Wednesday, March 15, 2006

Hard Out Here for a Pimp.....
From the New York Times:Young Doctors Learn Quickly in the Hot Seat
A favorite time to grill students has been on rounds, when doctors and students examine hospitalized patients. Here, senior attending physicians may ask students to list the various types of lymphomas, point out structures on X-rays, describe clotting disorders or choose among antibiotics.

At times, particular students are singled out, especially if they are following the patient in question. If the student is having difficulty and the senior doctor keeps pushing, rounds may suddenly become very uncomfortable. At other times, other students or resident physicians may be allowed to bail out their colleagues.

Let's activate the Bard Parker Internet wayback machine to July of 2003 and a discussion of Pimping, Surgeon-Style
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 experience 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 encouragement. 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 DOING 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.

Ahh, the memories...
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