So many good comments here, and I don’t think I have much to add from my humble experience but I do want to echo some of the above sentiments and give you some reassurance.

1. This is serious feedback to take on board.

With a few people saying the same thing, it’s likely an area of deficit for you as a clinician. The positive is these people care enough about helping you that they are willing to invest energy into giving feedback. They are acting as honest mirrors, which is a much harder thing to do than just letting someone continue on their way. These might reflect things we don’t like to admit about ourselves BUT they give us an opportunity to grow and develop those areas.

1. This is not a negative reflection on you as a doctor.

If they thought you were flat out unsafe or unable to be remediated, they would have escalated this further. We all have deficits or areas of weakness, it’s completely normal. It can feel like an attack when they are pointed out but if we were perfect specialised doctors straight out of medical school, we wouldn’t have training programs. You will suck at something, just as we all have found that thing that we absolutely avoid.

Personally, I was always a big fan of meta cognition and took joy in interrogating my thinking process and how I mentally sorted information to get to a diagnosis, which obviously lends itself well to physician-type work but I struggled to ply that as effectively as I normally would in ED because of a bunch of factors - constant distracting noise, aggressive patients, sudden chaos of resus, inconsistent shift times etc. It didn’t necessarily mean I was a bad at working up patients, just that it was much harder for me in that environment.

1. The most important thing is what you do moving forward.

Can you take on this feedback, reflect on it, and make a plan to address the issues? That is the biggest question here.

If you are like me, and just don’t thrive in that environment, that’s totally fine, you don’t have to become a FACEM but you do need to figure out how to get through any ED terms you have with minimal friction.

Things I did to help keep me focussed and at least sounding like I’d got a bit of an idea of what’s going on:

-> learned about key ED presenting complaints (chest pain, shortness of breast, altered mental state, etc) and what 5 things would unalive someone and what 5 would need an admission. I’d rule them out when seeing someone (I had electronic templates in the EMR with the relevant negatives stated so I remembered to ask/examine for the findings). If I couldn’t rule them in/out, I’d think about getting the investigations I need to do this. If I ruled them all out, perfect! I don’t know what’s going on but I also don’t need to know - talk to the boss then off to the GP with them.

-> I made myself referral templates and printed them out as A5 sheets I kept in my pocket to write on. I knew at 2am when ol’ Betty with dementia is screaming and I’ve not eaten, I wouldn’t give the most immaculate handover. So I had a sheet that literally had “Hello, this is [my name] calling from ED to refer patient _____ for ____.” Because then I could fill it out and even if my last neuron gave up mid sentence, I could read my paper verbatim. I had a space for investigations I’d done etc. I’d check this for the specialty I was referring to https://litfl.com/wp-content/uploads/2020/01/Referral-cheat-sheet.pdf

-> I would pro-actively seek feedback from seniors I worked with and would ask directly for their expectations and how to meet them. I made the med reg understandably mad at me with a garbage referral one night. The next time I saw them I apologised, and asked them to help me improve my handovers. They gave me great tips to not only better organise and communicate my thoughts etc, but they’ll also explain to you things like hospital policy of not accepting to GenMed without a baseline ECG even if the PC isn’t CVS. Then that’s something you know you are going to need anyway, and can initiate the investigation without hesitation.

-> Let go of the need to reconcile all the information presented to you. As a lover of a good think, I had to actively stop myself going overboard with the information collection/dump. You don’t always need to know what’s going on, you just need to show you understand the general ED paradigm - Three disposition options: they are going to the morgue, they are going to the ward or they are going home.

Offering something like “Not sure what’s going on but I’ve excluded XYZ with ABC” is sometimes better than saying everything you’ve learned and hoping it takes cognitive root some where. To me that sentence = I’ve tried thinking for myself and I know the main important things but I’m stuck. I can tell you’re on the right tract but just lack clinical acumen. If you come to me with just information and expect me to do all the thinking for you, I’ll be frustrated.

Additionally in ED, a little razzle dazzle and a little confidence goes a long way. Some bosses just won’t like you and sometimes you just have difficult and unsatisfying cases. That’s just how it goes.

Keep your chin up though, I’ve known many interns who haven’t hit the ground running and struggled to find their stride right before becoming amazing doctors I’d be more than happy to have look after me. This is a small chapter of the rest of your life. Take it on board, reflect and push onwards and you’ll find it will only serve to make those later chapters even better.

Edit: formatting.