Tuesday, July 10, 2007

Feeling Incompetent?


It's the 2nd or 3rd weeks for most new interns and residents.

The first month sucks. Actually, the first week of any rotation sucks, but the first month(s) of internship/non-prelim year is the worst.

As an intern, you wander the halls afraid you're going to kill someone with your incompetence. If this is you, DON'T WORRY. Many have gone before you with the same incompetence, the same fears, and learned how to be comfortable in their new role. Besides, four years of medical school does a pretty good job of preparing you for a medicine internship. (Now, that's not to say it's not terrifying to pronounce a patient or run a code for the first time. But the comfort level will come with time.)

Trust in the process, and just take it day by day. Besides, you've always got your resident, fellow, and attending for backup.

If you're starting your "real" residency after a prelim internship, it's in some ways worse. You, as a member of this group (ophthalmology, radiation oncology, dermatology, etc), probably did very well in medical school, and did well during internship. Now, all of a sudden, you're thrown into a different sub-culture, where the jargon is completely different and the field has little resemblance to what the prior five years of training has taught you.

You were so glad to finally reach this point, to be DONE with your preliminary year, and finally be able to do what you want to do for the rest of your life. Except, now that you're here, you have NO IDEA what the heck is going on. You're very grateful to have matched in the field, but as you struggle to even understand the language these people speak, you're secretly afraid that whoever let you in made a HUGE MISTAKE. And when these people find out about their mistake, you just might find yourself... unemployed.

After a crazy day in clinic, where you understood just the bare minimum needed to get by, you go home determined to make yourself smarter. These fears are amplified as you try to read the assigned reading from the text of choice.

Little did you know that "reading" has turned into a veritable ordeal.

You get out the fat book. Twenty pages of reading, you think to yourself. Should be done in an hour, and then I'll go for a run. Except as you read the first few sentences, you realize that you need a dictionary to understand what you're supposed to be learning. So you get that handy medical dictionary you bought as a first year medical student. And try to look up all these fancy new words. And realize that if you can find 50% of them in this book, it's a good day. So you add something else to your ever-growing "to-do" list - "buy a SPECIALTY dictionary."

In the meantime, you try to make do. After all, you can find some of the words in the "regular" medical dictionary. So you look up a fancy word, like, say, parakeratosis. And the definition is not much better than the word itself.
"Abnormal retention of the nuclei of the keratinocytes in the stratum corneum."
As opposed to orthokeratosis. And, you scratch your head, how is that different from hyperkeratosis? or acanthosis? and how is acanthosis different from acantholysis?

Or perhaps the word of the day was spongiosis:
"Intercellular edema, most commonly in stratum spinosum."
Hm, you think to yourself - which of the many layers of the epidermis is the stratum spinosum? And why does this other text refer to the malphigian layer?

Startled, you realize that fifteen minutes have gone by while you've tried to figure out the above, and chiding yourself for getting off topic, you go back to reading the text. Three sentences later, you come across parakeratosis again.

Aha, you think, I know what that means. Or wait, is that orthokeratosis? Or hyperkeratosis? You end up having to look it up, again, because, although you just read it fifteen minutes ago, it already flew out the other ear. And before you know it, it's several hours later, you're only on page 4 of the assigned reading, and you had better get to bed since you have to get up in a few hours.

Such, is the life of a new resident.

*****

Your friends who went into other fields have a hard time understanding why you're exhausted by the end of a week. Actually, you're not even sure, until you realize that even though medicine internship meant you were in house for many more hours, there was down time. Whereas now, you run around like a headless chicken while in clinic then try to read gobbledy-gook for several hours a night. And truly feel like a headless chicken, for all the amount of material you seem to be (not) absorbing.

It's also an isolating time, because you struggle, maybe for the first time, with your feelings of utter inadequacy and feel like you're the only incompetent one. Because your colleagues always seem to know what they are talking about when they pipe up.

*****

Here are the truths:

Truth:
Everyone in your class is equally incompetent.
You just don't see it because you're not working side by side, like on the medicine service. Every single person has the same feelings you're having, and like you, they're trying to keep their head above water and not show how hard they're flailing.

Truth:
It is okay to not know, and it is very normal to feel completely overwhelmed. It's a new field that you've never been exposed to before.

Truth:
You are still the great person you've been so far, (no, you haven't been slowly getting dumber during internship) and you too, will learn all the material with time.

Truth:
That after nights of beating your head against the books, one day you'll understand parakeratosis. And spongiosis. And how spongiosis is different from acantholysis. And why that will make you a better physician.

It will all come with time.

Just put one foot ahead of the other, work hard, and try not to stress too much. You've already done the hardest part. Enjoy life. Take care of yourself. The year will be over before you know it. Although you may not feel all that much smarter throughout the year, pretty soon, you too will be welcoming a new group residents. And their naivete will show you how much you've learned in the first year.

It's a tough year, but you'll make it through with flying colors. We have faith in you.


But don't ever forget how hard it was when you first started out, and because of this, don't forget to extend a hand to the next group.

Take care of them the way you were - or wish you had been - taken care of.

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