Thursday, July 24, 2003

Poking around the othe medblogs and came across this post about "pimping" at Force of Mouth. While written from an internists standpoint it strikes a chord with me and my experince in residency as pimping is described as how the "shame-based motivational system of medical education is applied". See, a surgical residency is at least five years of shame based motivation. Surgeons can be sadistic bastards with very little encouragment. I mean, how many students have been driven from medicine teaching rounds in tears because they cannot answer questions. Seen it twice on the vascular service where I trained. In addition to the categories described in the piece, there are some pimping situations unique to surgery:
HEY, WHAT'S THIS? The most basic pimping in the OR. The living anatomy lesson.
WHY ARE WE DONIG THIS OPERATION? What other options are there? This and the anatomy quiz described above are student and intern-level pimps.
WHAT CAN YOU DO IF YOU....cut the ureter, divide the common bile duct, find cancer everywhere.,ect...? This is a midlevel/Chief Resident level pimp. Usually there are five solutions to each problem, and if you can only name four you receive a butt-chewing so bad you need a colostomy.

The above games are simply a warm-up for the weekly pimp-fest that is the SURGICAL MORBIDITY AND MORTALITY conference. This is where you get up in front of all of the attendings an residents an present your complications. Lots of blood in the water here. Best part is where the attending of the case presented : 1.Disavows you ("Well, thats not how it really happened......") or 2. Nearly comes to blows with another attending over how the case was handled. "Bluffs" as described in the post usually result in the hapless resident being led down a path that results in the death of the patient in a spectacular fashion.

All of this is supposed to prepare the budding surgeon for his AMERICAN BOARD OF SURGERY CERTIFYING EXAMINATION or THE ORALS. This is you and about thirty other poor souls in suits sitting in hotel rooms being slow-roasted by examiners. And you pay $800 for the pleasure. Bluffing is treated as above, but you also fail the exam and get to pay to take another beating in a year's time. According to the board the pass rate for last year was 83 percent.

There are a multitude of books to assist the student/intern/resident in the pimping game. The best for surgeons (IMHO) are here and here.
Enjoy rounds today!!
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