Improving medical students

Archive for the ‘Pimping’ Category

Long Term Impacts of Pimping

Posted by medliorator on September 8, 2008

Woe be the person who can’t answer. Or, worse yet, dissolves into tears. It took the young Doc Gurley longer than it should have to realize that your first answer should be the most obvious answer. I would get asked something like “Can you tell us what this patient has?” and the only possible answer (to me), based on the patient’s two-week hospitalization that had baffled eight sub-specialty services and their nineteen invasive procedures, was “uh, no.” Unfortunately, the correct first answer was “This patient has a fever. It won’t go away. No one knows why.” The next correct answer was “A fever of unknown origin can be divided into two categories – true and false.” Sigh.

One of my goals post-training has been to ask more often than I tell. It’s a shockingly positive thing to do – when done gently and considerately – and a wonderful form of post-pimping-rehab for those of us in recovery from the trauma of medical residency. When you ask someone what they think is going on, the answer can be really surprising. Everything from “I just want to know I’m not pregnant,” to “I’m pretty sure I’m dying” (when he is…).

Asking: Or Is It Pimping? [Doc Gurley]

Correlate: Pimping: How to Cope

Correlate: Pimping: What to Expect

Correlate: Pimping in Action

Correlate: Survive OR Pimping

Posted in Communication, Pimping | Comments Off on Long Term Impacts of Pimping

Pimping in Action

Posted by medliorator on June 19, 2008

The attending asked who the first years were and we sheepishly raised our hands. Then, looking to one of my classmates, he asked what is the blood supply to the stomach. My classmate replied that it was the gastric arteries coming off the celiac trunk.

That answer is true, but the attending wanted more. Not getting any more answers he asked, “Did you make it to second year?”

He then looked to another first year and I. I said “gastroepiploic,” while the classmate next to me answered “right and left gastrics.” Well we both were right (since there are five vessels), but then we got lectured for answering a question with the wrong intonation. He told us we need to be confident. No questions. And then the follow-up, “You want to be doctors, right?” (For those of you wondering, a third year finally correctly answered, “left and right gastrics, left and right gastroepiploics, and short gastric.”)

On the Wards – General Surgery (Day 4) [JeffreyMD]

Correlate: Pimping: How to Cope

Correlate: Pimping: What to Expect

Correlate: Survive OR Pimping

Posted in Clinical Rotations, Pimping | 1 Comment »

Pimping: How to Cope

Posted by medliorator on April 27, 2008

More pointers from Someonetc at Orthopaedic Residency

it is more important for the student to understand the classic defense strategies to stymie the master pimp. When using these tactics, the student must be careful not to anger the questioner making the situation worse.

  • The stall – this is commonly used in x-ray conferences. The student typically looks at the study squinting, and bring their face so close their nose almost touches it. Then the study characteristics are described. “This is an AP, Sunrise, Notch, and lateral in a skeletally mature patient dated January 5, 2007.” The next step is to describe what is not present. It is important [to] interject pauses, face holding, and pointing, as diverting gestures. The hope with this technique is that the questioner will fatigue and ask someone else.
  • The dodge – this is a way of avoiding the question and wasting time. The most common ways this is applied are by answering the question with a question and/or answering a different question.
  • The Bluff – (3 classes)
    • Hand gesturing – this is making reference to hot topics in medicine without supplying either substance, detail, or explanation.
    • Feigned erudition – answering as if you have an intimate understanding of the literature and a cautiousness born of experience. For example, “To my knowledge, that has not been addressed in a randomized prospective controlled study.” These statements are usually made after clearing the throat, standing professorially, and while holding something, coffee cup, glasses, etc.
    • Higher authority – this is done by referencing someone higher up in the hierarchy or another institution. Using a senior attending as a reference is common. “In my discussion with Dr. x, he stated ….” It is also common to mention another institution where the student may have trained. “At Duke we …. “

Just as problematic as improper use of a defensive tacts is not having good control of the “Brain Mouth Filter.” …Once a novice learner gains some experience and knowledge, they begin to overstep their understanding and bring up other topics and controversies without being asked. …a running dialog of thoughts opens [the door] to more questioning. …Filtering their thoughts prior to speaking is a must.

In the end, the pimping phenomenon is a game. The educator is the game master controlling the many of the parameters of play. With time, a learner will develop both a knowledge base and thought process. They develop there own styles of processing and answering “pimp” questions. Hopefully at end game, education occurs.

Brain mouth filter … [Orthopaedic Residency: The attending perspective]

Correlate: Survive OR Pimping

Posted in Clinical Rotations, Pimping | 1 Comment »

Pimping: What to Expect

Posted by medliorator on April 26, 2008

Someonetc shares some pointers for pimpers at Orthopaedic Residency

In the art of pimping, questions should come in rapid succession and be somewhat unanswerable. Questioning can be grouped into approximately 6 categories:

1. Arcane points of history – facts not taught in medical school that have no relevance to medical practice.
2. Teleology and metaphysics – questions that lie outside the realm of conventional scientific inquiry. Most often found in the National Enquirer and addressed by medieval philosophers.
3. Exceedingly broad questions – for example, what is the differential for a fever of unknown origin. These questions are best asked at the end of conference. Regardless of how many good points the student makes, s/he will always be criticized on the points missed.
4. Eponyms – questions like, what is the Hoffa fracture? These are usually dated terms that should be struck from memory.

For a master pimp, these are important categories to understand. Their utilization, while at a nursing station or in front of many naive on lookers, can gain the questioner many power points. It is like flexing your muscle in the gym mirror in front of the elliptical machines.

Brain mouth filter … [Orthopaedic Residency: The attending perspective]

Posted in Clinical Rotations, Pimping | 1 Comment »

Survive OR pimping

Posted by medliorator on April 5, 2008

here’s a novel idea: Study in advance! The best way to survive long pimping sessions in the OR is to be prepared and to impress with your knowledge. It’s not the easiest or the most fun way to make it through your Surgery rotation, but it is gratifying and it works!

How to Survive Pimping in the OR [The Differential]

Posted in Clinical Rotations, Pimping, Surgery | 2 Comments »