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Getting Drilled

NewannaAnna Burkhead -- ”Pimping” … ’tis the season for it! For those who are unfamiliar with the use of this term in a way other than the derogatory street name, walk in a student’s shoes for a day and you will learn its meaning.

In a medical student’s world, “pimping” is an art perfected by many attendings. It is the art of asking questions, sometimes at warp-speed, sometimes on completely irrelevant non-medical material, all to test your knowledge and poise. As in the Getting Caught Unprepared entry below, I recently had a bad experience being pimped.

This week I was working on the Gynecology Oncology service. I scrubbed in for many a surgery, where I soon realized that I was basically a sitting duck for 5 hours straight, or however long it took. I was asked questions ranging from “What are the anatomic borders of the perirectal space?” to “What are the seven ancient wonders of the world?” and trivia ranging from “In which portion of the fallopian tube does fertilization occur?” to “What is the Greek origin of the word ‘trivia’?”

Some questions I answered correctly, others incorrectly. After morning rounds on Thursday, I was satisfied with my overall performance in the pimping sessions. Thursday night I was on call, and after a busy night including stat C-sections and babies born so quickly the doctors didn’t even have time to run down the hall into the room, I was exhausted by Friday morning. It was almost time to go home, and only one thing was standing in my way … morning rounds with my attending.

Of course he had to pick Friday morning for the day we have “late rounds”. So, after arriving at the hospital at 4:30am on Thursday, pre-rounding on my Gyn-Onc patients at 4:30am Friday, and finishing my duties in Labor & Delivery at 7:00am, I waited around until 8:30am for rounds. I dared not find a place to catch an hour’s worth of sleep, because I knew I would wake up and be in a daze during rounds.

Rounds started off quietly, and as we had a lot of patients to see, the attending kept the questions to a minimum. Then, outside the room of a patient with ovarian cancer, he suddenly went into full pimp mode: “Ovarian cancer is usually diagnosed at what stage?” I know this. Next, “What percentage of ovarian cancer is diagnosed at that stage?” I think I know this. “What is the 5-year survival rate for ovarian cancer diagnosed at that stage?” I don’t know the exact answer, I’m going to estimate. “What is the first-line chemotherapy for ovarian cancer?” Don’t know that, would have known that if I studied more. “What is the response rate for the first-line drug for stage IV cancer?” Don’t know that either. From that point on, the questions were outside of my knowledge base.

I was feeling dumb, and my 28-hour sleep-deprived brain was not allowing me to take it gracefully. After grinding my self-esteem into the sanitized hospital floor, the attending closed up the patient’s chart and went to replace it on the cart. In the process, the chart dropped to the ground, the binder came apart, and three weeks worth of progress notes, labs, and orders scattered all over the hall. As the rest of the team invaded the patient’s room in a swarm of white coats, clipboards, and the quiet nods that are customary in a cancer patient’s room, I stayed behind to pick up the papers and reassemble the chart. As I was on my knees in the hall cleaning up the mess, I looked at my amniotic fluid-stained shoes (by the way, OB/GYN requires shoe covers, I learned the hard way) and realized I was at a low point.

I felt like I would burst into tears if the attending asked me one more question I couldn't answer. But, I tried to keep my “I’m interested in the things you’re saying” expression plastered on my face for the last 20 minutes of rounds. The attending asked me a few more questions, and thankfully I was able to answer them correctly. At one point, he actually said I “nailed” one of the answers! That made me feel better.

At the end of rounds, I was excused, drove home, and slept for five hours. When I woke up, it was a new day. Actually, it was early afternoon on the same day, and I was still in my scrubs on the couch (gross, I know). But it felt like a new day, if you know what I mean. I felt happy with the work I did while on call, and satisfied with my pimping performance during rounds. It’s funny how the wrong answers, near-tears, and low points are brought into perspective by a few hours of sleep.

(PS – the string of questions on ovarian cancer was asked specifically to teach me the “Rule of 70”, which my tired brain was not picking up on. So, in retrospect, the questions were not that hard, but going on no sleep, you could have asked me my birthdate and I would have had a hard time coming up with the answer!)

September 17, 2007 in Anna Burkhead | Permalink

Comments

Great recollection Anna...I just finished my first 24hr shift on my OB/GYN rotation and was quite proud of myself for being able to walk during morning rounds, much less remember the specifics of all 19 s/p c-section patients while managing not to slam into the wall face-first or simply fall asleep against the wall in the nice, dark patient rooms at 6am!!!

It's amazing how quickly we make the transition from 9-to-5 academic medical students to full-blown bleary-eyed bloody messes, and bounce back with a cool 5 hours of sleep!

Keep up the good work...someday it'll be you on the pimping-end trying to teach a bright-eyed young MS the ropes!!

Posted by: Jeremy | Sep 17, 2007 5:47:46 PM

yes dear Anna,being able to sleep is a great blessing sometimes,really refreshing.

Posted by: Innocence_e1 | Sep 18, 2007 2:00:35 PM

Exact recollection of what I saw. Now I have my pimping shield which is: your questions may be not so important.
To the pimping that comes after that: I know I'm a fresh graduate and am not going to do the surgery for you sir.
I don't speak them out but my answers underline them.
And study hard.

Posted by: | Sep 19, 2007 1:57:41 PM

well, it's ok for attending to pimp you but what i hate most is your co-interns pimping you!!!!

Posted by: ninette_umpa | Sep 22, 2007 9:31:00 PM

Give me a break, pimping is a valuable tool to assess if a student/resident has learned the appropriate information and has the critical thinking skills necessary to think through a problem. Granted, most of your questions were better suited for a gyn resident not a student.

Posted by: bryan | Sep 25, 2007 1:17:09 PM

Good point Brian, it the long run pimping is a great way to instill competency. But comon, if you ever have been pimped before, you must know how intimidating it feels. Good article though.

Posted by: Jason | Sep 25, 2007 2:20:26 PM

Stop crying. You're a doctor, or at least soon will be one. Act like it. Play the game and you will one day be a master of the craft you study. Remember, your rotation will end in a month anyway. Study. Suck up the hours, because when you are a real doctor, you will be expected to know your medical information and teach those below you, even on the 28th hour with no sleep. Good luck. This too shall pass.

Posted by: Doctor Christopher | Sep 25, 2007 4:38:01 PM

Everyone, in every profession, has undergone a similiar "baptism by fire". But even in "pimping" there is a remarkable transformation that takes place and that is the transition from novice to a seasoned professional. It is not always pleasant, nor does it "tickle" the ego. But in the endurance and perserverance of this rite of passage, Anna, will look back upon these experiences and realize that they helped to mold her into a first rate clinician who will make significant contributions to the well being of her patiens and to the world of medicine.

Posted by: Paul 1Cor. 2:2 | Sep 25, 2007 5:50:32 PM

Pimping is really just an ego-boosting game played by immature doctors who mistake it for "teaching." It has no real relation to teaching; it's pure purpose is intimidation and ego gratification. It continues, as with so many things in medical training, because it's how people were treated when they were training. If your school has access to community sites (or rural locations) away from academic centers, you can discover how much more learning occurs when there is real teaching, done by someone who wants you to learn. You'll never mistake pimping for real learning ever again.

Posted by: Kris | Sep 25, 2007 7:28:26 PM

Good Job . But i do agree with the people who said to suck it up . cause thise is what are doctors life is about , so i suggest to get used .
and concerning the Overian cancer . and its stages , its really not an easy question could be asked for your stage of knowldge .

Gretz

Posted by: Shade | Sep 26, 2007 9:06:05 AM

The greatest learnings in medicine for me is how I could reduce suffering and not cause more harm, how to help patients understand and cope with their conditions, understanding systems on how the illness affects the family and society and vice versa.

Posted by: | Sep 26, 2007 10:23:47 AM

Well written :) The issue isn't all black and white - there's good pimping - questions that help you focus your studying for the clerkship exam and sort through the mass of information for whats important ... I remember feeling educated afterwards sometimes ... but there's the pimping thats done to humiliate students and boost senior ego's, when it stops being about getting a point across or teaching and starts to border on sadistic :) Take the good with the bad and never assume that you can never learn something from someone, anyone :) And for the other stuff, you'll bounce back :)

Posted by: Bosi | Sep 26, 2007 11:40:16 AM

"Doctor Christopher"'s comments are typical of an old-world doctor-in-the-making - and I mean that in the worst sense of the term. "Stop crying - you're a doctor?" I don't think the author was crying (she certainly wasn't crying while doing her "doctor-duties). She was just sharing her thoughts on being a human being. Likewise to the comments: "Act like it; play the game, suck it up." People are becoming awesome doctors everyday - without that kind of attitude. And in fact, what kind of attitude does Doctor Christopher have? Without knowing you, DC, I'd have to say that you're starting to sound like one of those hard-nosed, humourless MDs with nothing of value outside medicine who think their colleagues respect them, when in fact, their colleagues, patients, and those "below them" avoid them whenever they can. And "that too" shall NOT pass.

Posted by: Jennifer Rae | Sep 26, 2007 1:46:33 PM

I agree with Jennifer. There is little point in denegrating students, particularly with questions that have nothing to do with the topic at hand (i.e. the Seven Wonders of the ancient world). The author is not crying; quite the opposite, in fact. No wonder people struggle with telling their docs everything - if Dr. Christopher is any example, why would any patient risk being so judged by him? A little compassion goes a long way.

Posted by: | Sep 26, 2007 2:18:39 PM

hey,all of ur guys comments are great...cool opinions!

i study medicine in a college where PBL or problem based learning is used as a basis for most, if not all, learning purposes...

in that sense, it becomes a bigger challenge when some1's "pimping during rounds (esp rounds, as u all know how tiring and boring they can get!!)..we are left on our own to research on a particular topic meanwhile we are supposed to know certain specifics on common cases being presented. we learn it the hard way few times..formal lectures are a thing of the past they say...

..any of u guys going thru the same system...and how do u find this??

Posted by: shayne | Sep 26, 2007 3:51:00 PM

Aside from the sleep deprivation (that the health care field still 'endorses’ and yet we have more rigorous rules for the trucking industry!) I hope you remember this post 10 years from now. When you are working with a brand new attending or resident, I hope you find it in yourself to share your hard earned knowledge in a more compassionate & constructive way. Your chosen profession is health care....not pimping.

Posted by: | Sep 26, 2007 4:07:05 PM

I agree with Kris my school is at a community sites and is rural located far away from academic centers. I have certainly learnt a lot more away from the intimidation of pimping and have developed a lot more confidence too. It seems to have taken me most of a year to get the confidence that I have some knowledge I am not sure I could have survived your baptism of fire

Posted by: Eboney | Sep 27, 2007 4:11:55 AM

hi, Anna :)
salute for you! when i finishing my co-assistant in obgyn, it's so hard for me to receive lot of nights without sleep. but u did it so well! sleepless 28 hours, do the rounds at 'very' morning, and still trying to look as a good student to your 'teacher', i guess it's a big thing. well, maybe it's sounds ordinary because we all face it. but in fact, it's not just as easy as we read or listen. keep on fire n don't give up. when u finish ur co-ass n be a doctor, u'll remember it as a sweet thing :)
trust me.. i've been there before. God bless u.

Posted by: yemima | Sep 27, 2007 5:56:24 AM

Gosh... I share your pain although i do pull shifts in the hospital just yet. Coming off my night job and going straight down to academics in the morning is the absolute most gruesome task in the world!

Posted by: Lawrence | Sep 27, 2007 9:57:42 PM

well, it does nt matter what time cancers always appear, at the end of the day, it is ovarian cancer and it has to has to be managed. pimping just aint the thing. I learn most in quite calm atmosphere

Posted by: ruth | Sep 28, 2007 2:13:54 AM

Dear frnd Anna Burkhead,

Myself writing from India.
Read your article ‘Getting Drilled’
It was very nice exprinence sharing your experiences. We too share this type of similar robust experience.
What I think & like also is that administrations must take care so that students get proper time to sleep. Because if you have not read something how much you hammer a person you probably cant get the proper response . according to me we juniors must be given enough time for reading ; because in current days of medicine all that matters is knowledge . as its said that what brain doesn’t know eyes cant see.
until & unless we sleep properly our work performance will fall.
Anyway this is how I feel .
Looking forward to here from you
My e-mail id – dr_sumantasaha@hotmail.com
Buy.
Your article was nice
Sumanta .

Posted by: Sumanta Saha | Sep 28, 2007 10:03:01 PM

the brave may fall but never yield, success comes before work only in the dictionary, keep on pushing only so many more miles to go, keep heart and good luck. It may seem cruel but it's a necessary evil. LOL

Posted by: richard | Sep 29, 2007 5:01:00 AM

Hi,
I am an American who just finished med school in Europe, and I can honestly say that I have never been 'pimped' in my 6 years at med school. Here it is expected that the STUDENTS ask the questions, if there is something we still don't understand after having read it. I don't doubt that I will become just as competent and compassionate a doctor as you all in the U.S., without having had to endure the the hellishness you guys have to put up with. I'm impressed with everything you have to do, but also horrified at the same time. I had 2 kids during med school here, and I sure don't think I could have pulled that off with the schedules you have. So, hats off to you all 'back home', who have suffered much more than I ever did to get the title of M.D. behind my name!!!
-Kristina

Posted by: Kristina | Sep 30, 2007 11:35:10 AM

I wish the med school experience in the US was like Kristina's. Questions are ok but they don't necessarily need to be asked at blazing speed and in a threatening manner. Incorrect responses should be seen as opportunities to teach rather than lack of competence...just as some students do written tests better than others, some students are better pimpees than others.

Dr. Christopher's attitude is unfortunately all too common among medical instructors. As long as those in charge continue to think "suck it up, quit whining, it gets harder later" and fail to practice the compassion that they often preach, medical students will continue to learn to "do as we say, and not as we do".

Posted by: | Oct 1, 2007 8:59:00 AM

Hey Shayne,

I'm in the PBL system, too, and think it's a good way to learn...but still have to put up with being drilled on ward rounds like the US lot have to. Wouldn't mind so much if it was always relevant, but have been asked weird questions like, "What is Coral made of?" (calcium hydroxyapatite - whadda you mean you didn't know that??) and other bizarre questions. I don't mind so much if it's done with the intent of learning, but at the moment, am working with a prat of an intern who is patently only asking the questions to make me feel stupid...so gives me dud ECGs to read, then smirks when i ask him how i went...and never actually tells me if i'm right or wrong! very aggravating.

whereabouts is your pbl system?

and you go, Kristina! i had two kids before med school, can't imagine how it would be with two during!! hats off to you, mate.

here's to a future with teaching rather than hazing...from sunny Adelaide, farewell till next post.

Posted by: Tonia | Oct 2, 2007 2:00:07 AM

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