Medical Pimping

Pimping can be an awesome learning experience or a horribly humiliating experience.  There is a fine line between the two.

Pimping is when an upper level resident, attending, or other faculty member asks you questions about a topic, any topic.  These questions start out simple and basic and rapidly accelerate into the deep details of a very specific topic. It can be about anything. It can start anywhere and end anywhere. The purpose is two fold.  The first part is to teach the student or show where the student should focus his/her studies because of lack of knowledge.  Second, is to be Put In My Place.

Another, more gentle, name for it is the Socratic Method.

Example: When you admit a patient to the hospital, they have other medical issues and they become your responsibility.  So you need to know them even though not directly related to OMS.  So you present your patient to the attending, then they start firing away.  What is the most common type of mandibular fracture outside of the United States? What are surgical approaches you would use to gain access?  What are possible complications of different approaches? What is Frey Syndrome and how can you treat it? What is the DOC for pinworms?

Pimping is usually done at conference, case discussions and morning rounds on patients with all of the attendings and residents present.  This can be very stressful because you are singled out one at a time and you are on your own.  If done correctly, pimping can be constructive and reinforce what you know and even teach you.  This type of pimping is usually more gentle, constructive, and purposeful.  On the other end of the spectrum is the more traditional, surgical style of pimping.  It can be malicious.  If so, it is usually meant to humiliate and publically embarrass the student.  Some attending surgeons seem to do it for sport to show that they know a lot and some do it just to belittle another student.  I like to believe that the majority of attendings do it to teach.  Even if it comes across in a harsh manner.  The bad part about these pimp sessions is that eventually the attending will get to the edge of your knowledge and you will not know the answer.  This happens every time.  So you are exposed every time.  This can mess with someone's mind when they have been labeled the "bright and intelligent one" their entire life.

So through these pimping sessions I have been humbled to dirt.  I have had to learn to be ok with not knowing the right answer.  I have also learned to NOT say "I don't know" if I am not 100% sure of the answer.  I should give my best educated answer.  This will help me not look like a fool.  I want to impress others, but there is a huge difference between 1st year OMS residents and the Seniors/Chief residents and then there is another big jump to attending surgeons.  The learning curve is incredibly steep in every year of residency, part of it is due to the pimp sessions.  So it is a love/hate relationship with these sessions.

My goal is to gain a large base of knowledge while in my 1st year and build upon it.  I need to do more reading from the OMS textbooks and truly grasp it.  I need to attend the conferences and journal clubs.  I need to review head and neck anatomy.  I need to learn medicine.  I need to practice OMS procedures.  There is a lot to do.

As far as pimping goes, my long term goal is to be an attending surgeon and use pimping successfully as a teaching tool in a humanistic way.

1st Finals Week: Finding Balance

I finished the first module of 2nd year of MD school. It was the general concepts of pathology and pharmacology. We also had a practical physical exam and a practical for taking a medical history with standardized patients. Standardized patients are volunteers who spend an afternoon in a gown in a small exam room. Then the students rotate one at a time and perform a memorized portion of the head to toe physical exam or take a medical history of the actor patient.

The Physical Exam Practical is to help students ease into the hospital rotations next year. The med students learned the exams in 1st year. So the OMS residents had to catch up in this area. They gave us a 2 hour rundown of what the others learned over the course of a year. The instructor told us that all we have to do is go through the motions of the physical exam. We did not have to record any findings. The only recording we had to do was the medical history portion of the exam. The other med students advised us that all they do is pretend like they know what they are doing and they get good scores. A sort of "fake it till you make it" philosophy. The instructor also gave us the same advice, followed with the statement that we would be learning each of the physical examinations more in depth this year before we head to the hospital rotations. So we memorized the script and motions of each of the portions of the physical exams. The head and neck exam was straight forward having done many of those in dental school. But the script states we must say, "I am inspecting the skin of your head and neck"  and "I am inspecting your outer ear" as we go through the motions. It was a little awkward but the patients know that it is part of the script. It was fun. One advantage we did have during this exam was that the OMS residents have had years of patient interaction so talking with the patient, helping them feel comfortable, taking the medical history, asking them personal and potentially awkward questions was quite easy. We did not, however, have experience palpating the lymph nodes and pulses in the groin on male or female patients. Or how to palpate the and listen for sounds of the heart on a bare chested female. We had to learn how to gown and drape patients so they did not feel awkward, especially the females. My only hope was that the upper body examination was a male during the test. Most volunteers were males and retired. Males help the timed exam go faster since there is no need to gown and it is less awkward. Well, nope, no such luck, I walked into the room to find a cute, athletically fit, 21 year old Latina. Big difference from the usual retired male. 

The practicals were pass/fail and everybody passed. No biggie.

The first written exams were pretty stressful. I did not know what to expect because I wasn't here last year like the rest of the med class. The first couple of weeks of the module, I came home at noon every day, but the last week and a half I studied pretty hard where I stayed at school until midnight. The week prior to the exam there was no school so all the students could study for the exam. It was a whole week off!  Ridiculous amount of time to study. So the weekend before the Monday exam, I decided to go on vacation with my family. We went and visited some old friends. It was a nice break. So the last 3 days before the exam, I did not study. But I felt prepared enough to pass. That is the beauty of already being in my residency. I don't have to compete against others who are trying to get into dermatology or whatever else there is. There are some pretty smart kids in the class and some pretty competitive ones as well. I am done with those days. I am already here. I don't need an A in every class. So I didn't study as much. But the interesting thing was that I only scored a few points lower than I normally would have if I would have studied intensely like I did back in dental school. It takes a lot of energy and effort to gain a few points but that little bit is what makes all the difference. Crazy.

So I have come to the conclusion that all I need to do is study consistently every day after class until about 5pm. I can have all evenings and the entire weekend: Saturdays and Sundays to be with my family. I can study hard during the week and even more so during the week off prior to every final and do well on my exams. That is how I need to balance my days. I can spend time with my family and not study for too long and be successful at school and at home. I think balancing life is one of the biggest lessons I can learn during residency and it is getting more and more important to do while life is getting more and more complex. I think I am starting to learn how to do it.