Wednesday, July 13, 2011

Mixed Feelings

Today was a day full of mixed feelings.
I got my Step 1 USMLE Board Exam score. I passed . . . but I didn't do nearly as well as I was hoping or expecting. In fact, I did almost 20 points worse than estimated. T.T I really have no choice but to accept my score because once you pass this exam, you can't re-take it. I did solidly below average for all medical specialties, even pediatrics and internal medicine.

For a few hours I had some serious doubts about my aptitude and ability to just know/remember medical knowledge. I had doubts on whether or not I really "belong" here. Then I remind myself that it's just one test, just one number. I have chances to redeem myself on my residency application in a couple years - I've already done a lot my first two years, I've held quite a number of leadership positions, I'll have an MPH behind my name as well. All I need to do now is obtain amazing letters of rec and rock Step 2 next summer . . .

It's not over quite yet. I may still have a shot at a top 10-15 pediatric residency spot (I just have to work even harder for it)!!
And for the past couple days I've been taking care of a patient who's been getting increasingly agitated. Last night he refused all medical treatment. When I read this in the nurses' progress notes I went to his room to talk to him. I explained to him why he's here, what we're trying to do, that his meds are working, etc. He didn't believe me. So I asked him what he thought his problems were and how we could better help him. I wanted his perspective of his health. But he snapped back that "I'm not the doctor! Don't ask me! I don't care about no perspective."

I reported all of this to my attending, who then went with me to see the patient again. He was judged "decisional" and he just wanted to go home. He left a few hours later AMA (against medical advice). In a way it felt like a "loss" because there was nothing I/we could do to improve his medical problem, because we can't force care upon someone who doesn't want it and is competent to make his/her own decisions.

Later I recounted this to my pharmacist friend, and here's a snippet of our convo that followed:

Her: "Awww. But wow, [Aek], I am seriously impressed. You're going to make an awesome doctor."
Me: "Lol, impressed by what?"
Her: "I've seen attendings handle difficult patients like that. But not residents. And definitely not med students."
Me: "But isn't that what we're supposed to do? . . . Like, that's part of the job description, lol, to talk to patients and see what's going on."
Her: "Yes, lol."
Me: "And try to help."
Her: "But you seem to have said all the right things. Even though they didn't work. Some people are better at it than others."

I'm glad that she has faith in me. I'm glad that my attending seems to be giving me some positive encouragement/feedback, even when I feel like a dumbass some days when I can't answer her questions as satisfactorily as I think she would like. All I can do is try my best and do what's best for my patients. Knowledge isn't everything, but knowing how to find and utilize knowledge is. Perhaps there is hope.


Anonymous said...

Congrats on passing, don't doubt yourself because the first two years is all about cramming which is not the best way to encode a long term memory. I have often wondered who are all these students scoring above average on these standardized tests and I thought their course work must be structured better than mine. For Step 2 CK and CS start working practice questions now, especially for medicine it is so broad.

From what you have said regarding your interactions with attendings today and in the past, I think you are making good impressions and will get good recs, it is about having a little knowledge and a high social IQ, in other words politics. See if you can get to know the residency coordinator at your school, they know coordinators at other schools if you want to go elsewhere, and will sometimes make a personal call for you. Pretend that you want to do whatever specialty your rotating through when asked by residents and attendings, I am convinced it helps your evaluations. The attendings base part of their eval on what your residents say as I am sure you know, so don't let your guard down and tell a surgery resident how much you hate surgery or even how much you like peds.

B said...

Good job staying positive in the face of the disappointing Step 1 score. As you said, it's only one factor, and it seems like you have a great attitude and bedside manner which I'm sure must count for a lot.

the island guy said...

You inspire me :)

I read something in my psychology book during my freshmen year in college and I hope you find it enlightening.

"Successful performance in a career and in life requires much more than the skills, abilities, and traits measured by standardized tests. While the best tests perform the valuable function of predicting how well people will do on the average, there may be decisional error for any given individual. People can override the pessimistic predictions of their test scores when ambition, imagination, hope, personal pride, and intense effort empower their performance. Perhaps it is vital to know when you should believe more in yourself than in the results of a test"
-Phil Zimbardo

Anonymous said...

Its going to take several more years of training before you feel comfortable practicing medicine. I think you will see, that so much of the field is learned by your personal reading agenda and observation. Several articles have been written about how there is less actual teaching from attendings now days. You will constantly be asked questions you have no way of knowing. My first day of surgery rotation, I was asked how much margin to remove in resceting colon cancer.

Aek said...

Anon 1: Thankfully I know the peds clerkship director and peds residency director pretty well. I'll definitely ask them for advice when I begin my peds rotation (in Nov. and Dec.) or maybe sooner.

B: Thanks!

the island guy: That's a nice quote. I'm glad I inspire you, though I'm not sure that I'm particularly inspirational, lol.

Anon 2: We actually have quite a bit of formal teaching by attendings, but they're usually not by the attendings that're grading us.

Steve said...

Let this be a reminder to you that you seriously kick ass.