the sex is that from my experience, some women can do the above easily and put their emotions/feelings of insecurity on hold, but others cannot (I'm sure some guys also are like this but let's just play statistics for now). If that is the case I can only suggest you find a suitable outlet for your emotional stress, like friends/family/SO, or even the school councellor who is there just for that reason. It's better to get a handle on the situation now before it affects your grades, and you decide to self-medicate or quit.

 

[Apply Pressure]

Thanks for the replies everyone... definitely a lot of helpful advice. It's also nice to know that I'm not the only one who may feel like this. I'm trying to look at this from the positive end and hoping that I'll come out of this year a much stronger and competent individual

 

[humuhumu]

I can relate to this to some extent. I did well in the first 2 years and on Step 1 but the 3rd year has been more challenging. One reason is sleep deprivation - I have a hard time presenting patients in a coherent manner when I've been awake for over 24 hours. I hate feeling stupid, and yet the clinical years almost seem designed to make you feel stupid every day. Public humiliation is a tough but admittedly effective way of learning. I'm just trying to keep my chin up and hang in there. Finding enough time to read is important too...still working on that one...

 

[ucsb101]

wow i feel like im in the same boat