Medical Knowledge and Skills:
- 2.4: Understand the indications, contraindications, and potential complication of common clinical procedures and perform the basic clinical procedure expected of a new PGY-1.
As I began my second year of medical school, I continued with my ultrasound training with the ultrasound interest group. I had just entered into the intermediate class and we were starting to learn more advanced techniques. One of the lessons was how to place a central venous catheter (CVC). I remember intently focusing on the wire, making sure to have it in my hands at all times. Little did I know at that time, that those lessons would help me during my general surgery rotation in my fourth year.
It was the second to last day of the rotation and it was a normal day like any other. We had several cases to attend and I was excited to get to improve on my surgical skills. The next case was a removal of a chemotherapy port, but first we were going to place a CVC under anesthesia. My chief asked if I wanted to try and place the line and immediately I started to worry about my ability perform. The fear of potential failure started to creep in and I worried about being inadequate.
Fear of inadequacy and failure are common feelings that I have felt throughout my medical career. As a novice in the medical field, I am constantly surrounded by people who know more than me–nurses, residents, attendings, etc. Even though all of these individuals have many more years of experience than myself, it is hard not to compare myself to them. Constantly throughout my education, I am being compared to others. I am being ranked against my peers both with my tangible grades and my evaluations. Additionally, I am being compared nationally with residency applications. The feeling is constant and it can be difficult at times to separate my own self-worth from these grades, evaluations, and rankings.
Throughout these past four years, I have learned how to better cope with these feeling of inadequacy. Now when I don’t know how to do something or I don’t know the answer to a question, I take a moment to feel grateful. I am grateful for the opportunity to learn something new. Grateful to now have this new knowledge that I can use to help my future patients. I remind myself that I am the student and I am not suppose to know everything. Each pang of inadequacy is simple a growing pain, taking me one step closer to where I want to be, and I had a big growth spurt in the OR that day.
After setting up the kit, my chief told me that I only had two attempts at placement and then she was going to take over. I took a deep breath, re-checked my kit to make sure that everything was easily accessible and in order. With one hand holding the probe and the other with the needle, I searched for the patient’s left internal jugular (IJ) vein. With the vessel centered on my screen, I slowly inserted the needling, remembering the NALTA technique that Dr. Bahner had taught me all those years ago–north start view, angle the needle, leap frog technique, tent the target vessel, aspirate vessel. Within seconds I had successfully placed my first CVC. My chief was in disbelief that I placed it on my first try in a matter of seconds and I was honestly in disbelief too.
That day I realized that even though I had felt inadequate at the beginning of the case, I actually knew a lot more than I was giving myself credit. Even though there is much that I don’t know, I have learned so much these past four years. As my medical knowledge expands and grow I will need to continue to work on trusting myself and my abilities to adequately perform and treat my patients.
Goals/ Plan:
- Further my ultrasound knowledge.
- Practice with the ultrasound at every possible time during future rotations, specifically during my emergency medicine rotation in January 2021.
- Look to see if there is an available time to practice scanning.
- Proctor ultrasound guided line placement.
- Become more comfortable placing CVCs.
- Utilize the opened CVC kit that is in the surgical resident lounge to practice moving the guide wire.
- Become more comfortable with medical knowledge “growing pains.”
- At the end of the day, journal or talk to someone how I am feeling. Acknowledge that the feeling is temporary.
- Help other students and residents combat their feeling of inadequacy.
- When I am a resident, I am going to talk to medical students at the my institution about how it’s actually better for them to get more questions wrong than right. I help will try and change their mindset into a positive constructive one.
- I will share my struggles with inadequacy with the younger generations, so that they understand that those feelings are normal.