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How to Survive Pimping in the OR

NewannaAnna Burkhead -- WARNING: Attempt at humor ahead … Abort your reading if you must…

I’ve written previously about “pimping”, the well-honed tool of many attendings to test students’ knowledge, and/or torture them. Now that I’m on my Surgery rotation, I’m spending more face time with attendings than on any other service. To what does this translate? Multiple un-interrupted hours of being pimped, each and every day in the OR.

For the most part, I don’t mind being pimped, because I know I’m not expected to know everything. Also, I rarely forget the answers to the questions I miss. Pimping can be a good teaching tool.

But some students detest being put “on the spot”. This is a column for these students.

How to survive being pimped in the OR:

-When asked a question, try your best to answer. When wrong, try a pensive silence. If you’re silent long enough, maybe the attending (engrossed in his gastrojejunostomy) will forget he ever asked the question.*

*May be effective only with older attendings.

-Answer a different question (correctly). Example: Attending – “What are the boundaries of dissection for a mastectomy?” Student – “Well, I don’t know, but if we were doing an axillary dissection, the borders would be…” You can still sound smart!

-Never forget that the student wields the suction. Stick the sucker-thing in a shallow pool of blood in the abdominal cavity, and it may create a gross sucking noise loud enough to drown out the nonsense answer that you know is wrong … but you may risk a blood spatter. Due to the risk of this OR foul, this should be your last resort.

-Answer with another question. This is probably the most “smooth” escape plan.

-Before the surgery, tell the attending that you’re hearing impaired. Explain that with masks on, you can’t lip-read.*

*This is probably a bad idea.

-Ask if you can “phone-a-friend”. Most attendings are ok with you passing the question to your intern or resident. Unfortunately you only get an average of two “phone-a-friend”s per surgery.

-Use humor. Example: Attending – “In what situation would one observe a ‘winged scapula’?” Student – “When the patient is in a bathing suit.”

When all else fails, and you know you’re going to be pimped during surgery the next day, 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!

Good luck to all :)

March 24, 2008 in Anna Burkhead | Permalink

Comments

i aborted my side reading, and you managed to humour me, great post anna!! :)

Posted by: sam | Mar 25, 2008 3:36:52 AM

lovely!
silence is golden. :)
great post.

Posted by: | Mar 25, 2008 9:31:08 AM

Don't forget the other classic response - really more of stall tactic - and that is to repeat the question back to the attending, as though you just wanted to make sure you heard him correctly. You'll look like an ass every time.

Posted by: cha cha cha | Mar 25, 2008 2:32:31 PM

Well, you can respond by asking extra detailed questions about the surgery however irrelevant, only if it indicates 'your' line of thinking; and 'demand' to have extra access to the operation details and techniques at all times suitable or unsuitable... that should create a formidable challenge to the attending everytime you're on the field.
Most of all drive the whole process towards your benefit and your understanding, he's the one doing the operation and you're the one learning and gaining experience so the process as far as you're concerned has to be on your side. This requires you to have an understanding of the condition at hand however primitive it may be ... but it's YOUR understanding after all.

Posted by: | Mar 26, 2008 2:05:24 PM

That was actually pretty funny!

Posted by: Doctajay | Apr 1, 2008 3:59:25 PM

There are a couple ways to survive pimping:
1) a miracle from God or whatever deity you believe in
2) Study the cases in advance
3) A friend whispers the answer
4) When all else fails, take the Bit@# slap from the attending.

I was observing a Whipple, could see much, and the attending's partner came in and started to pimp me. Pancreatic CA marker then Breast CA marker, then Ovarian CA (I forget this easy one).
Just answer to the best of your abilities. Usually the first or second questions are expected to be answered, but the rest are just seeing how much you know or how much they can frustrate you. Considering it extra credit without getting credit from it. Some attending that ask you questions and ask you to look it up, really dont know the answer to it.

Posted by: Dr.MI | Apr 1, 2008 5:05:20 PM

"-Before the surgery, tell the attending that you’re hearing impaired. Explain that with masks on, you can’t lip-read.*

*This is probably a bad idea."

This probably would be the case for the majority, but not for me since I'm deaf and am enrolled at a Physician Assistant program, beginning this summer. I am looking forward to learning the world of medicine!

Thanks for sharing your tips! :-)

Posted by: Marsmile | Apr 1, 2008 6:30:43 PM

I'm a PA student, and just came off my surgical rotation. I was pimped to death, and it was the only rotation that I felt like a total idiot, because most of the questions were about the finest details of anatomy (stuff I had forgotten, and didn't even remember dissecting over a year ago). I would try to review beforehand, and was only successful about 1/4 of the time. . .

What we were taught to say if we didn't know the answer when we're pimped is: "I don't know, but I'll look it up." I would go home that night, look it up, and come back and tell the surgeon the next day. He'd always forgotten that he'd asked me, so I guess he was a bit impressed by that at least!

Posted by: Talia | Apr 1, 2008 7:33:38 PM

thanks for your advice...i need it so much!........

Posted by: Victor Antonio | Apr 2, 2008 12:13:00 PM

it was fun to read all of the tips, they really become handy when being pimped, but has anyone tried to "pimp" the attending? meaning that instead of being questioned you start asking about the little details, expected results, complications, rehab, etc... this will lead to 2 things: the surgeon will get tired of answering so he won't ask back, you can either look dumb or interested in the subject (that depends of how annoying you are) but it'll be helpful next time someone asks...it's a faster way to learn about the procedure...of course reading a bit in advance may help to your interrogation.. lol

Posted by: gaby | Apr 2, 2008 2:42:50 PM

brilliant tips! reminds me of my student days!

Posted by: anjali | Apr 3, 2008 5:40:30 AM

''it was fun to read all of the tips, they really become handy when being pimped, but has anyone tried to "pimp" the attending? meaning that instead of being questioned you start asking about the little details, expected results, complications, rehab, etc... this will lead to 2 things: the surgeon will get tired of answering so he won't ask back, you can either look dumb or interested in the subject (that depends of how annoying you are) but it'll be helpful next time someone asks...it's a faster way to learn about the procedure...of course reading a bit in advance may help to your interrogation.. lol

Posted by: gaby | Apr 2, 2008 2:42:50 PM''

Yeah but the only problem with doing that is that it can make you look really arrogant!! Lol, I tried it once and it really did not work - the attending never forgot and now hates me working in the same hospital as him!! I think he was a bit extreme though. But either way, it's not always a good idea to pimp the attending. Fun at the time though! xxx

Posted by: Kate | Apr 3, 2008 9:47:41 AM

AMAZING ANNA ever 1 will associate with u.. i m in surgery right now i go thru this trauma almost every day now.......

Posted by: sawee | Apr 4, 2008 4:07:32 AM

Yeah agree with Anna totally .... I think the best option is looking up the operation list for the next day and coming prepared. If you really dont know something then just accept the fact that you dont know it and remain silent! Beating around the bush wont get you anywhere as most surgeons want the nail to be hit on the head and no where else!

Posted by: Sandy | Apr 5, 2008 4:24:43 PM

i like the advices its really true... thanks for the tips.... note in advance ...read more... accept the facts... take note the experience... and learn from it.

Posted by: jasmin | Apr 6, 2008 7:09:22 AM

really good stuff. best thing tho is to pay attention, try to enjoy what ypu're being taught and have fun.( I'm in final year and have obviously forgotten how horrible pimping can be!)

Posted by: Ughe | Apr 14, 2008 4:16:03 PM

On surgery, always have a copy (hardcopy or on your PDA) of "Surgical Recall". If you didn't get the case list the day before, you can do last minute look-ups. Very rarely on surgery have I been pimped on things that *weren't* covered by SR!

Posted by: NYCChiquita | Apr 19, 2008 1:23:44 PM

I think the best thing you can do if you don't know the answer to a question is:

1) Say "I don't know." This ends the pimping on that question right there. It might start a diatribe about "why don't you know that simple question blah blah blah," in which case move to:

2) Say "Hmmmm...." Maybe they'll just keep talking and make themselves look stupid. If not, and they ask you anything else, you can move to:

3) Say, "Ah, I see..." These three phrases are like Magic!! Of course if you actually want to look like you know it all you do have to prepare. Taking five minutes before the surgery to go over things with your intern can be a lifesaver for both of you.

Posted by: surgery resident | Apr 22, 2008 12:26:22 PM

when somebody pimped you, you have 3 strcit possibilities. you don't know it, you don't know completely or you have the exact answer. let's think what will happen in these 3 situations. in the first one you may make ashame of yourself for the worst. not completely know: the examiner will ask somebody else. know exact answer: there could be another question. everybody may think that you are genious. you think for a moment that you are the best. so every situation may have a drawback.so whatever the situation one should be intimate and try to learn what one's don't know.

Posted by: dosty | Apr 22, 2008 1:16:57 PM

in Makerere U.niversity,Kampala Uganda,its called percusion.when u cant answer many of the questions you are declared as 'reasonant' as an air filled cavity. of course it pains but as you get used to it and after you do your homework you discover its a good method of teaching, except the reasonant part

Posted by: geoffrey | May 21, 2008 5:30:36 AM

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