clinical rotations Not Feeling Confident

[Detroiterpa93]

Hello there,

This is my first time writing on the PA forum. I’ve been having really bad anxiety since the start of rotations and need some words of wisdom.

I have been a very good student all my life. I maintained above a 3.5 GPA throughout my undergrad and I received As and Bs in all my classes though out my didactic year of PA school. I have passed all my EOREs and received good evaluations from my preceptors for the rotations I had so far,  but I feel like I forget everything I learned from my previous rotations and didactic year, thus, I feel dumb and I feel like a fraud.  I am currently on my 5th rotation (which is Cardiology) and I am still not feeling confident in myself and feel like I am no where close to being the PA I want to be.

I grew up having ADHD and have taken various medication since I was young, but I feel like my medication no longer works because my anxiety is so bad that I can’t study during my down time. Also, my anxiety is affecting the way I think, communicate with peers and patients, and even sleep. I take medication for anxiety, but I do not want to increase the dose until I get my sleep problems taken care of.  I feel like I should take a step back and take care of my own health first, but I am so close to graduating and I don’t know what to do. I don’t want to start my career feeling burnt out and not getting nights of sleep because of feeling incompetent. Just looking for some advice.

Thank you!

Edited October 20, 2019 by Detroiterpa93

[deltawave]

You are feeling like every PA student... with a little extra anxiety which seems to be recurrent. Remember that clinical rotations are designed for exposure not mastery. You will not become an expert cardiologist or orthopod or whatever in one clinical rotation, and that does not make you incompetent. A healthy fear of not knowing everything is a good thing, and knowing your limitations is a benefit to you, your patients, and your immediate team. 

Push through and manage your anxiety as best you can, and if that means med adjustments I would advise that. You're close to the next bench mark, as there is no finish line- you will be a lifelong learner. Graduate no matter what. 

Edited October 31, 2019 by deltawave

[macyonthewaytoPA]

It's pretty normal to not feel 100% confident. Keep in mind that your preceptor doesn't expect you to know everything, but they expect you to ask questions and be a good student. Anytime I don't know something I'll write it down and look it up when I get off. I don't want to get caught not knowing it next time around. 

As far as the anxiety goes, I used to get so anxious that I would get nauseous. One thing that helped was I started challenging my bad thoughts. Anytime I would have an irrational thought like “I’m going to bomb” I would remind myself “I am not going to bomb. I’m just nervous. I’m prepared and I cant expect everything to be perfect, some things will go well and some wont. That's ok.” If you remember to shut down those thoughts eventually you will automatically do it. 

[ohiovolffemtp]

As others have said, a ~ 1 month rotation is an exposure to an area, no where enough time to achieve comfort, much less mastery.  I recall that I had a series of cycles that began with total fear to some slight comfort with the simple routine tasks of each part of medicine.  Remember, every rotation you're learning a new culture, facility, personalities, as well as the medicine.  How long did it take you to learn your way around the facility, where the restrooms and food sources were, etc?  Your level of fear is good - it shows you appreciate the significance of each part of medicine and the risks of doing it wrong.

Think about how long physician residencies are, with the shortest being 3 years.  That's the standard to become a solid beginner in medicine.  Please prepare yourself: it will probably take at least that long practicing in an area to feel confident.

So, push through it now.  Please do your best to find a first job that's a good learning environment.  I didn't do a residency, due to needing to get back to my family.  My first FT EM job was that good learning environment - and I still had many days of doubt, days of being yelled at by consultants (mostly because I didn't yet know how to do a good enough job - some because they weren't good people).  At about the 3 year mark I began to hit the flattening of the learning curve.  All of this, plus extra outside learning, paid off.  I now have a very autonomous EM job at a critical access hospital.