The Imposter Syndrome Project is meant to demystify and normalize the many stressors involved in medical school. We have highlighted the struggles and mental health issues surrounding Step 1 previously and now we would like to turn our attention to clerkship rotations! Below are excerpts from your fellow students who so willingly told their vulnerable stories and pieces of advice during this time. Hopefully these can be a collective of thoughts and experiences that unite us and where we can find solitude.
“I often felt I wasn’t doing as well as I expected. I think it was hard for me to understand what a good or stellar performance looks like. Rarely do you work side by side with another medical student to gauge your level of performance. I sometimes felt isolated when I was doing rotations outside of my foundation site. It helped to call family and friends. Playing online games was a great way to connect with friends during the covid quarantine.
I dealt with a lot of anxiety about performance, grade, and my concern of other’s perception of me. I never took any medication because I did not think my anxiety was severe enough to warrant treatment. But, talking with others really helped work out my emotions and helped break me out of any negative thought pattern I had. I personally struggled with the feeling of discrimination because of my race, but I could never prove it. I also struggled with being overly concerned with grades. We have to care about our grades because it will play a huge part in our future.
You may think that choosing the best specialty or choosing the best residency will be one of the most important decisions in your life. It can be true, but at the same time in the large scheme of things, it won’t. There will be many specialties that probably are a good fit for you. The future of medical specialties surprisingly change often as well. Everything will be okay. I wish I made more time for friends. Career is important, but so is building memories outside of a textbook.
Focus your energy on how to adapt to the uncertainty of life rather than trying to control every aspect of it.
I wish I knew going into clerkships that: Clerkship grades – bullsh*t. Residency application – bullsh*t. The entire system can seem like there is no rhyme or reason. The only thing that truly matters is what you can learn and how you can help your patient. If you can do those two things, and not worry about anything else, you’ve done an excellent job.”
“Overall, my third year went better than expected. I truly feel that the vast majority of the people I worked with were passionate about their work, excited to teach medical students, and genuinely cared about their patients. But honestly, I felt pretty inadequate about 70% of the time. I would forget things that I had definitely known just a day prior, my alarm once went off (VERY loudly) during a C-section that I was scrubbed into, I dropped a tampon on the OR floor and contaminated myself trying to very sneakily pick it up, got pimped by a surgery attending and got all 11 questions wrong in a row, and just overall felt like I was so behind my classmates. Looking back, I wish I had been more open about what I didn’t know and just accepted that that’s where I was at. I still feel like I know way too little so often and I am trying to embrace that I am here to learn and that everyone who is teaching me was once in my shoes. I have also learned to take “harsh” feedback less personally; I now just try to take whatever will help me become a better doctor, do my best to implement that, and leave the rest be. When somebody gives me critical feedback, it is not them making a judgment on my character – even those who come across as a bit abrasive often really do just want to help me do better. Know that EVERY single student, resident, and attending have plenty of stories where they didn’t know something or made a mistake – some are just more open about it than others. And if nothing else, mishaps as a med student make for great stories as an attending.”
“My first clerkship was a really difficult learning environment. My attending was very demanding, and he often made me feel stupid by off-hand comments he made. He also talked poorly about nurses and other medical staff, which made me wonder what he said about me to others. It was hard on me emotionally, but I just dealt with it and tried my best to meet his unrealistic expectations. It ended up working out as far as my grade goes, but that didn’t make how I was treated ok. On the survey after the clerkship, I mentioned what had happened, but because it was my first clerkship, I assumed that was how it was as a medical student and I needed to deal with it.
After completing the rest of my third year, I have come to see that my thinking that this was somehow the norm was absolutely false! We may be at the bottom of the totem pole, and we may feel uncomfortable or be pimped for answers or not click with an attending, but no one should have to be intimidated or treated disrespectfully like this. Reach out to the clerkship director, your clinical dean, Student Affairs (Melinda Frank is really great!), or a host of other people who can help you. That’s how things get changed and how you can prevent future students from having to go through similar experiences.
That being said, I have had great experiences with the majority of my attendings. They get where you are in your clinical training and have realistic expectations. They are kind and helpful. Take their feedback and you will grow more than you ever thought possible.”
Also, take care of yourself – self-care will keep you healthy and allow you to better care for patients and retain the information you learn.
“Pick a few of your most valued hobbies and keep them up. You will be busy, tired, and you will always feel like there is more to learn. But as the adage goes, you can’t pour from an empty cup. You need to maintain your own passions outside of the hospital to allow you to recharge. Squeeze it in wherever you have open time- whatever it is you need to do to feel like you’re maintaining yourself. Being on clerkships alone is sometimes like being newly single – it can be isolating, and you might not notice until you’re feeling pretty alone. So whoever you like to talk to when you need to decompress, get in the habit of calling those people early. Treat every clerkship like it’s the only education you’re ever going to get on that subject. Get comfortable with being uncomfortable. You will often feel like you don’t know enough, aren’t prepared for the next leg of your training, and that’s okay! Trust that you have made it this far because you are, in fact, learning at the appropriate pace, and that you will continue to learn what you need along the way. Maintain that humility even as you accumulate knowledge, because it will always serve you well.”
“Prioritize sleep, especially on surgery and OBGYN where you need to be physically alert. You have 2 years of studying under your belt and there is a lot of knowledge in your brain already. You can stay up an extra 2 hours cramming anatomy review or you can let your brain rest and show up mentally and physically ready to help in the OR. Also take advantage of hanging out with the patient in pre op. It’s another chance where you can do a quick anatomy review to prep for OR pimping.”
“Inspired by how difficult 3rd year was for me, I created a module called “Grief and The Healing Power of Poetry”, which helps students process the grief that naturally comes with our profession through the exploration of poetry. This online module is under the Humanities and the Arts Pathway, but is available for ALL medical students to take and access if they need it and are interested. I encourage students who are struggling to look it over and see if it helps them with their grief and healing.”
“Starting clerkships was definitely challenging for me. Leaving the classroom and being surrounded by residents and attendings with far more clinical experience made it difficult to gauge the adequacy of my performance. I felt that the grading system also created too much focus on performance, likability, and trying to know everything, instead of letting students acknowledge the process of career-long learning and the slow building of clinical skills through experience.
I also struggled with the subjectivity of the grading system. I felt I gave a consistent performance my 3rd year, and in the end I had a very random mix of pass, HP and honors. What I took away from this is don’t put too much stock in it, diversify your application, and don’t sit up at night stressing about your grade. There are parts of it that you have no control over. For me, shifting my focus from grades toward preparing myself for residency helped to better align my own values and needs as a learner, and made me happier overall. I think my best advice to others in clerkships is to focus on your overall goals and get involved in activities that will help you get there, make time for your own wellness, for friends and family, and know that medicine is only one special part of life. Don’t let it consume all of your time.”
“I nearly always feel that I’m doing less well than expected even when I receive praise or positive feedback from attendings and residents. I got divorced in between 3rd and 4th year during our time off clerkships due to COVID and this has been less than great. Additionally, the nature of 4th year makes it essentially impossible to establish with a mental health counselor due to having to move around constantly. I’m essentially homeless for the next year so it feels silly to even try to find someone to talk to. If I could go back, I would get established with a counselor in preclinical years so that I had something to help me during the clinical years.”
“I started on antidepressants during the summer after my first year of medical school and I feel like this really helped. My grades went up, my motivation went up, and I felt more inclined to socialize with fellow classmates and more excited to talk to patients. Looking back, I wish I had been more open to trying medical management. Up until then I had seen counselors every now and then and discounted my depression to being situational. However, medical school is challenging and life in general is challenging, so I would tell my younger self not to hesitate giving new treatment options a try, even if it were to involve medication.”
“Social isolation during clerkships? You bet ya. I did clerkships in the time of COVID. Many nights I would cry trying to make sense of experiences my non-medical friends would not understand (like not being up to par with my clinical knowledge) and wonder if there were any classmates or mentors I actually trusted enough to share my fears and frustrations with. If there were, I have not met them yet. I wish there were ways I could build community in the town I was living in, but then I couldn’t be socially responsible in my professional and community duty to reduce the spread of COVID. I guess having a cat around helped, but honestly, I don’t think anything helped me cope. I just hope this loneliness doesn’t last my whole career or that I learn there are people in this field that are actually worth trusting.
I remember 3rd year being a time of reckoning with this career unlike the earlier phases. I kept meeting preceptors/faculty who would wildly disappoint me. Some vividly described their hate towards marginalized groups: transgender folks, medicaid recipients, people working through addictions (often assuming I shared these views with them). Some were so inept about talking about racism, they accused students for bringing the topic up. I figured there would be a few bad eggs in this field, like any other stressful job that works with the public. However, I was struck by how often and how many of my faculty members would display their hate, arrogance and white fragility. I stopped thinking that medicine was a noble field and started the work of ignoring the faculty I could not look up to. I could have tried to learn what I could from their good qualities, but it ultimately was not worth the extra work of splitting hairs. I had to teach friends and family that there is nothing honorable about being a doctor if so many can get away with the unchecked behavior my faculty displayed regularly. By attempting to reason with these faculty in 3rd year, I learned that I cannot change the field and I probably cannot make a dent in all the doctors who failed to see humanism and privilege in the work of caring and healing. My determination to finish this program and enter this field took on a new and heavy burden.
Will the joy and appreciation from patients, and the satisfaction of being of service to my community, no matter how slow, be enough to motivate me through this? I hope so, but I’m just not sure.”
RESOURCES
Step 1 Imposter Syndrome
SOM Career Advisors
Wellness Council Facebook Page
Counseling Services: joanneed@uw.edu and ckelly70@uw.edu
Student Affairs
Learning Environment Reporting: Melinda Frank – mfrank@uw.edu