Pimping

[Frazier]

Got pimped today... in a clerkship transitional course. Prof asked me to name 10-12 extraintestinal manifestations of inflammatory bowel disease out of the blue..

Is this normal? Am I getting picked on.. this seems overly harsh.. or am I mistaken? Just wanted to know what others thought..

Well... some people are better at pimping than others when it comes to quality.

Being told "name a list of 10-12 extraintestinal manifestations of inflammatory bowel disease" is a low quality pimp IMO. It gives too much away to the student (i.e. "well, there must be more than only 3"). By also including the "10-12" part it takes away from the meat of the question (i.e. the student starts sidetracking to think more about "how many have I named so far?" instead of "okay, is this a manifestation?")

You say "out of the blue". If I was pitched this question on the ophtho service, after presenting a patient coming in with glaucoma and w/o h/o GI issues... I would consider that indeed somewhat out of the blue. For many other services it is fair enough.

Key take away is "so what?"

You get a question, you try to answer it, you will often get them wrong. Act interested when they give you the correct answer, or act interested when you report back with the correct answer. Rinse repeat.

In all reality, most often pimp questions are just spontaneous, seat of your pants, "oh yeah, I have a med student with me, I better ask him something" type questions. So instead of the doc sitting up late last night crafting the perfect pimp question....it is more likely he would be like "Thinking about X. Thinking about Y. Thinking about Z. Hey med student answer this. No, here is the answer. Thinking about A."

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[username456789]

Parenting is a form of education.

And ringworm is a type of rash, but I'm not going to use steroids to treat it.

 

[Psai]

I didn't pretend to have formal proof about the effects of humiliation and domination in the medical field. I simply said "education". I find it fairly simple and honest to make inferences based on the information given, however. Perhaps you do not.

(And if you insist on incorrect English, paraphrasing does not require quotation marks.)

You said research shows. That implies having research articles at hand. If you said that to me, I would ask you who wrote it, what the title of the study is, what journal, what year. If you're going to say "research says", you better have said research. If you can't produce a single legitimate article when you have all the time in the world sitting at a computer, how are you going to handle this in real life? If you showed doctor a random website and offered it as proof, they would laugh at you. Google searching and copy/pasting haphazardly offers nothing. It just shows how lazy you are and how little you actually know

 

[Doudline]

The vast majority of clinical clerks are adults age 24+. They are big boys and girls.

Sure. Adults have better coping mechanisms and logical reasoning, so I don't actually think they are as affected as children. Yet it's absolutely ludicrous to pretend that they are not affected negatively by such behaviors at all (or that they benefit from it more than they are hurt by it).

In my experience most doctors (including surgeons) are not especially mean or hostile people. It's true that some (especially surgeons) have a bit of an edge and like to give people a hard time, but their intent isn't to destroy you as a person. This isn't killing something for the pleasure of watching it die. "Humiliation" and even "authoritarian" are strong words, at least in terms of medical students to whom they're usually somewhat apathetic.

Authoritarian is this context refers to before who are both strict/demanding, and lack warmth and nurturing.
It's not a comparison to Stalin.

In this context perhaps the behavior is more common?

 

[username456789]

Sure. Adults have better coping mechanisms and logical reasoning, so I don't actually think they are as affected as children. Yet it's absolutely ludicrous to pretend that they are not affected negatively by such behaviors at all (or that they benefit from it more than they are hurt by it).

Show us on this doll where the attending touched you:

 

[Doudline]

You said research shows. That implies having research articles at hand. If you said that to me, I would ask you who wrote it, what the title of the study is, what journal, what year. If you're going to say "research says", you better have said research. If you can't produce a single legitimate article when you have all the time in the world sitting at a computer, how are you going to handle this in real life? If you showed doctor a random website and offered it as proof, they would laugh at you. Google searching and copy/pasting haphazardly offers nothing. It just shows how lazy you are and how little you actually know

Honey you are simply grasping at straws, here. I don't know who you are trying to convince.

When there is overwhelming evidence, creating a resource or database containing all -or a lot of - the pertinent information is the fastest way to inform people. If you are still curious, you are free to check the given sources for yourself.

 

[username456789]

Honey you are simply grasping at straws, here. I don't know who you are trying to convince.

When there is overwhelming evidence, creating a resource or database containing all -or a lot of - the pertinent information is the fastest way to inform people. If you are still curious, you are free to check the given sources for yourself.

Girlfriend, if there was overwhelming evidence you would have given us some by now.

 

[Snoopy2006]

Got pimped today... in a clerkship transitional course. Prof asked me to name 10-12 extraintestinal manifestations of inflammatory bowel disease out of the blue..

Is this normal? Am I getting picked on.. this seems overly harsh.. or am I mistaken? Just wanted to know what others thought..

An attending who likely has sacrificed a considerable amount of salary to remain at an academic center was trying to teach you. Be grateful. If you don't know the answer, say you'll look it up, and thank him. Clinical attendings deserve a s***ton more respect and gratitude than we give them.

 

[pulmoblast]

 

[pulmoblast]

Do you want to learn Kung fu?
Then I am your master !

 

[22031 Alum]

Got pimped today... in a clerkship transitional course. Prof asked me to name 10-12 extraintestinal manifestations of inflammatory bowel disease out of the blue..

Is this normal? Am I getting picked on.. this seems overly harsh.. or am I mistaken? Just wanted to know what others thought..

To actually answer the question, OP- you're mistaken. It sounds like this course was presented to you as some sort of way to "ease into" the wards. There's really not a way to do that. Attendings (who aren't generally called Professors despite holding that title) see students, they ask questions of students. Even the stuff that seems really out of left field to you, can actually have some relevance to whatever topic you're discussing. And if it's truly out of left field, that's helping you too, since in medicine you'll often have multiple disparate things demanding your brainpower all at once. Just answer when you know, say "I don't know/I'll find out" when you don't.

 

[Wordead]

Sure. Adults have better coping mechanisms and logical reasoning, so I don't actually think they are as affected as children. Yet it's absolutely ludicrous to pretend that they are not affected negatively by such behaviors at all (or that they benefit from it more than they are hurt by it).

Are you saying that children and adults react the same way (just to a lesser extent) to negative reinforcement/punishment? That it has the exact same effects on their ability to learn?

 

[Gadofosveset]

Pimping makes a lot more sense on the other side. I agree with the above that it's usually something floating around in the attending's head put in the form of a question. How you answer is often more important than what you answer, and most attendings have probably forgotten asking you anything five minutes later.

 

[qw098]

Thanks guys for the feedback! You guys know who you are! Appreciate it. It was my first time being "pimped" and I was simply curious about the process.

Also, for the others.. thanks for the attacks

 

[charmiedermie]

You just came off of taking Step 1 and you couldn't name even one extraintestinal manifestation of UC or Crohn's? That's like basic Step 1 territory. Don't know why you're complaining, since this wasn't on a clerkship and there was no name-calling. There was no pimping either.

Yeah there kind of is a reason. The goal is to have the person who doesn't know the answer run home and read about it and know it cold. To a large extent someone busy on rotations is going to be quick to shrug off things he thinks will not come back to bite him. Putting a little fear of embarrassment into the situation makes sure that's not the case. If "not knowing" is tolerated the training is garbage. If people run home and read because you equate them to a peni$ flavored lollipop, then it served it's purpose. And if that helps you learn you'll actually have a thicker skin, get why they are doing this, and not hold a grudge. There are tons of nice attendings that let you coast and from whom you learn nothing. They aren't doing you any favors. The sad truth is it's often the SOB that's the only one who cares about you coming out of there well trained.

You can probably get most beginning 3rd year med students, stepping onto the wards, to read because they are so fearful of looking incompetent in front of a group of older people while rounding, because that grade matters for getting a residency. A simple, I am really disappointed or expected you to have read up on this because it's important to what we are going to do with this patient, usually works. Even if it is a rotation, it's still a workplace, and calling someone a penis-flavored lollipop is unprofessional, even if it's condoned by everyone else. You can easily embarass someone to motivate them, without using such filthy language. As with anything else, there is a line, but maybe that is why there is an HR department in all workplaces, so that some people can see what the line is.

I'm willing to bet that anesthesiologist that was recorded talking about a patient during a colonoscopy about wanting to punch a patientin the face and other pearls of wisdom, started out with a bad mouth with those around her, and used the same excuse.

 

[22031 Alum]

You can easily embarass someone to motivate them, without using such filthy language.

I work on honing this skill every day.

 

[22031 Alum]

I'm gonna go against the grain a little bit.

Most pimping is useless. It's esoteric, "read my mind" questions, often out of context.

It's not effective learning, nor is it Socratic in nature as its intended to be.

I do think there is something to be said for making expectations clear and holding students to said expectations. You can do that without relying on lazy pimp questions.

What are some lazy pimp questions you've seen? I'd never call pimping useless, but I have come to use the word as a general term for asking any questions at all. I'd hardly call the path of the ureter or the shunts of fetal circulation esoteric, "read my mind" questions.

 

[Señor S]

I'm gonna go against the grain a little bit.

Most pimping is useless. It's esoteric, "read my mind" questions, often out of context.

It's not effective learning, nor is it Socratic in nature as its intended to be.

I do think there is something to be said for making expectations clear and holding students to said expectations. You can do that without relying on lazy pimp questions.

Generally agree with this; I think "go read up on this and we'll talk about it tomorrow" is a better approach. And this part

I do think there is something to be said for making expectations clear and holding students to said expectations.

Amen. Attendings and residents, especially early in the year: a little guidance is always appreciated.

 

[pulmoblast]

I am glad I was pimped (although I admit I sometimes hated it at the time). Overall I enjoyed working with the toughest attendings/fellows/residents since it motivated me to read up on stuff and challenge them back. Other times I wanted to impress them by reading what I didn't know. I still remember many useful facts because I remember arguing with my attendings as I was being pimped. I also remember my embarrassingly wrong answers and awkward silences to questions I didn't know.

Of course all this assumes that the "pimper" has nothing but your education in mind, and is not doing it to make himself feel better.

With great pimping power comes great responsibility

 

[Señor S]

Authoritarian is this context refers to before who are both strict/demanding, and lack warmth and nurturing.
It's not a comparison to Stalin.

In this context perhaps the behavior is more common?

"Lack warmth and nurturing"...well, that's true enough, but I don't see it as a huge deal. You're just passing through after all. How "strict" and "demanding" is the attending though, in most situations? The worst they can do is give you a bad evaluation, and even that is somewhat circumscribed by the understanding that third year students generally do not fail out. This isn't the military.

 

[FrkyBgStok]

i have had some worthless pimping and some excellent pimping. the worthless pimping is when you are being grilled on the minutia that you would only learn as a specialist going into a certain field and questions that no 3rd or 4th year medical student should know if not interested in that specialty. Asking me where the 3 most common variations of a superficial nerve path in the lower extremities is a completely useless pimp question, and telling me that i need to read more and take my education more seriously is stupid. Not only am i not going to read about it, but I am blow it off at the end of the day as i am not interested in surgery. but being pimped on nasal canula oxygen effects on shunt dependent neonates when i am interested in pediatrics helps me understand the science behind it and is something i will go read about.

and when a doctor tells me to read about pertussis, and i know that doctor will grill me on everything pertussis related, including the physiology, it makes me go home and read about it until i understand it. so pimping, even when tough, can be incredibly motivating.

 

[Law2Doc]

Generally agree with this; I think "go read up on this and we'll talk about it tomorrow" is a better approach...

It's a better approach only if it works. 9 times out of 10 it doesn't -- weve all been there -- the student knows the attending likely will forget, and the student is busy/tired and really isn't afraid enough of the consequences if he knows he won't be verbally disemboweled. We've all shrugged off the nice feel-good attending. We don't take those risks with the lollipop guy.

 

[Psai]

It's a better approach only if it works. 9 times out of 10 it doesn't -- weve all been there -- the student knows the attending likely will forget, and the student is busy/tired and really isn't afraid enough of the consequences if he knows he won't be verbally disemboweled. We've all shrugged off the nice feel-good attending. We don't take those risks with the lollipop guy.

So true. Nothing motivates me more than looking stupid in front of all the residents and students

 

[Tots]

I'm gonna go against the grain a little bit.

Most pimping is useless. It's esoteric, "read my mind" questions, often out of context.

It's not effective learning, nor is it Socratic in nature as its intended to be.

I do think there is something to be said for making expectations clear and holding students to said expectations. You can do that without relying on lazy pimp questions.

I would say 90% of the questions I am asked are definitely "read my mind" type questions. Most of the time I can't win even when I actually know the answers. That being said, 90% of the time the attending(or resident) actually is trying to teach me something instead of just trying to make me feel like an idiot so the pressure is appreciated.

I love when the attending/resident says "How can you not know X? Your going to be a doctor!?" I have to hold myself back from making some smart ass comment.

 

[qw098]

You just came off of taking Step 1 and you couldn't name even one extraintestinal manifestation of UC or Crohn's? That's like basic Step 1 territory. Don't know why you're complaining, since this wasn't on a clerkship and there was no name-calling. There was no pimping either.

What, I couldn't name one? I named 8 and then I was told I should know more from the top of my head. That's irrelevant though. Thanks a lot guys from the help (those that did share their thoughts in a constructive way).

 

[Psai]

What, I couldn't name one? I named 8 and then I was told I should know more from the top of my head. That's irrelevant though. Thanks a lot guys from the help (those that did share their thoughts in a constructive way).

you're welcome (passive aggressive statement inserted here)

 

[Tots]

What, I couldn't name one? I named 8 and then I was told I should know more from the top of my head. That's irrelevant though. Thanks a lot guys from the help (those that did share their thoughts in a constructive way).

I can name like 3...geez I must be a slacker.

 

[Psai]

I can name like 3...geez I must be a slacker.

No worries tots. They're either a huge liar or the next coming of Osler

 

[Goro]

The problem with your logic is that these results did not concern adult learners.

You can start here for example: http://www.parentingscience.com/authoritarian-parenting.html

Lot's of Internet sources for you, dear.

"American adolescents have reported that teens with authoritarian parents were the least likely to feel socially accepted by their peers. They were also rated as less self-reliant"

"When researchers questioned 231 young adolescents about their cultural values and experiences with peers, they found that kids from authoritarian homes were more likely to have experienced bullying -- both as victims and perpetrators"

"In Dutch studies, kids with authoritarian parents were rated as less helpful and less popular by their teachers and classmates. They were also rated as less mature in their reasoning about moral issues"

"In Dutch studies, kids with authoritarian parents were rated as less helpful and less popular by their teachers and classmates. They were also rated as less mature in their reasoning about moral issues"

"Melissa Kamins and Carol Dweck have shown that a common tactic of authoritarian caregiving--shaming a child for poor performance--can make kids perform more poorly on problem-solving tasks"

"experiments suggest that people learn better from positive feedback than from negative feedback, and this may be especially true for kids"

"a study of adolescents in the San Francisco Bay Area found that the authoritarian parenting style was linked with lower school grades for all ethnic groups"

etc etc. And a quick Google search -tell me if you have difficulty with typing "authoritarian education" in the search engine! I will be glad to help- will yield thousands more result.

 

[Doudline]

The problem with your logic is that these results did not concern adult learners.

I know. I'm suggesting that we can draw inferences from the results anyway.

If someone in authority says something outrageous to you, e.g. "You're a piece of ****, go kill yourself", I think we can all agree that it's going to have negative psychological consequences whether the recipient is 7 y/o, 15 y/o or 25 y/o.

The case in the OP wasn't nearly this egregious -or egregious at all, for all I know- but if authoritarian teaching methods like the ones in the study are replicated with adults, I don't think it's unreasonable to say it'll have similar results to some extent.

 

[TBV]

This thread brought to you by Kleenex. From teary eyes and runny nose to full on butthurt, we are here for you. Kleenex.

 

[Wordead]

I know. I'm suggesting that we can draw inferences from the results anyway.

If someone in authority says something outrageous to you, e.g. "You're a piece of ****, go kill yourself", I think we can all agree that it's going to have negative psychological consequences whether the recipient is 7 y/o, 15 y/o or 25 y/o.

The case in the OP wasn't nearly this egregious -or egregious at all, for all I know- but if authoritarian teaching methods like the ones in the study are replicated with adults, I don't think it's unreasonable to say it'll have similar results to some extent.

The whole damn point everyone has is that no, we don't think it's going to have negative psychological consequences in a 25 year old because you're not an impressionable child anymore.

Your hypothesis is basically that there is no change in how we react to stimuli whether we are 5, 25, or 50 yrs of age. It's baseless and rather stupid.

 

[Tots]

I know. I'm suggesting that we can draw inferences from the results anyway.

If someone in authority says something outrageous to you, e.g. "You're a piece of ****, go kill yourself", I think we can all agree that it's going to have negative psychological consequences whether the recipient is 7 y/o, 15 y/o or 25 y/o.

The case in the OP wasn't nearly this egregious -or egregious at all, for all I know- but if authoritarian teaching methods like the ones in the study are replicated with adults, I don't think it's unreasonable to say it'll have similar results to some extent.

Though to be fair the 25 y/o will hopefully have developed successful coping mechanisms that they won't take personally some crazy physician calling them a piece of ****.

There is a silver lining in the 3rd year of medical school: Unless you do something egregious, you are going to be a physician in 2 short years. Yes, you shouldn't have to deal with the physician calling you a piece of ****, just because thats stupid, useless, and unhelpful but if its seriously giving you negative psychological consequences you should talk to someone about that. Your goal is to learn so you can be a good doctor someday, and you are invariably going to come across people with unsavory personalities but thats more of a fact of life and less specific to medicine.

 

[Goro]

A pathologist colleague of mine once suggest that if you're on the receiving end of an over-eager or harsh pimper, ask him/her to name the essential amino acids.

 

[Doudline]

Though to be fair the 25 y/o will hopefully have developed successful coping mechanisms that they won't take personally some crazy physician calling them a piece of ****.

There is a silver lining in the 3rd year of medical school: Unless you do something egregious, you are going to be a physician in 2 short years. Yes, you shouldn't have to deal with the physician calling you a piece of ****, just because thats stupid, useless, and unhelpful but if its seriously giving you negative psychological consequences you should talk to someone about that. Your goal is to learn so you can be a good doctor someday, and you are invariably going to come across people with unsavory personalities but thats more of a fact of life and less specific to medicine.

I agree with the general sentiment of your post, though abusive speech/behavior rarely happens in a vacuum.

Being told to kill myself wouldn't affect me very much -I played way too many games of LoL and DotA for that!-, but in reality it's likely to be the culmination of a history of physical or sexual harassment, public humiliations, etc. That's the more damaging part.

 

[trev5150]

On my med school surgery rotation, god help you if you couldn't tell you Eddie Money from Queen from Van Halen while holding the camera.

That's just a basic life skill.

 

[Dave89]

A simple, I am really disappointed or expected you to have read up on this because it's important to what we are going to do with this patient, usually works.

Yes, but it's quite possible for a student to be pimped on a patient (s)he just picked up that morning. In such a case, the student will most likely not have had time to read the UTD or Medscape article on the patient's conditions.

 

[amichel]

Just because med students have developed coping mechanisms doesn't mean it's okay for people to be abusive.... I get that a little bit of fear can be a motivator. But telling someone "you're stupider than you look" (story I head today) is just abusive and not helping anybody.

And, "that's how it is, deal with it" is not an appropriate response to abusive behaviour in medical training. Just because something has always happened doesn't mean it should continue.

 

[Tenk]

One of my attendings in med school and residency would always pimp me on super old school topics and things that I had no chance of hell at knowing. He'd always roll his eyes at me too.

Love the man for it because I am a better physician because of those interactions. You just need to have a better outlook on pimping. If you actually get engaged with the topic being presented and show interest (even if it's fake) the person pimping you will generally not care if you don't know or even get every question wrong. They just want you to show interest in their field or that topic, that's all.

For the people who use derogatory language though, that has no place anywhere and there is really no excuse. This doesn't sound like that, seems normal. Next time it happens just act interested and try your best. If you don't know just say: "I don't know but I'll read about it and get back to you."

 

[Tots]

Just because med students have developed coping mechanisms doesn't mean it's okay for people to be abusive.... I get that a little bit of fear can be a motivator. But telling someone "you're stupider than you look" (story I head today) is just abusive and not helping anybody.

And, "that's how it is, deal with it" is not an appropriate response to abusive behaviour in medical training. Just because something has always happened doesn't mean it should continue.

I completely agree that it is not OK and should not happen. But I also think that if it does happen a 25 y/o medical student should be able to handle it.

 

[22031 Alum]

A pathologist colleague of mine once suggest that if you're on the receiving end of an over-eager or harsh pimper, ask him/her to name the essential amino acids.

I just chuckled at this, I know it's a joke, but I feel compelled to warn students to never actually do this. Even a well-meaning attending who pimps to teach relevant info is unlikely to respond well to it. The prickly type who pimps to stroke their own ego would respond even worse.

 

[Gadofosveset]

We, as human beings and as doctors, do not like admitting when we are wrong or when we don't know something... But knowing how to deal with this is one of the essential skills for medicine and for life.

It won't come naturally, and it comes even less naturally to some people... You know the ones who always have to explain in detail why they are actually correct even if they're wrong. Pimping is a way to drive that skill into some people, and to be fair, it's extended to everyone.

 

[Gadofosveset]

I just chuckled at this, I know it's a joke, but I feel compelled to warn students to never actually do this. Even a well-meaning attending who pimps to teach relevant info is unlikely to respond well to it. The prickly type who pimps to stroke their own ego would respond even worse.

+ 10

Think it. Don't say it.
You will be entering a world of pain.

 

[22031 Alum]

We, as human beings and as doctors, do not like admitting when we are wrong or when we don't know something... But knowing how to deal with this is one of the essential skills for medicine and for life.

Another valuable aspect of pimping- getting you comfortable with admitting that you don't know something. My "meanest" moments as an attending have come when someone has tried to BS their way through something and put a patient at risk because they never learned to say "I don't know."

 

[Stagg737]

I know. I'm suggesting that we can draw inferences from the results anyway.

If someone in authority says something outrageous to you, e.g. "You're a piece of ****, go kill yourself", I think we can all agree that it's going to have negative psychological consequences whether the recipient is 7 y/o, 15 y/o or 25 y/o.

The case in the OP wasn't nearly this egregious -or egregious at all, for all I know- but if authoritarian teaching methods like the ones in the study are replicated with adults, I don't think it's unreasonable to say it'll have similar results to some extent.

To the bolded: That's called extrapolation and it is generally frowned upon by anyone with a basic understanding of scientific research. If you're going to say "research shows", you need to have studies that are specific to that question being asked, not something that may or may not somehow be related.

To the rest: I don't think anyone here would argue that telling someone "You're a worthless piece of ****" or "Go kill yourself" is appropriate, but you can insult someone appropriately and get a positive response. Plus there's a huge difference between those statements and saying something like the penis flavored lollipop thing or "How do you not know this?". At least 5 people in this thread have said they're grateful they were given harsh critiques, so clearly it has it's uses. I just hope my attendings are clever enough to hurl insults as unique as the lollipop one so I can laugh at myself when the time comes.

 

[Psai]

Another valuable aspect of pimping- getting you comfortable with admitting that you don't know something. My "meanest" moments as an attending have come when someone has tried to BS their way through something and put a patient at risk because they never learned to say "I don't know."

Agree. It's very humbling. Sometimes I say things that I'm not 100% sure about but I've learned that even if I'm right, it's better to be certain. One of the best lessons I've had in medical school so far

 

[Doudline]

At least 5 people in this thread have said they're grateful they were given harsh critiques, so clearly it has it's uses.

That's called extrapolation and it is generally frowned upon by anyone with a basic understanding of scientific research.

 

[Stagg737]

I'll edit that to say "it has it's uses for some".

Or you can just look at the tens of thousands of students that get insulted and go learn from it instead of crying in a corner. Doesn't change that you haven't provided any legitimate evidence for your argument or that the 'evidence' you presented was irrelevant crap.

 

[username456789]

snip

This post was nowhere near as clever as you thought it was.

 

[Psai]

It's not even right, the guy wasn't extrapolating. It was more a question of sample size