Learning to Be Patient with Myself During My First Months Working as a New PA

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I've said it once, and I'll say it a million more times. There is no time that is more stressful than transitioning from PA student to new graduate PA starting your very first job. This is a time that we should be proud of our accomplishments and excited for us to embark on this new chapter. A chapter many of us have been working YEARS toward achieving.

So, why are we not MORE excited? Why are we feeling so torn down? Stressed? Impatient with ourselves, knocking ourselves down every chance we get with the intrusive negative thoughts? Thoughts like, "I could be better at" or "I should have known this", or even, "why am I not getting things quicker".

Hopefully you find it reassuring when I say EVERY new grad struggles with this, with a sprinkle of imposter syndrome on top. But I am also aware this reassurance does not make things easier. Honestly, the only thing that makes this transition easier is time. And although each year I personally am convinced time somehow finds a way to go by faster and faster, when you're in the middle of such a stressful transition, it feels like time moves at speed x0.5.

Of course, things like mentors, new graduate education opportunities (lectures, SIM labs, etc), and good support systems help tremendously, however, none of these compare to simply just gaining needed experience over time.

In this stage of your career, you'll feel like you're constantly running to catch up to where you think you should be until one day you blink, and you realize, you're no longer running, but instead in a light jog. And that jog eventually turns into a fast walk. Until one day, you're simply just walking. There will be some days that send you SPRINTING all over again, but those days too will pass.

So, if the only thing that really makes this new graduate learning curve better is time, what can we do in the meantime to feel less helpless?

Most people study. Like we're back in school again, because well, that's what we know and just spent every day of the last 2-3 years of graduate school doing. This will feel like it's helping in the beginning, until you realize how studying for the PANCE and EORs truly differs from studying for real life patients, cases, and shifts.... Trust me, they are SO different.

That's why this transition IS so hard. Some things simply can't be taught in a book, through flash cards, or on a quiz. Some things just need to be taught via clinical experience and physically just doing. No amount of books or studying can prepare you fully for real world medicine.

So now that you learned studying can't get you out of this, what next? That, my friends, is what I am here to share with you.

I know what you are going through because I went through it myself. The imposter syndrome, lack of confidence, self doubt, and struggle of dealing with stress.

I used to come home, and review cases CONVINCED I missed something or did something wrong, although I had an experienced attending by my side, guiding me with every case, making it literally impossible to make this mistake. I felt like this perpetually for the first 6 months, which in my opinion, are definitely the hardest. But honestly, even though things get better each day that goes by, the entire first year is rough.

It isn't because you're not qualified, well trained, smart, or even prepared. Because you are all of these things. I think the hardest part of all of this is learning to trust yourself, be kind to yourself, and be patient with yourself.

I know this is 100% easier said than done. But the way I started to implement this mindset was by taking the time to be mindful.

Once I realized that studying all day every day on my days off was not helping me, but instead burning myself out I stopped doing it. I started limiting my time reviewing medicine and working on my charts that were left over from prior shifts to the days I was scheduled to work. I wouldn't do it all day, but maybe an hour before or hour after work, depending on my shift. I saw these days already dedicated to medicine, so I figured it would be better to keep all medicine-related things to these days only. My days off I purposefully busied myself with things I enjoyed that had nothing to do with medicine. In the beginning when I started implementing this, I felt guilty for not trying to 'be better' and honestly a little stressed. Again, I felt like I always needed to be reviewing something to prepare myself for my next shift. But sticking with this practice, and learning to separate work from pleasure, showed me that the breaks from medicine were exactly what I needed.

One way I would review concepts I felt I needed to brush up on was by listening to podcasts in the car to and from work. I found this to be a perfect little refresher. I would pick podcasts that were the time of my work commute (15-30 minutes in length). I didn't need a big deep dive, just enough to refresh knowledge I already learned into the forefront of my brain.

Another way I practiced mindfulness was by taking time after each shift to write down 5 things I did well that day, and 5 things I could improve. An example of one of my lists is:

Things I did well:

1. Completed my notes this shift

2. Complimented on bedside manner by patient

3. Getting better at reading my own XRs

4. Took time to eat on my shift

5. Faster at seeing more patients on shift

Things to Improve:

1. Review RSI induction agents

2. Efficiency of work flow

3. Continue working on reading CTs

4. Keep practicing US IVs

5. Review correction of hyponatremia/hypernatremia

I would find creating these lists made things more attainable. I found them helpful to track my progress. I knew if I kept writing the same things down that I needed to improve, that I was encountering the same difficulty enough that I should dedicate time and energy to work on it.

Writing down the things I did well kept my spirits up. In the moment, it's so easy to focus on the things you don't know or are struggling with. Focusing on the good, too, will remind you that you are doing great things, even if it doesn't always feel that way. I found keeping a positive mindset during a stressful and hard time is like keeping the "light at the end of the tunnel" lit.

The last thing that helped with this mindset was seeking opportunity. This means taking advantage of the resources around you. This is your attending physicians, your fellow APs, and all the other components of your teams. In the beggining, I felt shy. Like asking their opinion on patient management or about something I didn't know made me look weak. But truthfully, it was the opposite. Keeping to myself made me weaker, and talking things out with my peers simply just made me a stronger provider. Sometimes a different perspective will make all the difference.

One struggle I faced often that made me feel over my head was dealing with critical care patients. To this day, I simply don't feel enough PA curriculum is centered around it. I felt the least prepared for these cases. So, to help me become more comfortable I made sure not to 'cherry pick' patients. I would sign up for the next patient to be seen and if I felt the case was challenging, I would heavily rely on my team members to teach me new things. I would get my attending involved early, and thoroughly talk out our medical decision making and management plan 100% together.

When really critical patients would come in, and they weren't my patients, I would go into that room to watch the attendings medical decision making firsthand. To observe what they were doing and why. I would ask them my questions in real time and ask why they "chose this med over that". Doing these small things expanded my knowledge and confidence considerably. I still find my way into critical cases so I can continue to learn.

Overall, the biggest thing to remember is that whether you've been practicing medicine for 5 weeks, 5 months, 5 years, or even 50 years, it is impossible to know everything!!!! There will always be an advancement, a new medication, or even a new guideline. There will always be things you need to look up. And that is ok!! The day you assume you know everything in medicine is the day that you should no longer be practicing medicine. The best clinician is able to recognize what they don't know, and either consult the appropriate specialist that does or know how to look up the answer themselves.

Speaking from experience, I feel new graduates find not knowing everything is a flaw, but in reality, the seasoned clinician sees it as a way of medicine. No one is judging you for not knowing every single thing. Over time, you will understand this concept and finding patience for yourself will slowly become easier.

So, the next time you have a stressful day and start doubting your capabilities, remember where you started from. Remember your first day of your first PA job, first day of clinicals, or even your first day of PA school. It will be humbling to see how far you came in such a short time. You are capable of amazing things. Just imagine how far you have yet to go!

Don't let the stress of medicine and the feeling of needing to be perfect to practice medicine ruin the joy of living your dream. Take things one day at a time, because you can do this.

YOU CAN DO HARD THINGS!!

XO,

Manny

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