I’m not a girl, not yet a woman.

Through our years of medical training we have assessments that are designed to give us feedback, both on our clinical skills and on our personal traits and interactions within the department. It is a testament to how poorly they are generally completed that I am in my 5th year of training, and in the last 2 weeks have received my first ever genuinely constructive, slightly negative, feedback.

And it wasn’t enjoyable.

There is a tendency in medicine towards feeling that negative feedback is a reflection on your character. Nobody likes to receive criticism, however constructive, but as a medic you spend the vast majority of your life attempting to be a good doctor, to manage patients in an appropriate and empathetic fashion, and you are continually striving to be the clinician you want to be. We go weeks and months, if not years, without useful direction or advice about our clinical skills, and speaking for myself, are fooled into thinking that no news is good news. Then along comes an appropriate feedback session, and you learn that you are not as good as you think you are. For someone with chronic imposter syndrome this means you feel like the shittest doctor in the world.

My current stage of training is a funny one, I am at the end of my SHO years and from August, if I stayed in the UK, I would be embarking on registrar training. I feel competent as an SHO and totally out of my depth as a registrar. In the words of Britney – “I’m not a girl, not yet a woman.”

My current department gives ST3s (my year of training) the opportunity to step up as registrars. However, they quite unhelpfully don’t distinguish on the rota or in practice between an ST3 and an ST6 – a doctor with 3 more years of emergency medicine experience. As a result, in an already very stressful environment, you feel like you are consistently underperforming and being held to an unacceptable standard.

I personally do not feel that it is appropriate for me as a doctor with a total of 20 months of ED specific training to be leading a resuscitation room alone in a major teaching hospital. I don’t feel that I should be managing majors alone and making decisions about all the patients seen by the more junior doctors. I definitely shouldn’t be doing this without appropriate induction or training. This is where it feels different to other specialties. I have friends in medical and surgical specialties who become registrars at this level. However, they have had much greater exposure to their chosen profession (at least 2 solid years prior to becoming a registrar), plus, I hope they will forgive me for saying, their knowledge base and patient variety is not as vast. As emergency medics we have to know a bit about everything, and be confident risk stratifying everything from chest pain through to ectopics. This takes time, and patient numbers, to achieve with any degree of certainty or safety.

I have really struggled with this year, and that was unexpected. I came from a hospital that had a bad reputation and no senior support, into an emergency department with some of the best consultants in the country, with 24hour consultant cover, and I expected more.

My first 6 months was in paediatrics and I had the best time. The teaching was unparalleled. The department was super supportive, and I never felt outside of my comfort zone without knowing exactly who to call about it. Admittedly, I had no paediatric experience, so they weren’t trying to get me to act more senior than I felt.

Going from that state to leading a busy ED area is stressful for anyone. And then when you receive feedback that you are not doing that effectively, it makes you defensive, and you fail to see the usefulness or accuracy in the feedback you are given. No I am not performing at ST6 level, and nor should I, or anyone else, be expecting me to. However, there are things that I can strive towards improving, in order to perform better and eventually become a competent registrar.

There is a reticence to acknowledge when we are out of our depth. Not the crushingly scary, sick patient in the middle of the night, out of our depth – everyone recognises that, if they don’t they have no business being in medicine. I am talking about the consistent, low grade effects of repeatedly operating just that little bit out of your comfort zone, and feeling unable to voice it because everyone else seems to be coping fine. Not having anyone check on you and make sure you are ok. Being the only senior in a department for others to ask questions to because the consultant is in resus. Just being expected to cope.

It takes a lot to voice unease when everyone around you is giving the impression of you being able to cope. And you can cope. But really, coping isn’t what we should be aiming for. Confidence is the aim. And my experiences this year have totally stripped me of mine. I have been made to step up into a role that I was eager to take, without any significant training, without acknowledgement that this was new and difficult, without someone touching base to see how I was going. And I coped. And now I feel less confident in my medical abilities than I have in a long time.

I am grateful to be taking some time out in August. The thought of continuing to ST4 training is enough to make me hand in my training number. I am approaching this move to Melbourne as an opportunity to see more patients, hone my diagnostic skills, and come back a better, stronger doctor and person. Or alternatively I will run away to the sun forever and never come back…

One thought on “I’m not a girl, not yet a woman.”

  1. You should not be receiving criticism as feedback.

    You should be receiving a critique; where what you did well is clearly expressed, along with what you could do better and how. It’s supposed to be a positive process.


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