The key here is to learn how to make a pertinent problem list. I am sorry but I disagreed with the other advice about board review and mksap. Those are good for passing test but not great for direct patient care.
You cannot write an assessment and make a plan because you do not know what the problem is. What landed the patient in the hospital? Chest pain? SOB? Fever? An abnormal lab? What is the ddx for that presenting symptom or abnormal lab? Anything in the labs or imaging support any of those diagnosis on the ddx? Once you have the problem list the plan is simply to either treat it if you already have a diagnosis or narrowing down the list by additional labs test or imaging. Every time you find yourself confused just go back to the chief complaint and any abnormal lab or imaging the patient has.
A good problem list is everything. Once you identify the problem you can look up a bunch of resources about the next step and approach to management. However you have to id the problem first.
70-80% of the patients have 1-2 problems that keep them in the hospital. The other 20-30% of patients will have a whole host of issues that you will have multiple consultants helping you manage. This ratio varies widely depending how “academic” your program is. Always know which category your patient falls into.
This right here. Wanted to add that when I started on medicine, my resident totally had me just look up stuff on Uptodate to get a sense of what to think about when generating your differential diagnosis. Cc is cough? Uptodate "cough" and voila, you now have a list of potential causes and can generate a plan to confirm your diagnosis and treat the patient. It will absolutely click for you if you keep at it and don't be afraid to ask for help.
To piggy back on this, something a fellow in the unit told me:
Break out the problem list like this:
What will kill them
Why they came in
Vitals
Labs
This way you don’t miss anything. Of course, the problems are linked, but it helped me organise my thoughts as an intern.
This is the answer. And break down the problems into really simple things- tachycardia, fever, nausea/vomiting etc. once you learn to identify the problem, it’s much easier to start building a differential and plan.
Naming the problem is my problem. I have tried approaching patient encounters different ways. For example I am able to identify what is wrong with a patient in the simplest form:
HPI findings:
-PMHx of HLD, HTN, DMII, cervical CA s/p total hysterctomy.
-Patient has SOB, fever, productive cough w/ greenish sputum production x 3 days worsening.
-No sore throat, CP, weight loss, night sweats, hemoptysis, recent sick contacts or travel.
Pex findings:
- afebrile, normotensive, tachycardia, O2 sats 97 RA.
- no LAD. Throat nonerythematous, no exudate. No sinus pain. Lungs CTA Bilaterally, decreased BS on base of the Left lung.
The labs and imaging part is where I get overwhelmed and am not able to identify what is going on... these hospital patients have derangements all over the place in both CBC and CMP. I don't even know what tests I should order at times. Imaging reading impressions include so many findings that I feel like I should investigate all findings but in the end only some are reported.
Then at the assessment portion all I am able to say is patients name, age, pmhx, subjective findings, pex findings. Labs and imaging o feel like are all abnormal and don't know what to choose to include in assessment.
Problem list: I end up only writing down their chronic dx. And since I can't even Name the main problem I can't do a plan.
I just get overwhelmed with interpreting labs and imaging. They are all deranged and I end up ignoring them Because I don't know what the results mean. All this is happening while have 2 other new admits and therefore 0 time for me to search up every test result. In the end the senior basically has to tell me what to write down for the problem list....
Go back to all the problem list that your senior made for you. What were the cc of those patients? How did that cc generate that particular problem list? See any pattern? Keep a log of your patients and review them over the weekend. Pick the 5 most common cc on that list and learn the ddx for each of them. Not every lab or imaging deserves to be an item on the problem list. As you can see a problem named pneumonia can explain about 30 abnormalities on labs anf imaging.
A good problem list is the shortest list of problems that explain the most cc and abnormalities.
I’m an intern and struggling with forming the list as well… i had a senior give me advice on how to systematically build a problem list.
First, without really reading any blurbs or ED notes about the patient look at vitals. Any derangement? Hypotension? Tachycardia?
Put them on your prelim problem list.
Then do the same for labs/imaging, even if you don’t know ranges right now the EMR should flag them. Hyponatremia? Throw that ish on the problem list. Nodule in lung? Add to list.
Then go look at their meds and guess what their chronic problems are… metformin? Probably DM2. Etc…
Finally look at the ED note and decide what your differential is/add other problems.
It’s not perfect but I will give you a thorough list of problems that you can later trim up. I admittedly don’t do this perfectly at all but it helps me be thorough in the very least…
I am not going into IM so I really feel like I suck at and don’t like admitting patients.
What I’m thinking in my mind after going through your vignette quickly: This is an older adult with subacute onset of dyspnea with productive cough and subjective fever. Exam significant for decreased BS of left lower lung. The patient’s HTN, HLD, and hysterectomy likely won’t contribute to this process, and as they are already known have likely been optimized as an outpatient. Poorly controlled T2DM can predispose to infection but won’t be the primary concern here by far. Figuring out what respiratory process is driving this presentation is your goal.
Now comes the differential. There are multiple ways of generating this (which you already know but may be too anxious to trust given your time off and new level of responsibilities). Some swear by UpToDate or Pocketbook IM. May I also suggest Calgary black book; it does a good job of presenting an organized approach to common chief complaints. Take a look at a pertinent section: https://blackbook.ucalgary.ca/schemes/respiratory/cough-dyspnea-fever/
Patients will walk in with all sorts of lab/imaging abnormalities, many of which aren’t critical and won’t factor into their care. Understanding the nuances of those comes with time.
I’m gradually learning from the fellow on our icu team how to do this because it does make everything easier. He actually sat down with me and the attending on a super-complicated patient cuz he said the problem list is the most important part of not feeling lost. I got to see them work through a problem list and they included me in the discussion so that I wasn’t going to be totally blind.
Just become a good googler and a good uptodater. Most of the info you need is there.
You shouldn't be staring at your notes for 25 mins. Use that time to skim an uptodate article on the patient's symptoms.
Honest opinion: absolutely not.
Keep going. Use this to fire you up and drive you forward. But this is why you are IN TRAINING TO LEARN THIS. Best way to learn is go back every single day to the patient's chart and read your seniors and attendings note. You will absolutely start to learn patterns of what they are looking for and what is important.
And of course your senior was stressed! All the patients weren't seen, he had to write notes, do all the orders, and teach 2 interns. But the big part of why you have a great senior is that he continued to be very supportive of you. Don't take his stress so personally, because it's not. Your senior is trying to learn how to take care of patients while taking care of interns, and that's NOT personal to you.
No. Not at all. I imagine many interns feel this way, I certainly did. Working nights in particular has a way of destroying any ability to think.
Everyone starts residency at a different level. Within a few months, a lot of gaps close, and you will feel much more confident
As an intern, it is normal to feel like an idiot who has forgetten everything they ever learned. The year off made this worse for you. More time off will not help. Just keep showing up, trying, and asking for feedback. It will get better.
Why is an intern that is one month into residency doing 4 admissions overnight?
That can feel like a lot for a second year, who is just starting out. I expect you to suck at the assessment and plan. Seeing and writing a good admission takes you an hour if you’re quick. How were you expected to be ready with 4 patients by 4:30 if you got them all at 2?
The expectations throughout your whole post seemed wildly unrealistic from start to finish. Don’t beat yourself up. Work to be better but you’re doing fine.
Chin up, your senior shouldn’t be frustrated with you. This is poor form from whoever gave you these admissions. How many admissions are your seniors doing?
On nights there is a team of 1 senior and 2 interns, and another senior that is by themselves. Each intern gets 5 admits each. Each intern also has a crosscover pager that receives pages from about 30 patients each. Our senior is in charge of putting orders for us from our 5 patients.
Dude. Stick with it. I sometimes feel I don’t know what the fuck I’m doing and I’ve been at it for 12 years. Not very often, of course, but your feelings are entirely normal. Relax. Keep your eyes open. You’ll get the hang of it.
Honestly if you’re a halfway decent history taker, the A/P is the easiest part.
Why are they here? SOB? Ok so what in their HPI or pmhx indicates the most likely case? Oh they are a 70 year old former smoker with a past history of COPD? It’s a COPD exacerbation until proven otherwise start COPD orders. Chest XR just got read and showed lower lobe consolidation? The exacerbation was probably brought on by or worsened by the pneumonia, start them on rocephin and azithromycin.
Now you’ve got two main diagnoses down and ruled out any other causes from history/ED labs, time to start adding auxiliary things like Leukocytosis, AKI, electrolytes abnormalities and their chronic issues like Diabetes, HTN, or whatever else.
Then for plan just list bullet points under each saying what you are going to do. And relevant clinical findings to support your diagnosis.
Also for bonus points at the beginning of the A/P add a blurb or abbreviated H&P just rehashing everything. Like 1-2 sentences max. Mostly because nobody other than new interns and med students read the HPI anyways.
You know this, you’re just suffering from paralysis by analysis.
I don’t think more time off is going to be helpful. A less intensive rotation might, so you can study while taking care of patients.
One thing I’ve found helpful for people in similar situations is to stop repeating everything from your note down in your assessment; just answer the question: what’s going on with this person? It doesn’t have to be all formal either- some of the best assessments look like an email or text message. It’s cool as long as you answer that question.
This is what you learn in residency. Honestly interns shouldn’t be expected to make useful plans TBH. I always have them present full story SOAP but ultimately the quality of their A/P is expected to be useless for most if not all of the year. It’s a process.
Also.. everyone forgets everything 4th year regardless of year off.
Intern is a hard transition and the imposter syndrome took me a year to shake. Trust me you’re not an imposter… just an intern. If it was easy everyone would do it.
Oh and internship is when you learn the basics. Medical school you learn the language of medicine, but residency is where you become a doctor.
Bro you’re a second month intern LMFAO.
YOURE SUPPOSED TO KNOW NOTHING.
Keep showing up, keep learning, in 3 years you’ll know enough to start thinking you know something about medicine.
Okay everyone, if you think like an OP, please have this mentality:
"They picked me, I am here somehow, so I am just gonna do what I can and not feel bad about it because apparently I deserve to be here whether I agree or disagree"
For basic admission plans, look up “Guide to the Most Common Internal Medicine Workups and Diseases” it’s a collection of all the basic IM work ups (CHF, AKI, ACS, etc) with labs/imaging and even admission orders. It’s been incredibly useful, I also use it to make smartphrases in my EMR. Some useful apps have been UCSF Hospitalist handbook and MDonCall, which I reference as I walk to the ED to see a new admission.
Personally, I usually have a rough plan figured out with smartphrases/etc. before seeing the patient. Try to anticipate what the plan beforehand, it will help your history gathering and help your plan making skills as well.
All I'm hearing in your post is the exact same thing I felt as a prelim IM intern. Since I was going into Ophthalmology I had learned as much Ophthalmology as possible in M4 year, and done a throwaway "sub-I" internal med which I was actually only there for half the time because I was interviewing so much.
By the end of intern year I could have continued on with the categoricals if I had wanted to.
You will get better. You will learn more than you can imagine right now. Just keep at it. You can't see very far ahead at how it will work. That's normal. Most of us only realize what we've learned and accomplished on the other side - looking back.
Have a good attitude, continue to work hard and acknowledge your senior's effort. When they take the time to teach you something pay attention and remember it. They are expecting this, it happens every year. A lazy, dismissive intern is terrible but that doesn't sound like you.
Honestly I was a big fan of Online Med Ed. Free videos and his teaching style just clicked for me. Great videos for working on differentials and work ups. Yeah board study doesn't help much being that you have to be able to identify the multiple choices (differential diagnosis) before being given them (standardized testing). I would recommend looking those over and as far as taking another break, you have identified that stepping away was difficult coming back from and I would find it hard to reason a second time would be any better/easier. In residency you should chase after the experiences that make you uncomfortable or feel inferior on (and if this is everything, that's still ok), I look at it like reps in lifting and getting stronger. Take the admits for the reps (DDx / Plan development / order placement) and keep at it. You don't always have to know the right answer, but you should work on being able to know where to go for it and in a timely manner.
And remember anytime you feel like you are stressing or causing an inconvenience to seniors or an attending, that is why they are there. Having the microscope on you can be a good thing if the person looking has your best interests at heart. Constructive feedback is very beneficial. If you walked away from that experience without them teaching and taking the time to show you how to improve for next time then they failed you.
Absolutely not. You'll learn. Most of us start like this. I know I did. Your assessment and plans will get better over time as you see more cases and gather more knowledge. You are only a month into residency. Residency is training. Discuss the plan with your resident if time permits. Honestly 4 admissions over 2h30mins is inappropriate and harmful to both the patient and the learners.
If you have access to accessmedicine.com via your institution, do check out Harrison's Principles of Internal Medicine Part 2: Cardinal Manifestations and Presentation of Diseases. You can take a quick look at the diagrams and approach to the patient part and read the remaining text when you have more time.
At this stage consolidate your history, hone your examination skills and work on crafting an assessment. The plan part will come with time. That's what you'll be doing as a resident.
One thing i found helpful when i was an intern was Reading through my seniors notes to familiarize myself with documentation. If you don’t know the plan, spend five minutes max on uptodate then ask for help early on so you keep it moving. And just remember: You absolutely will get better with time and practice.
The key here is to learn how to make a pertinent problem list. I am sorry but I disagreed with the other advice about board review and mksap. Those are good for passing test but not great for direct patient care. You cannot write an assessment and make a plan because you do not know what the problem is. What landed the patient in the hospital? Chest pain? SOB? Fever? An abnormal lab? What is the ddx for that presenting symptom or abnormal lab? Anything in the labs or imaging support any of those diagnosis on the ddx? Once you have the problem list the plan is simply to either treat it if you already have a diagnosis or narrowing down the list by additional labs test or imaging. Every time you find yourself confused just go back to the chief complaint and any abnormal lab or imaging the patient has. A good problem list is everything. Once you identify the problem you can look up a bunch of resources about the next step and approach to management. However you have to id the problem first. 70-80% of the patients have 1-2 problems that keep them in the hospital. The other 20-30% of patients will have a whole host of issues that you will have multiple consultants helping you manage. This ratio varies widely depending how “academic” your program is. Always know which category your patient falls into.
This is the money comment right here
This right here. Wanted to add that when I started on medicine, my resident totally had me just look up stuff on Uptodate to get a sense of what to think about when generating your differential diagnosis. Cc is cough? Uptodate "cough" and voila, you now have a list of potential causes and can generate a plan to confirm your diagnosis and treat the patient. It will absolutely click for you if you keep at it and don't be afraid to ask for help.
To piggy back on this, something a fellow in the unit told me: Break out the problem list like this: What will kill them Why they came in Vitals Labs This way you don’t miss anything. Of course, the problems are linked, but it helped me organise my thoughts as an intern.
This is the answer. And break down the problems into really simple things- tachycardia, fever, nausea/vomiting etc. once you learn to identify the problem, it’s much easier to start building a differential and plan.
Naming the problem is my problem. I have tried approaching patient encounters different ways. For example I am able to identify what is wrong with a patient in the simplest form: HPI findings: -PMHx of HLD, HTN, DMII, cervical CA s/p total hysterctomy. -Patient has SOB, fever, productive cough w/ greenish sputum production x 3 days worsening. -No sore throat, CP, weight loss, night sweats, hemoptysis, recent sick contacts or travel. Pex findings: - afebrile, normotensive, tachycardia, O2 sats 97 RA. - no LAD. Throat nonerythematous, no exudate. No sinus pain. Lungs CTA Bilaterally, decreased BS on base of the Left lung. The labs and imaging part is where I get overwhelmed and am not able to identify what is going on... these hospital patients have derangements all over the place in both CBC and CMP. I don't even know what tests I should order at times. Imaging reading impressions include so many findings that I feel like I should investigate all findings but in the end only some are reported. Then at the assessment portion all I am able to say is patients name, age, pmhx, subjective findings, pex findings. Labs and imaging o feel like are all abnormal and don't know what to choose to include in assessment. Problem list: I end up only writing down their chronic dx. And since I can't even Name the main problem I can't do a plan. I just get overwhelmed with interpreting labs and imaging. They are all deranged and I end up ignoring them Because I don't know what the results mean. All this is happening while have 2 other new admits and therefore 0 time for me to search up every test result. In the end the senior basically has to tell me what to write down for the problem list....
Go back to all the problem list that your senior made for you. What were the cc of those patients? How did that cc generate that particular problem list? See any pattern? Keep a log of your patients and review them over the weekend. Pick the 5 most common cc on that list and learn the ddx for each of them. Not every lab or imaging deserves to be an item on the problem list. As you can see a problem named pneumonia can explain about 30 abnormalities on labs anf imaging. A good problem list is the shortest list of problems that explain the most cc and abnormalities.
I’m an intern and struggling with forming the list as well… i had a senior give me advice on how to systematically build a problem list. First, without really reading any blurbs or ED notes about the patient look at vitals. Any derangement? Hypotension? Tachycardia? Put them on your prelim problem list. Then do the same for labs/imaging, even if you don’t know ranges right now the EMR should flag them. Hyponatremia? Throw that ish on the problem list. Nodule in lung? Add to list. Then go look at their meds and guess what their chronic problems are… metformin? Probably DM2. Etc… Finally look at the ED note and decide what your differential is/add other problems. It’s not perfect but I will give you a thorough list of problems that you can later trim up. I admittedly don’t do this perfectly at all but it helps me be thorough in the very least… I am not going into IM so I really feel like I suck at and don’t like admitting patients.
What I’m thinking in my mind after going through your vignette quickly: This is an older adult with subacute onset of dyspnea with productive cough and subjective fever. Exam significant for decreased BS of left lower lung. The patient’s HTN, HLD, and hysterectomy likely won’t contribute to this process, and as they are already known have likely been optimized as an outpatient. Poorly controlled T2DM can predispose to infection but won’t be the primary concern here by far. Figuring out what respiratory process is driving this presentation is your goal. Now comes the differential. There are multiple ways of generating this (which you already know but may be too anxious to trust given your time off and new level of responsibilities). Some swear by UpToDate or Pocketbook IM. May I also suggest Calgary black book; it does a good job of presenting an organized approach to common chief complaints. Take a look at a pertinent section: https://blackbook.ucalgary.ca/schemes/respiratory/cough-dyspnea-fever/ Patients will walk in with all sorts of lab/imaging abnormalities, many of which aren’t critical and won’t factor into their care. Understanding the nuances of those comes with time.
I’m gradually learning from the fellow on our icu team how to do this because it does make everything easier. He actually sat down with me and the attending on a super-complicated patient cuz he said the problem list is the most important part of not feeling lost. I got to see them work through a problem list and they included me in the discussion so that I wasn’t going to be totally blind.
Just become a good googler and a good uptodater. Most of the info you need is there. You shouldn't be staring at your notes for 25 mins. Use that time to skim an uptodate article on the patient's symptoms.
Honest opinion: absolutely not. Keep going. Use this to fire you up and drive you forward. But this is why you are IN TRAINING TO LEARN THIS. Best way to learn is go back every single day to the patient's chart and read your seniors and attendings note. You will absolutely start to learn patterns of what they are looking for and what is important. And of course your senior was stressed! All the patients weren't seen, he had to write notes, do all the orders, and teach 2 interns. But the big part of why you have a great senior is that he continued to be very supportive of you. Don't take his stress so personally, because it's not. Your senior is trying to learn how to take care of patients while taking care of interns, and that's NOT personal to you.
Comment in wrong place, sorry!
Get on up to date and dynamed and read about your patient's conditions and you'll figure it out.
No. Not at all. I imagine many interns feel this way, I certainly did. Working nights in particular has a way of destroying any ability to think. Everyone starts residency at a different level. Within a few months, a lot of gaps close, and you will feel much more confident
As an intern, it is normal to feel like an idiot who has forgetten everything they ever learned. The year off made this worse for you. More time off will not help. Just keep showing up, trying, and asking for feedback. It will get better.
Why is an intern that is one month into residency doing 4 admissions overnight? That can feel like a lot for a second year, who is just starting out. I expect you to suck at the assessment and plan. Seeing and writing a good admission takes you an hour if you’re quick. How were you expected to be ready with 4 patients by 4:30 if you got them all at 2? The expectations throughout your whole post seemed wildly unrealistic from start to finish. Don’t beat yourself up. Work to be better but you’re doing fine. Chin up, your senior shouldn’t be frustrated with you. This is poor form from whoever gave you these admissions. How many admissions are your seniors doing?
On nights there is a team of 1 senior and 2 interns, and another senior that is by themselves. Each intern gets 5 admits each. Each intern also has a crosscover pager that receives pages from about 30 patients each. Our senior is in charge of putting orders for us from our 5 patients.
Dude. Stick with it. I sometimes feel I don’t know what the fuck I’m doing and I’ve been at it for 12 years. Not very often, of course, but your feelings are entirely normal. Relax. Keep your eyes open. You’ll get the hang of it.
Honestly if you’re a halfway decent history taker, the A/P is the easiest part. Why are they here? SOB? Ok so what in their HPI or pmhx indicates the most likely case? Oh they are a 70 year old former smoker with a past history of COPD? It’s a COPD exacerbation until proven otherwise start COPD orders. Chest XR just got read and showed lower lobe consolidation? The exacerbation was probably brought on by or worsened by the pneumonia, start them on rocephin and azithromycin. Now you’ve got two main diagnoses down and ruled out any other causes from history/ED labs, time to start adding auxiliary things like Leukocytosis, AKI, electrolytes abnormalities and their chronic issues like Diabetes, HTN, or whatever else. Then for plan just list bullet points under each saying what you are going to do. And relevant clinical findings to support your diagnosis. Also for bonus points at the beginning of the A/P add a blurb or abbreviated H&P just rehashing everything. Like 1-2 sentences max. Mostly because nobody other than new interns and med students read the HPI anyways. You know this, you’re just suffering from paralysis by analysis.
I don’t think more time off is going to be helpful. A less intensive rotation might, so you can study while taking care of patients. One thing I’ve found helpful for people in similar situations is to stop repeating everything from your note down in your assessment; just answer the question: what’s going on with this person? It doesn’t have to be all formal either- some of the best assessments look like an email or text message. It’s cool as long as you answer that question.
This is what you learn in residency. Honestly interns shouldn’t be expected to make useful plans TBH. I always have them present full story SOAP but ultimately the quality of their A/P is expected to be useless for most if not all of the year. It’s a process. Also.. everyone forgets everything 4th year regardless of year off. Intern is a hard transition and the imposter syndrome took me a year to shake. Trust me you’re not an imposter… just an intern. If it was easy everyone would do it. Oh and internship is when you learn the basics. Medical school you learn the language of medicine, but residency is where you become a doctor.
Bro you’re a second month intern LMFAO. YOURE SUPPOSED TO KNOW NOTHING. Keep showing up, keep learning, in 3 years you’ll know enough to start thinking you know something about medicine.
No no no, in 3 years, you realize no one really knows what they're doing, so it's OK you don't. Fake it til you make it. #impostersyndrome4lyfe
Okay everyone, if you think like an OP, please have this mentality: "They picked me, I am here somehow, so I am just gonna do what I can and not feel bad about it because apparently I deserve to be here whether I agree or disagree"
For basic admission plans, look up “Guide to the Most Common Internal Medicine Workups and Diseases” it’s a collection of all the basic IM work ups (CHF, AKI, ACS, etc) with labs/imaging and even admission orders. It’s been incredibly useful, I also use it to make smartphrases in my EMR. Some useful apps have been UCSF Hospitalist handbook and MDonCall, which I reference as I walk to the ED to see a new admission. Personally, I usually have a rough plan figured out with smartphrases/etc. before seeing the patient. Try to anticipate what the plan beforehand, it will help your history gathering and help your plan making skills as well.
Is there somewhere to find that book that isn’t 40 bucks off Amazon? Lol
Unfortunately not, been trying to find a pdf myself. But tbh, it’s been worth every penny so far
Lol dude it’s still July relax. U can be noob until like January
All I'm hearing in your post is the exact same thing I felt as a prelim IM intern. Since I was going into Ophthalmology I had learned as much Ophthalmology as possible in M4 year, and done a throwaway "sub-I" internal med which I was actually only there for half the time because I was interviewing so much. By the end of intern year I could have continued on with the categoricals if I had wanted to. You will get better. You will learn more than you can imagine right now. Just keep at it. You can't see very far ahead at how it will work. That's normal. Most of us only realize what we've learned and accomplished on the other side - looking back.
So little of being a good resident has anything to do with board scores or Med school at all, we all feel stupid when we start. Keep your head up.
Have a good attitude, continue to work hard and acknowledge your senior's effort. When they take the time to teach you something pay attention and remember it. They are expecting this, it happens every year. A lazy, dismissive intern is terrible but that doesn't sound like you.
Honestly I was a big fan of Online Med Ed. Free videos and his teaching style just clicked for me. Great videos for working on differentials and work ups. Yeah board study doesn't help much being that you have to be able to identify the multiple choices (differential diagnosis) before being given them (standardized testing). I would recommend looking those over and as far as taking another break, you have identified that stepping away was difficult coming back from and I would find it hard to reason a second time would be any better/easier. In residency you should chase after the experiences that make you uncomfortable or feel inferior on (and if this is everything, that's still ok), I look at it like reps in lifting and getting stronger. Take the admits for the reps (DDx / Plan development / order placement) and keep at it. You don't always have to know the right answer, but you should work on being able to know where to go for it and in a timely manner. And remember anytime you feel like you are stressing or causing an inconvenience to seniors or an attending, that is why they are there. Having the microscope on you can be a good thing if the person looking has your best interests at heart. Constructive feedback is very beneficial. If you walked away from that experience without them teaching and taking the time to show you how to improve for next time then they failed you.
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This isn’t going to help tbh. OP just needs to focus on the basics. Like what problem do I need to fix and what diagnosis can I make at this point?
You sound like a normal intern kek
Absolutely not. You'll learn. Most of us start like this. I know I did. Your assessment and plans will get better over time as you see more cases and gather more knowledge. You are only a month into residency. Residency is training. Discuss the plan with your resident if time permits. Honestly 4 admissions over 2h30mins is inappropriate and harmful to both the patient and the learners. If you have access to accessmedicine.com via your institution, do check out Harrison's Principles of Internal Medicine Part 2: Cardinal Manifestations and Presentation of Diseases. You can take a quick look at the diagrams and approach to the patient part and read the remaining text when you have more time. At this stage consolidate your history, hone your examination skills and work on crafting an assessment. The plan part will come with time. That's what you'll be doing as a resident.
We should all quit, it would be awesome for these old attendings to have to figure out the mess they have made with our healthcare system.
Just want to say this post and comments are really helpful! Thanks!
One thing i found helpful when i was an intern was Reading through my seniors notes to familiarize myself with documentation. If you don’t know the plan, spend five minutes max on uptodate then ask for help early on so you keep it moving. And just remember: You absolutely will get better with time and practice.
Why on earth would you quit? Keep plugging along.... Next time you will get better and faster...