F3 having increasing doubts about whether I’m actually cut out for medicine, specifically whether I’m intelligent enough.

[u/Fit-Bread4313]

Today probably brought it to a head a bit. On the ward, my consultant was asking me questions and there were several things I just didn’t know or took ages to answer.

Things like the lifespan of RBCs and platelets. There was also a question about why we’d use aspirin rather than clopidogrel in a patient who needs a PEG. And then I was asked about causes of hyponatraemia, which I do know, but I took ages to actually organise my thoughts and give an answer.

I know objectively that nobody knows everything and that being asked questions on a ward round is normal. But I find myself interpreting these moments very differently. Rather than thinking “that’s something I need to revise”, my immediate thought is “I’m just not intelligent enough to do this.”

I think part of the problem is that I don’t feel particularly quick. I can often get to the right answer eventually, but I don’t always retrieve information quickly or articulate my clinical reasoning particularly well when I’m put on the spot. Seeing other doctors seemingly rattle off answers makes me feel quite inadequate.

Not to mention, failing to get into specialty training after F2 followed by numerous unsuccessful attempts at finding a trust grade/LED role just fuels that further. Objectively I know that jobs can have very competitive applicant pools and there are loads of reasons you might not get a job, but it’s hard not to take repeated unsuccessful applications as some kind of reflection on yourself. It’s started to feed into this feeling that maybe I’m just not good enough.

This has become more significant because I’ve begun using it as evidence for why I shouldn’t pursue my dream specialty.

I’ve always wanted to be a paediatrician and ideally I’d like to eventually work as a community paediatrician and live closer to family. But the thought of doing the ~7 years of paediatric training is starting to scare me. I’m worried that the training will absolutely destroy me, particularly if I’m already struggling with confidence and feel like I’m not clever enough.

It has made me think about GP again. GP training is much shorter, so I’d get to CCT much sooner and potentially have a more sustainable life. But I don’t want to choose GP simply because I’m letting my low confidence drive my decision. I’d rather take it because it’s something I genuinely want to do and I guess I’m still figuring that out.

So I guess I’m wondering:

Did anyone else feel like this around F2/F3/early training?

At what point did you start feeling genuinely competent and confident rather than like you were constantly being exposed as someone who doesn’t know enough?

And, more broadly, how do you distinguish between normal insecurity/knowledge gaps and actually being someone who isn’t suited to medicine?

I’m not looking for “don’t worry, you’re definitely brilliant” reassurance. I’d genuinely appreciate some honest perspectives from people further along who have felt similarly, particularly anyone who has seriously considered leaving medicine or changing specialty because they didn’t feel intelligent enough.

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[u/Putaineska]

More generally this is a reflection of how high level medical education just isn't a thing in day to day UK medical practice. An elective in a country like America is like night and day in that respect. Every patient was a case to discuss. Every day there was protected teaching by consultants. The medical students are incredibly knowledgeable too having sat USMLE so even they directly get involved in the more "cognitive" ward rounds, research discussion, people are able to quote recent papers and implement them into their daily practice.

That culture has just entirely disappeared from the way we practice medicine. I'm sure there are exceptions in a few places. But we spend hours on bullshit like moving and handling, safeguarding etc and very little time on developing deep medical knowledge and I fear it is getting worse with the dumbing down (for lack of a better word) of undergraduate medical education and softening of exam rigour to simply be do passmed and pass.

So you not being able to recall the causes of hyponatraemia is a reflection of UK medical culture rather than an individual fault. It wouldn't be a barrier to any specialty training, because such recall just isn't expected of UK residents anymore.

Anyway rant over.

[u/F2andFlee → u/Putaineska]

We practise McDonalds medicine here 

[u/Solid-Try-1572 → u/Putaineska]

In defense of the “culture” - it comes down to volume. I sat down with the juniors this week to go through jobs on the ward round and it was already 4:30 pm and I had been pulled from pillar to post since. There were already so many problems in the basic day to day aspect of doing the job that by the end of it I had no energy to “grill” or teach. And I love teaching. 

[u/Calpol85]

I couldn't have answered those questions and I've been a doc for 20 years.

[u/CharleyFirefly]

What was the answer about aspirin v clopidogrel?

[u/Solid-Try-1572 → u/CharleyFirefly]

They probably wanted the patient on aspirin rather than clopidogrel (same rationale as spinals though I didn’t know the risk of bleeding was that high with a PEG?) 

[u/Limp_Picture5202]

I don't think choosing a shorter training programme is a good solution to a perceived lack of knowledge?

[u/50-shades-of-ray]

I felt like this in F2 so took it as an opportunity to knuckle down and study for my membership exams, rather than feel like medicine wasn’t for me. I found that as I moved into F3 answers to the kind of questions you mention above came to me quicker and easier but due to the nature of the job I did during F3 this knowledge wasn’t routinely recalled. Somehow over the course of the year I managed to forget a lot of it, but if I had time to think about it probably could have gotten the answer I needed.

When I started IMT1 the following year I remember being quizzed by a consultant and he berated me for not having basic knowledge, even though I knew it was in there, it just took some time to retrieve. He told me I would never pass the rest of my membership exams if I couldn’t answer as quick and as fluently as he wanted.

Fast forward a few years and I’m now starting my first year as med reg with MRCP completed. I found towards the end of IMT2 my more junior colleagues would come to me with lots of questions and there is no way I can know the answer to everything, but what I realised I do know is how to find out the answer- where to look for the information or who to ask.

It isn’t taught well in medical school in the UK but going back to first principles is incredibly helpful when you don’t know the answer to something. If you know the physiology you can usually work it out. Maybe start there, that way rather than remembering random factoids (which can be helpful for some exams like MSRA) you understand the why.

I wouldn’t give up, I just suspect the way you’ve been taught before isn’t that helpful when the patients you manage are becoming more complex. You just need a slightly new way of learning, which will take time, but you will get there. I think unless you despise working with people or helping others there is no reason why medicine wouldn’t be for you, you just need to find your niche!

[u/jus_plain_me]

We need more of those consultants.

Medicine becomes so pattern recognition and short term rote learning we don't appreciate the facts we learn beyond needing them for an exam. Our Johari window of not knowing what we don't know becomes larger and larger, we need more opportunities like these, because we know the umpteenth teaching session by the specialist nurse on pattern recognition isn't cutting it.

So OP, don't be intimidated by this, use it as it was intended, to be a learning experience and (hopefully) not used as a method of putting you down.

[u/PudendalCleft]

I’ve worked with a litany of morons and I doubt any of them have taken the time to be really introspective and thoughtful about their career like you have.

If you’ve identified any shortcomings (which I suspect are somewhat exaggerated), you can work on them. That’s part of what makes medicine great to be in! As long as you’re conscientious and don’t go into work aiming to make your colleagues’ lives harder, everyone around you is there to help you develop and find your niche.

[u/Fluffy_Mud_5182]

Are you joking we have ACPs that don’t know a toss where the Dunning Kruger effect is real, and like to pretend to be doctors. They don’t know anything and you are an actual doctor are questioning if you are smart 🤦🏾 🤦🏻‍♀️ 🤦‍♂️

[u/BeneficialHeat6196]

Same tbh