Almost overnight, my answer to “Are you more excited or nervous about residency?” went from the former to the latter. Well, I should say it happened over the course of the morning on March 5th. Residency suddenly went from this nebulous, foggy concept with rainbows and gumdrops to a stark reality (with a metric tonne of paperwork, no less). It’s one thing to pick a residency program, but quite another to prepare yourself for living it.
I am excited about a couple of things; it’s been many a year since I’ve been closer than 6 hours from my family, never mind 15 minutes. So it’s nice to not have to worry about navigating a brand new city while having my family a short drive away. I don’t know yet if it’s a certainty, but having my old room and my old house there if I need it takes the pressure off finding accommodations right away.
On a more academic note, having signing authority is going to be a big change, but one I think I’ll really appreciate. For the simple, straightforward issues, it’ll be exceedingly nice to be able to give orders over the phone; having to get up and go see a patient who wants their Tylenol changed to PRN, talk to them, then page the resident is certainly disruptive. And, like most, my brain doesn’t function well when it’s sleep-deprived. On a similar note, being in a rural program means more home call and less in-house call, which I couldn’t be more excited about. I’m not burdened with laziness, I just feel that to learn well and learn a lot, I shouldn’t have to hate my life (case in point: internal medicine).
My “excited” tally is longer than I anticipated… but every time I think of the “nervous” column, I feel a mild sense of dread. Being on emergency medicine right now after a 2-3 month break from anything even remotely related, some of my “detail” knowledge and skill has gone right out of my head. I don’t know if there’s anything quite so demoralizing as blanking when your staff asks you the COPD dose of amoxicillin. I’m nearly graduated, and that’s basic stuff I knew at the beginning of 3rd year. It’s easy to feel guilty about, even if, logically, I understand that I can’t reasonably expect my brain to retain dosing when I haven’t used it for months. And it makes me worry that, come July 1st, I could embarrass myself pretty profoundly.
Yup. “Impostor syndrome.” It’s found me at last.
It’s a miracle I’ve avoided it so far, but I couldn’t escape it forever. During our lecture on the topic this week, I remember checking off most things on the list. “Everyone else is smarter than me.” “I’m not competent enough to do this.” “Everyone else is coping better than me.” It was somewhat reassuring to see all those thoughts up there for the world to see and to know that I’m not the first (nor the last, I daresay) to experience them… but it didn’t stop me feeling like my ER staff’s praise came from pity rather than belief in my prowess. On some level, I realize that I’ll look back at this and think, “Huh, well I guess I had a bad week.” But in the middle of it, it feels like the ground has suddenly given out beneath you and every confidence you ever had in your ability seems silly and unfounded.
Sure, there are other little concerns I have like getting along with the residents I’ll be spending a large part of two years with or getting used to a new hospital, but all those pale in comparison to the idea that I could be a bad resident.
So the question becomes, what can I do about it? On one hand, I feel like excessive studying is only going to feed the fires of anxiety. On the other, I do clearly need to review some things.
Even in the process of writing this, I feel like I’ve purged some of the shame and guilt that’s been sitting on my chest this week, so hopefully I’ll remember to just pick up a pen (or my laptop!) if I’m having some trouble. Failing that, some focused study (i.e. around a question or topic, not trying to memorize a textbook) is probably in order, followed by something fun to help clear away the unhelpful emotions left over. I think I can use some of what I’ve been feeling to spur me to study and practice more, but the trick will be reining it in before it starts to affect my confidence and my ability to function. It’s hard (maybe impossible?) to force your brain to remember things when it’s flustered and overwhelmed.
Most importantly, I think I need to re-learn how to be okay with not knowing. My differentials are usually solid, my physical exam is reliable, and the rest is just study-stuff. I may have to review and remember, but it’s stuff that comes back with a little bit of reading and a little bit of practice. Here’s hoping my confidence isn’t far behind!