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New Grad Starting First Job...Imposter Syndrome in Full Force

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Hi All!

First and foremost, I appreciate any and all feedback. I am a December 2019 graduate and am starting my first PA job this week (amongst the COVID crisis...perfect timing...) 

I have, for as long as I can remember, struggled with feeling like I don't belong, am not good enough, am not smart enough, etc. and this has transformed into anxiety about being an inadequate provider. I am extremely excited to start caring for patients and I have the desire to learn as much as I possibly can, but I constantly have this nagging thought at the back of my head telling me that I am going to fail. That I'll hurt people due to lack of knowledge. That my attending and peers will think I'm dumb or that I'm not catching on quick enough. 

For those of you who have been practicing for a while, or even if you're a new grad who has found ways to deal with this - please help! I need some reassurance that my fellow PAs have not only felt this way, but found ways to overcome it. Thanks again!

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Let me try to help you look at this another way. I was never short on confidence and was pretty sure I had it all figured out. Now I look back on some of the things I thought and did and wonder that I didn't kill someone.

The first thing I used to tell a student was you have to know what you don't know. More accurately you have to know when you don't know.

You fail when your hubris or arrogance gets someone hurt. Having solid awareness of your skills and knowledge will let you know when you need to read, study, consult or refer. I have been at this for more than 30 years and I probably look stuff up and ask my colleagues opinions more often now than I did as a new grad.

You got this far and you didn't do that without having something on the ball. You'll be fine as long as what is best for the patient drives what you do and how you do it.

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8 minutes ago, sas5814 said:

Let me try to help you look at this another way. I was never short on confidence and was pretty sure I had it all figured out. Now I look back on some of the things I thought and did and wonder that I didn't kill someone.

The first thing I used to tell a student was you have to know what you don't know. More accurately you have to know when you don't know.

You fail when your hubris or arrogance gets someone hurt. Having solid awareness of your skills and knowledge will let you know when you need to read, study, consult or refer. I have been at this for more than 30 years and I probably look stuff up and ask my colleagues opinions more often now than I did as a new grad.

You got this far and you didn't do that without having something on the ball. You'll be fine as long as what is best for the patient drives what you do and how you do it.

yes, this. I know I am good at what I do, but if there is someone better around to do a particular task I let them do it and I watch and learn. I haven't intubated a lot of little kids , so if a CRNA is in the dept for a pediatric code I let them do it. If not I step up.

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Physicians go through a residency that is a minimum of 3 years, many more.  Specialist and sub-specialists do fellowships after those residencies.  Except for a few PA's, we don't do any sort of residency and instead learn from our 1st job.  Believe me PGY-1 docs haven't a clue until late in their 1st year, and don't get good until nearing the end of their residency.  So, everything you're feeling is good and contributes to your and your patients' safety.  Work hard, learn all you can - and give yourself at least 3 years to learn your trade.

The only difference between those of us who have practiced awhile and you is the number of patients we've treated.  Don't make your goal to be independent or right all (or most of the time).  Make your goal to learn as much as you can along the way.  Start looking back after 3 years and see how much better you feel.

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2 hours ago, PASav said:

Hi All!

First and foremost, I appreciate any and all feedback. I am a December 2019 graduate and am starting my first PA job this week (amongst the COVID crisis...perfect timing...) 

I have, for as long as I can remember, struggled with feeling like I don't belong, am not good enough, am not smart enough, etc. and this has transformed into anxiety about being an inadequate provider. I am extremely excited to start caring for patients and I have the desire to learn as much as I possibly can, but I constantly have this nagging thought at the back of my head telling me that I am going to fail. That I'll hurt people due to lack of knowledge. That my attending and peers will think I'm dumb or that I'm not catching on quick enough. 

For those of you who have been practicing for a while, or even if you're a new grad who has found ways to deal with this - please help! I need some reassurance that my fellow PAs have not only felt this way, but found ways to overcome it. Thanks again!

Great insight in the above posts. 

I think what you're feeling is pretty normal, especially for someone without significant prior HCE. I was nervous as all hell that I'd kill somebody, but that was just mainly newbie nerves. In reality, you got to where you are for many reasons, so continue to do your best, learn everything you can, and if you are unsure and need to run it by someone, do it! The worst is not knowing what you don't know, as Sas said above, so figure out what you don't know and change that.

At my first job, I had a supportive SP/mentor who made themselves readily available, so I was able to build my confidence while still receiving support/guidance when needed. But I also looked stuff up constantly which helped reinforce things. If you do inpatient work, nurses, scrub techs, MAs, physicians, other PAs, RTs, and other personnel can be incredible resources, so be a sponge! Your learning doesn't stop at graduation so utilize this time to really develop your skills and knowledge while building confidence in your own medical decision making.

It also helps to know that even seasoned providers don't know everything. After all, we're all just people with various sets of experience trying our best to do what's right. (Or at least I hope most are trying to do their best and not doing it for the wrong reasons...But I digress.) Hell, I just switched fields and I'm having to learn everything over again which is nerve-wracking but exciting to continue to challenge myself.

Good luck to you. 

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The only way out is through.

It'll all be OK in the end; if it's not OK, it must not be the end.

Keep on digging through that manure pile... there's gotta be a pony at the bottom of it!

No mud, no lotus.

Sent from my SM-G973U using Tapatalk

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One of my instructors once said "Fake it until you make it." That's how I survived my first year after graduation. 

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