Ok, so who here abuses Med Students????

[Dunce]

$50 says he tries to pimp his residents.

One of my classmates pimped an intern in the OR at the beginning of his 3rd year surgery rotation. Just some dumb question about innervation or something. I wasn't there, but apparently the backlash from the chief resident was top notch!
Needless to say, that student was deservingly pimped into submission. All scrubbed up and nowhere to hide.

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[deleted50478]

One of my classmates pimped an intern in the OR at the beginning of his 3rd year surgery rotation. Just some dumb question about innervation or something. I wasn't there, but apparently the backlash from the chief resident was top notch!
Needless to say, that student was deservingly pimped into submission. All scrubbed up and nowhere to hide.

We have a rule- 'No pimping upstream' with pimping defined as asking questions you know the answer to and upstream being anyone futher along in training than you. Good rule.

 

[Stable asystole]

I have Pimped (asked almost obvious question and waited quietly until they answered or said I don't know) and they sputtered and muttered until finally they said they did not know. Fine...Hey we all forget and go blank, So I suggested that they do some reading. I was so frustrated when I asked the same question the next day, they still did not know the answer. When I was a medical student, I hated not having the right answer, but I would rather burn in hades than not know the right answer and related topics the next day. Am I OCD or should I expect that if they do not know the right answer on monday, they would have a firm grasp of the info on tuesday.

 

[toofache32]

I have Pimped (asked almost obvious question and waited quietly until they answered or said I don't know) and they sputtered and muttered until finally they said they did not know. Fine...Hey we all forget and go blank, So I suggested that they do some reading. I was so frustrated when I asked the same question the next day, they still did not know the answer. When I was a medical student, I hated not having the right answer, but I would rather burn in hades than not know the right answer and related topics the next day. Am I OCD or should I expect that if they do not know the right answer on monday, they would have a firm grasp of the info on tuesday.

I was a little passive aggressive with residents like you. If I got the ol' "read about it and report to the rest of us tomorrow" bit, it was amusing to see the resident's frustration the next day when I reported that I still don't have the answer. Only did it a couple of times, but it was worth it. Then again, grades in med school never mattered to me. Now that I think about it, I never even checked most of my grades.

 

[Stable asystole]

I was a little passive aggressive with residents like you. If I got the ol' "read about it and report to the rest of us tomorrow" bit, it was amusing to see the resident's frustration the next day when I reported that I still don't have the answer. Only did it a couple of times, but it was worth it. Then again, grades in med school never mattered to me. Now that I think about it, I never even checked most of my grades.

Toofache, I am glad to hear that passive aggressive is working for you, unfortunatly for the med students that did not feel the need or show the desire to learn (that is what is supposed to happen in medical school) they missed out on the proceedures. I do not feel comfortable allowing students that can not understand the basics, to perform proceedures. I will go way out of my way to hand proceedures to students that show desire, but way too many just wanted to slink though rotations. Medical school is not about getting by, or giving attitude to attendings, residents, or nurses, it is about learning about medicine. I was blessed with great teachers during my 3rd and 4th years, but they all made it clear....show some interest and they would teach, want to learn, and they would all, with out exception stay late, encourage, and give me the opportunities to prove myself (proceedures)

Now I may sound like an old man, and I may be, but everyone in the hospital has something to teach a student, but the student has to earn the respect of those around him/her, before you can expect to be taught. The doctor that I want to treat me, should be interested in learning not getting by.

 

[f_w]

Toofache, I am glad to hear that passive aggressive is working for you, unfortunatly for the med students that did not feel the need or show the desire to learn (that is what is supposed to happen in medical school) they missed out on the proceedures. I do not feel comfortable allowing students that can not understand the basics, to perform proceedures. I will go way out of my way to hand proceedures to students that show desire, but way too many just wanted to slink though rotations.

Some of the medstudents don't understand that most of the relevant clinical teaching they are going to get is from the residents on their rotation. Particularly irritating are the ones that get all interested the moment an attending or even the clerkship director is around and turn into lethargic disinterested slouches the moment they think they are 'safe'. The part most of them are missing is the fact that while residents won't be the ones filling out the primary eval at many medical schools, often the attendings will ask 'mh, I have to fill out this thing, wasn't that kid on your team ?'. (some medstudents ambition is apparently limited to 'getting by' and graduating with the minimal amount of effort required, luckily most are trying to get into good residencies and specialties and keep an eye on what impression they leave).

 

[fab4fan]

I hate to admit this, but when I was a med student, I used to carry around a bottle of developer and a bunch of testing kits in my coat so that I wouldn't have to waste time looking for it. Wrose than the nurses hiding it is when they hide it only to find that it isnt where they remember hiding it Especially handy to carry it with me on my 4th year GI rotation.

FYI: We are no longer allowed to have the developer for guiacs on the unit. Test kits have to go to the lab. I believe this was another one of JCAHO's brilliant ideas. So staff may not be hiding the developer just to give you a bad day.

 

[toofache32]

...Medical school is not about getting by, or giving attitude to attendings, residents, or nurses...

....or med students.

Now I may sound like an old man, and I may be, but everyone in the hospital has something to teach a student, but the student has to earn the respect of those around him/her, before you can expect to be taught. The doctor that I want to treat me, should be interested in learning not getting by.

Interesting. This is typical from the residents (who like to hear themselves talk) that thought they did students a favor by "teaching" them and assessing the students level of "knowledge" by how well the student plays their little power-trip games. I didn't come across many residents like this, but certain ones thrived on the fact that they their very own band of people (students) who were supposed to grovel at their feet with admiration and instant respect. These were the same residents who used their position of power to punish (down grade) the kids who did not "show respect." Maybe your are older....previous generations demanded instant respect, deserved or not. In the modern day it seems everyone has to earn respect, including residents.

And when did "procedures" become the holy grail which is held out like a sweet dessert for the good little boys who were good enough to finish their dinner? More power tripping? Interesting.

 

[da8s0859q]

oh booh hooh, my resident was a meanie to me. he doesn't kiss my butt like i want everyone to. oh woes me.

please.

Hey afterwards, lets go to the heme-onc floor and make fun of all those annoying patients complaining of nausea. I mean come on, man up!

 

[turkleton]

As a graduating student, I'm glad that there are residents like stable,asystole. I didn't mind getting "pimped" if it was non malignant and there was a teaching lesson behind it. The most I ever enjoyed the floors was when I was learning or being taught (two different things). And as a future doctor, paying 30g's for the right to be in the hospital, I thought I had an onus to learn something rather than sit idly by. However, I did get lethargic and lazy when I was kept around uselessly by some resident so I could watch him put in potassium orders for 2 hours.

As far as procedures... power tripping?? I'm not some gung ho gunner, but if I wanted to do a procedure- not because its a holy grail, because its f'in cool- of course I'd show interest and ask to do it. That has nothing to with power trips, it's just giving the opportunity to those who want it.... I have no clue what you're talking about

 

[ChildNeuro]

Having just finished medicine and surgery clerkships, I will say that Medicine was a blast, when you know how to have fun, i.e. if you know enough to have a good time on the wards, so if you can, read as much NMS and Medicine First Aid, and I would highly recommend the John Hopkins Internal Medicine Board Review AND read up on your patients. Most residents and atttendings don't read every night sadly, but if you are committed to it then you will build a really good knowledge base, one patient with pancreatitis I had read up on the latest treatments and was actually able to converse reasonably well with a medicine attending about new research cocerning when to start enteral feeds, and another resident who had read the same paper chimed in too, eventually I was able to spend a chunk of medicine doing work in the CCU, and loved that too. My medicine and surgery residents gave me a very wide berth and because they recognized that I was rapidly acquiring the skills and knowledge and could help out in significant ways AND that I really care about my patients, more than some interns and even residents. I enjoyed staying late to scrub in on extra surgeries and stayed late during medicine to see extra patients being admitted, plus attended all of the medicine and surgery lecutres AND went to the board reviews for surgery and medicine residents. Although not by design, I was often working harder than my residents and attendings whether they knew it or not, and got a reputation for an extremely hard worker during these rotations was commented upon as being a hard worker, plus, my greatest pleasure was "hijacking" surgery lectures (by insisting to do as many of the presentations as I could), almost half of my psychiatry lectures, and handing out several articles to med students and residents during my medicine rotation. Once I even pimped an attending who was semi-hecklng one of my presentations. I just decided that I have nothing to fear of attendings and residents because:

1. I am likely more committed to learning medicine than you.
2. I can work harder than you and stay awake longer.
3. I can teach very well.
4. I am committed to patient care and serving indigent communities in developing countries.
5. If you pimp me I will probably answer correctly and pimp you back.

(I just wouldn't say this to their faces, try to be really nice!) Some attendings will abuse you very badly regardless, I would transfer out of the rotation and get a lawyer, medical student abuse should be taken seriously.

 

[punjabiMD]

Having just finished medicine and surgery clerkships, I will say that Medicine was a blast, when you know how to have fun, i.e. if you know enough to have a good time on the wards, so if you can, read as much NMS and Medicine First Aid, and I would highly recommend the John Hopkins Internal Medicine Board Review AND read up on your patients. Most residents and atttendings don't read every night sadly, but if you are committed to it then you will build a really good knowledge base, one patient with pancreatitis I had read up on the latest treatments and was actually able to converse reasonably well with a medicine attending about new research cocerning when to start enteral feeds, and another resident who had read the same paper chimed in too, eventually I was able to spend a chunk of medicine doing work in the CCU, and loved that too. My medicine and surgery residents gave me a very wide berth and because they recognized that I was rapidly acquiring the skills and knowledge and could help out in significant ways AND that I really care about my patients, more than some interns and even residents. I enjoyed staying late to scrub in on extra surgeries and stayed late during medicine to see extra patients being admitted, plus attended all of the medicine and surgery lecutres AND went to the board reviews for surgery and medicine residents. Although not by design, I was often working harder than my residents and attendings whether they knew it or not, and got a reputation for an extremely hard worker during these rotations was commented upon as being a hard worker, plus, my greatest pleasure was "hijacking" surgery lectures (by insisting to do as many of the presentations as I could), almost half of my psychiatry lectures, and handing out several articles to med students and residents during my medicine rotation. Once I even pimped an attending who was semi-hecklng one of my presentations. I just decided that I have nothing to fear of attendings and residents because:

1. I am likely more committed to learning medicine than you.
2. I can work harder than you and stay awake longer.
3. I can teach very well.
4. I am committed to patient care and serving indigent communities in developing countries.
5. If you pimp me I will probably answer correctly and pimp you back.

(I just wouldn't say this to their faces, try to be really nice!) Some attendings will abuse you very badly regardless, I would transfer out of the rotation and get a lawyer, medical student abuse should be taken seriously.

joke?

 

[Tired]

Some attendings will abuse you very badly regardless, I would transfer out of the rotation and get a lawyer, medical student abuse should be taken seriously.

You would get a lawyer?! Good God I hope this is joke . . .

 

[deleted87716]

I hope that's satire. If not, God help him.

 

[f_w]

I guess there is a fine line between being a good medical student and just a brown-nosing pain in the arse.

 

[8744]

I have Pimped (asked almost obvious question and waited quietly until they answered or said I don't know) and they sputtered and muttered until finally they said they did not know. Fine...Hey we all forget and go blank, So I suggested that they do some reading. I was so frustrated when I asked the same question the next day, they still did not know the answer. When I was a medical student, I hated not having the right answer, but I would rather burn in hades than not know the right answer and related topics the next day. Am I OCD or should I expect that if they do not know the right answer on monday, they would have a firm grasp of the info on tuesday.

Oh fer crying out loud. Like I said, the educational benefit of pimping is miniscule and not worth the effort. And this isn't third grade where we need to assign extra reading or punitive assignments. Not being able to recall Ranson's criteria when put on the spot says nothing about a student's intelligence or abilities.

As for preferring to burn in hades than not to be able to instantly recall some obsure point from a journal that nobody reads, well, life is too short to waste study time looking up trivia. You can spend an hour a day reading a review book for the rotation you are on or you can waste it looking up trivia.

Pimping is not the Socratic method. It's a poor excuse for it, actually.

You are OCD and you need to chill out.

 

[f_w]

Not being able to recall Ranson's criteria when put on the spot says nothing about a student's intelligence or abilities.

Being unwilling to look them up when asked to do so IS an indication of the student's intelligence and abilities.

 

[sirus_virus]

You would get a lawyer?! Good God I hope this is joke . . .

Why not? Everyone sues these days. With the right lawyer and right(or wrong) jury you can get any type of judgement you want.

 

[Stable asystole]

Oh fer crying out loud. Like I said, the educational benefit of pimping is miniscule and not worth the effort. And this isn't third grade where we need to assign extra reading or punitive assignments. Not being able to recall Ranson's criteria when put on the spot says nothing about a student's intelligence or abilities.

As for preferring to burn in hades than not to be able to instantly recall some obsure point from a journal that nobody reads, well, life is too short to waste study time looking up trivia. You can spend an hour a day reading a review book for the rotation you are on or you can waste it looking up trivia.

Pimping is not the Socratic method. It's a poor excuse for it, actually.

You are OCD and you need to chill out.

I guess I need to clarify what I consider pimping. When giving a drug, like coumadin how do you reverse the effects. When doing a central line, what is the anatomy that you might find, and what are the possible complications. I consider these basic points of knowlege. When I ask these quesitons I am trying to: 1 understand the level of knowlege of the student, so I don't underestimate or overestimate thier understanding. If you do not know this information, I personally think it would be in the students best interest to learn them, for boards, and to be a better physician. 2: Seeing if the student is prepairing for the day. I have to read, I have to be prepared. and I expect the same from the student. I never insult, belittle, or badger a student, I want to help and support them, but I have no obligation to teach, I have a desire to teach, if the student is intersted I will go way out of my way to teach and support, but if they are just hiding, why waste my time.

I wrote this to try to clarify this thread. I think there is a lot of malignant pimping that only serves to damage the learning process, but asking questions so that teaching can build from them is important, otherwise rotations are useless for everyone. I hate pimping that asks obscure and stupid topics. To me pimping includes probing the knowlege base of a student to see where to start.

 

[EctopicFetus]

Being unwilling to look them up when asked to do so IS an indication of the student's intelligence and abilities.

No its merely a sign of their interest.

 

[Apollyon]

So I have this total dingus of a drunk last night (I swear, the police wrote the whole book of tickets), who had a forehead lac. I was dreading this because, of course, I had other patients to wrap up. Well, I see the surgery resident, and say, "Do you have a med student who might want to do a closure?" He calls upstairs on the phone, and, in less than a minute, has gotten someone, and said, "Be here in 5 minutes to close a wound".

Just like that, this totally cute young lady (like, >10 years younger than me) shows up, and the resident first shows her a diagram he drew about the patient that I had called him for (an SBO), then guides her through the closure. Even though a third year student, she did a fine two-layer closure.

It was liberating. When you have a motivated student, it's evident.

 

[Tone2002]

No its merely a sign of their interest.

I would think that is part of it. Maybe the student isn't that interested in that specialty or procedure for whatever reason. Its not the end of the world, but of course there are consequences for every action.

 

[EctopicFetus]

totally.. but preparing a "talk" on a topic and then not doing doesnt mean they arent smart. I never failed to prepare for something like this but I had classmates who were real smart but just didnt give a F and often were just annoyed so they chose not to do it.

 

[turkleton]

To everyone who believes any sort of questioning of the medical student is vicious pimping... what the hell do you assess students on then? If their socks match? If someone is going to grade me, I'd like to think that there is some substance behind the process. If showing interest, demonstrating a basic knowledge base (p.s. if you're a 3rd year you should know where the IJ is and what coumadin does), and learning things you don't know are deemed superflous or a resident expecting that is an a**hole then what is it that you grade students on?

 

[EctopicFetus]

To everyone who believes any sort of questioning of the medical student is vicious pimping... what the hell do you assess students on then? If their socks match? If someone is going to grade me, I'd like to think that there is some substance behind the process. If showing interest, demonstrating a basic knowledge base (p.s. if you're a 3rd year you should know where the IJ is and what coumadin does), and learning things you don't know are deemed superflous or a resident expecting that is an a**hole then what is it that you grade students on?

I dont think anyone thinks asking "questions" equals viscious pimping. I think students should be evaluated on their timeliness, their effort, having things done and not making life tougher. As far as your "knowledge", isnt that what the shelf is for?

FWIW the purpose of pimping should be to encourage learning and reading. I think a lot of people just pimp away and dont even bother teaching, it is almost like they want to feel better about themselves. Im a resident now and I cant say I have had a problem with this ever but I have seen some and heard of some riduculous stuff going on.

 

[toofache32]

I guess I need to clarify what I consider pimping. When giving a drug, like coumadin how do you reverse the effects. When doing a central line, what is the anatomy that you might find, and what are the possible complications. I consider these basic points of knowlege. When I ask these quesitons I am trying to....

Why the games? If you want them to know something just tell them the info. That's how I learn best....just tell me.

 

[Mumpu]

I ask questions so I can assess what students do and do not know. If they know the answers, they win because I comment on their excellent knowledge base in my evals. If they do not know the answer, they win because they get taught and I never hold not knowing an answer on the spot against a student. I also consider it my job to find a bit of history or exam that the student missed because that makes for good teaching points. I also coach my students in terms of the most important learning points of their patients that they should be familiar with for rounds the next morning. I plainly disclose all of these facts to my students at the beginning of the rotation.

Can you be like Toofache and be a total ass about it? Sure you can but YOU will hurt for it.
1) I will write on my evaluation that you are disinterested and have poor work ethic
2) I will pass it on to my resident
3) The resident will pass it on to the attending

I buff my med students so they can get great attending/resident evals and get into residencies of their choice. Everyone pays attention to medicine eval and since IM docs are not known to be particularly vicous, bad comments will raise red flags on your dean's letter.

Aside from that, remeber that even though I love teaching, I can do things faster without a student at my side. Be an ass and you will have an easy rotation with short hours because I will not page you for procedures, interesting teaching from consultants or pathology, looking at urine micro/blood/Gram-stains. Since I decide which patients you get and you've made an effort to be difficult, you will not get anyone intersting, challenging, or in any way complicated. You will become the master of writing CIWA protocols by the end of the month.

Or you can behave like an intelligent, well-educated, decent human being -- show up, work hard, learn, reap rewards.

p.s. If you think I sound self-righteous or like a vengeful bitch, consider this: people will rely in part on my evaluations to figure out what kind of resident you will be (or if you should be allowed to graduate at all). Med students with **** for attitude make residents with **** for attitude who then make doctors who mismanage and misdiagnose and kill people. You can exclaim "au contraire" and that you just don't like the rotation or that you are fighting the Man and the Pimping Tradition. Perhaps, but I don't know that. All I see is a smart-ass with a crappy attitude and poor work ethic, and I will evaluate you as such.

 

[toofache32]

I ask questions so I can assess what students do and do not know. If they know the answers, they win because I comment on their excellent knowledge base in my evals. If they do not know the answer, they win because they get taught. I also consider it my job to find a bit of history or exam that the student missed because that makes for good teaching points. I also coach my students in terms of the most important learning points of their patients that they should be familiar with for rounds the next morning. I plainly disclose all of these facts to my students at the beginning of the rotation.

Can you be like Toofache and be a total ass about it? Sure you can but YOU will hurt for it.
1) I will write on my evaluation that you are disinterested and have poor work ethic
2) I will pass it on to my resident
3) The resident will pass it on to the attending

I buff my med students so they can get great attending/resident evals and get into residencies of their choice. Everyone pays attention to medicine eval and since IM docs are not known to be particularly vicous, bad comments will raise red flags on your dean's letter.

Aside from that, remeber that even though I love teaching, I can do things faster without a student at my side. Be an ass and you will have an easy rotation with short hours because I will not page you for procedures, interesting teaching from consultants or pathology, looking at urine micro/blood/Gram-stains. Since I decide which patients you get and you've made an effort to be difficult, you will not get anyone intersting, challenging, or in any way complicated. You will become the master of writing CIWA protocols by the end of the month.

Or you can behave like an intelligent, well-educated, decent human being -- show up, work hard, learn, reap rewards.

Just to be clear, I hope you haven't confused my refusal to kiss a$$ with my work ethic and other aspect of being a student. I always got my work done right, and quicker than most of the other students. I volunteered for the crappy jobs and asked "is there anything else I can do?" I got along very well with ALL my residents except 2 which were females (go figure).

On the other hand, I was always the guy who refused to follow around a resident to watch him write orders for 2 hours at the end of the day. Upon sensing this was happening, I would say "unless you've got anything else to do, I'll see ta tomorrow." They were often caught up in their own work and would say "oh yeah....you guys should have left an hour ago." The other students were always too scared to ask for some reason but loved having me around to do the "dirty work". I didn't mind because I would much rather see my family when skool is over rather than stand around doing nothing.

Again, I'm a "grown-ass man" as someone else stated....I'm a few years older than most med students and I know how to separate the real experiences from the bull****. I have to admit I have no idea what you're talking about concerning grades and evaluations....I don't even know if we got evals but probably so. And I don't even know what my grades were like. My med school was part of my oral surgery residency so I was "matched" before I even started med school.

 

[turkleton]

Agree with mumpu. Come to work. I'll admit I absolutely hated my ob-gyn rotation and didn't exactly put in a sterling effort- my eval appropriately reflected that. As for assessing knowledge, yea of course the shelf does that-but anyone who took one of those is aware that's not how the floor is run. Questions asked of me, and things I asked the resident, were to demonstrate at how many levels you have to think with one patient. I had some solid residents and attendings and learned muuuuuuuuuch more 3rd, 4th year then I feel I did 1st and 2nd... don't ask my how to qualify this.

 

[cdql]

Why the games? If you want them to know something just tell them the info. That's how I learn best....just tell me.

Ehh...I would say that's the fastest way to learn.

In truth, (while I also like being told things and not relentlessly questioned about them), it does help me learn if I'm forced to think of the answer

 

[Entei]

I also consider it my job to find a bit of history or exam that the student missed because that makes for good teaching points.

I'm not sure I see the teaching point that you're trying to make here. Is it that you as the resident are able to perform a more pertinent and complete history and exam than a third year student? Shouldn't that be obvious? You do have much more experience and deal with this everyday, whereas the student is only just starting out and is on your service for at most a few weeks before being whisked away. Maybe you didn't mean for this to sound so adversarial, but it's certainly frustrating as a student when you do a damn good presentation only to find someone in the audience that makes it his mission to find something, anything, you may have missed, no matter how trivial.

Be an ass and you will have an easy rotation with short hours because I will not page you for [...] looking at urine micro/blood/Gram-stains.

I agree with most of what you wrote, although your tone makes it seem like the "power" that comes with writing student evaluations may have gone to your head a bit. I'm one of those masochists who actually enjoys a good pimping session. I'm not afraid to say "I don't know." I'm very interested in learning things that I think will be important to my future field. And I enjoy working hard and helping out my team. I'm the first to volunteer to do scut. I derive great satisfaction from simply getting things DONE.

But I would rather guiac 20 patients, wheel 15 more down to CT, and get coffee and donuts for my entire team than be paged to go look at some "interesting" urine/blood/Gram-stains. This kind of activity is more punishment than reward, IMO. I just don't see the tremendous educational opportunity here beyond "gee whiz, doesn't that look cool?" and neither do I see how this makes the team more efficient or improves patient care in a significant way. Please don't write off students like me as slackers because we're less than enthusiastic about this sort of thing.

 

[deleted87716]

I would rather guiac 20 patients, wheel 15 more down to CT, and get coffee and donuts for my entire team than be paged to go look at some "interesting" urine/blood/Gram-stains.

Be careful what you ask for...you just might get it. "Unenthusiastic" students are frequently rewarded with extra DREs and Starbucks runs.

 

[CaliOBGynee]

I actually think it's fun when attendings ask questions when they're not trying to be intimidating. I learn a lot because it's interactive. When I give a good shot at the answer, I like it when they say..."that's a good thought, but what about...." It's best when I admit "I don't know" and the attending doesn't push it any further or belittle me for not knowing. That's how you get students to like you.

When they ask me to look something up that I don't know, that's fine. But if they ask me to prepare a presentation, and then they never have time for me to present ...that SUCKS. It's just disrespectful and a waste of my time. I could have just looked up the answer and saved the time I spent preparing my talk and a hand-out.

Also....other medical students should NOT pimp their classmates in front of other residents...EVER. You're just showing off so stop it now!

 

[lateness]

And why?

I just got chewed out in front of 7+ people by my chief resident b/c I missed a "what am I thinking" question. He didn't relent until he was stopped by the attending, and everyone came up to me afterwards and apologized for him. Why would someone do something like this? Don't you remember what it's like to be a medical student? Are we less than human to you? Do you get pleasure out of crushing what miniscule dignity we have in the clinics?

Or did someone abuse you and that made you a better doctor?
It would be really interesting to hear the rationale in this anonymous medium. I know there are people out there that have reduced others to tears - let's hear it!

thats just wrong. being mean is not cool. I remember during 3rd year surgery, where one surgeon was just mean to everyone, students, nurses, other docs, patients, etc.., and the other one worked harder, more experienced and was the nicest doc i have ever met, even when "pimping". bottom line is it's personality, some people are just ruder and mean by nature, and others are nice. lifes to short to waste stress on being mean, and angry,
i am never mean to anyone,

 

[Mumpu]

Entei, no the levels of knowledge are technically implicit in the job titles (although I've seen both stellar med students above and beyond my meager knowledge and stupid-ass senior residents). But what will a student learn if they present a patient and I go "yup." I learn something new every day because my senior, fellow, or attending points out something I missed, and many of these lessons permanently alter my H&P routine.

As for slide/micro stuff, you obviously have never been taught it well. If you have autonomy and care for sick patients, these skills can be invaluable. I can ascertain if my patient has ATN in 5 minutes and not after waiting for the 5 pm renal consult (very handy for that tanking ICU admit at 2 am). I have diagnosed rhabdo as the cause ARF when rhabdo was not even in the differential for the patient. I can make an educated guess about causes of anemia or other "-penias" from looking at a peripheral smear for 5 minutes before the battery of tests comes back. I have much better understanding of the rational use of antibiotics because I know a bit of microbiology. Actively engaging in these basic lab activities makes you think about the tests and the results and gives you a much better clinical understanding. Do a month of renal, a month of ID, and a month of hematology. Find someone who would be willing to each you about this stuff. To say the hands-on lab visits are unimportant is to say that physical exam doesn't matter because you are going to echo and pan-CT anyway. A monkey in a white coat can write for CT chest/abdomen/pelvis and 500 of levo. Presumably there is a reason why we do med school and residency. Or am I wrong?

 

[Entei]

Entei, no the levels of knowledge are technically implicit in the job titles (although I've seen both stellar med students above and beyond my meager knowledge and stupid-ass senior residents). But what will a student learn if they present a patient and I go "yup." I learn something new every day because my senior, fellow, or attending points out something I missed, and many of these lessons permanently alter my H&P routine.

No one wants you to say just "yup." The tone of your first post ("I consider it my job to find things that the student missed.") sounds less like a cooperative, educational environment and more like a situation in which the student will always be at fault for something. Yes, of course we all learn from going over mistakes, but there's a lot to be said for having help to addess those mistakes before they happen and also for giving encouragement when students show improvement. I think these things are important to keep in mind, especially when we're talking about students who may be less than enthusiastic about a particular subject. If all the student ever receives is negative attention, it's not surprising that they'll be quickly turned off the subject altogether. I'm not saying that you do this, but the tone of your original post made it seem like positive reinforcement is prioritized less highly.

As for slide/micro stuff, you obviously have never been taught it well. If you have autonomy and care for sick patients, these skills can be invaluable. I can ascertain if my patient has ATN in 5 minutes and not after waiting for the 5 pm renal consult (very handy for that tanking ICU admit at 2 am). I have diagnosed rhabdo as the cause ARF when rhabdo was not even in the differential for the patient. I can make an educated guess about causes of anemia or other "-penias" from looking at a peripheral smear for 5 minutes before the battery of tests comes back. I have much better understanding of the rational use of antibiotics because I know a bit of microbiology. Actively engaging in these basic lab activities makes you think about the tests and the results and gives you a much better clinical understanding. Do a month of renal, a month of ID, and a month of hematology. Find someone who would be willing to each you about this stuff. To say the hands-on lab visits are unimportant is to say that physical exam doesn't matter because you are going to echo and pan-CT anyway. A monkey in a white coat can write for CT chest/abdomen/pelvis and 500 of levo. Presumably there is a reason why we do med school and residency. Or am I wrong?

Actually, I had excellent teachers for my basic science curriculum, and I wouldn't blame any deficiencies I might have on their ability to teach the material. The emphasis though, was on the interpretation of the results and not the technical details of how those results are obtained. I don't find this interpretation and discussion uninteresting. In fact, I think it's very educational, but we were able to have these discussions just fine without making the field trip down to the lab to spin the urine ourselves. To use your monkey analogy, any monkey can order a CT, and a trained monkey can operate the machine and give the patient their IV contrast, but the real thinking lies in interpreting the results.

You mentioned physical exam skills. Even in today's pan-CT era these are still important. They are basic skills that every physician should know, and they're tested on Step 2. There are also plenty of questions on Step 2 on "how to interpret this lab data", "what kind of antibiotics should you use", or "what kind of anemia is this", but there are no questions on "what kinds of casts do you see in this picture" or "what are the steps in performing a Gram stain". I'm not trying to argue that all teaching should be directed towards passing Step 2, but if this exercise of going to the lab is supposed to be a "reward" for those students that demonstrate enthusiasm, why not spend the time going over things that will be more immediately useful to them?

 

[f_w]

I start to understand where the 'checkbox medicine' physicians come from that I deal with on a day to day basis.

 

[8744]

Being unwilling to look them up when asked to do so IS an indication of the student's intelligence and abilities.

No. He probably looked them up and then forgot them just like we do with most trivia that we don't use every day. But at least he knows what they are and can probably recall them in a pinch or at least look them up in five seconds. When he needs them for real and not for some pimping exercise he's going to remember them willingly.

Being unwilling to look things up just because his resident has no regard for his time says nothing about his intelligence or his abilities, just his low tolerance for chicken****.

Hey, you asked him, he didn't know. Rather than simply tell him you asked him to research it. Then you had the bad manners to put him on the spot the next day. He either looked it up or he didn't but that's his lookout and his shelf exam scores will tell you all you need to know. My attendings suggest certain readings and articles and by God I look them up and read them because they are sincerely interested in education and not on some power trip.

This is why I despise academic medicine. It is the most inefficient way to learn ever devised. basically, you get a captive herd of medical students and residents and drag them around all day wasting time to the point that all anybody really wants to do is sit down and rest.

If you really wanted to teach residency programs would devote more time to didactics and less to scutwork. My program has a protected block of time every week for lectures. It's a half day and I really appreciate it even if it should be a whole day. The problem is that a lot of residency programs begrudge this time to their slaves because it interferes with moving the meat.

 

[Tired]

If you really wanted to teach residency programs would devote more time to didactics and less to scutwork. My program has a protected block of time every week for lectures. It's a half day and I really appreciate it even if it should be a whole day. The problem is that a lot of residency programs begrudge this time to their slaves because it interferes with moving the meat.

You really don't put stock in the value of patient management to medical education? Lectures are necessary to an extent, but I've really bought into the older docs' argument that the more time you hang around patients, the more likely bad things will happen, and the more you learn. I, for one, can't stand lectures, and have had enough of them. I'll take clinical time over lectures any day of the week, even if it means getting the uppers coffee and dealing with periodic pimp-fests and abuse.

 

[elizabeth5863]

I've been pimped a whole lot as a med student and it bothered me at first but after awhile, it didn't. I started getting comfortable with saying "I don't know." The knowledge deficits and the "many I don't know's" also motivated me to study harder and learn more. When I get pimped, I remember things better anyway. Most of the pimping goes on during surgery, internal medicine, OB-GYN. I think that pimping is fine - if not in excess. Instead of thinking of it as pimping, I started thinking of it more as the socratic method. There were a few rotations where residents and the attendings didn't pimp at all. It was very boring for me because they didn't do much teaching either. The ones who pimp (or use the Socratic Method) often are the ones who do more teaching. I think that the pimping sessions also made me stronger. I'm not as scared about being humiliated or when I get yelled at by difficult and mean patients. Being pimped a whole lot also helps you to develop a thick skin. You either fall apart and become vulnerable, or you develop a thick skin - which I think is crucial in medicine. Also, the more you ask questions and show that you're really interested in learning, the less likely you are to get pimp. I also started thinking of pimping as more of a way to start a discussion on something. I wouldn't get too offended by it. It started with me losing confidence in my skills and capabilities at first, but then I started learning more and more with the pimping sessions and started piecing things together. Also, I'd rather be pimped (in a fun manner) than spend the whole day in clinic, ER, or on the wards without having been taught nothing. If you change your perspective a little bit and focus on learning as much as you can to provide the best care for your pts, it will only get better. Also, the pimping itself isn't that bad. It's how you deal with it - i.e. is it better to spend time getting upset or to do something productive like reading? Also, most docs who pimp me are not the insecure, incompetent ones but are the really smart, confident ones. They know a whole lot. Pimping is also necessary because they need to give you a grade at the end of the clerkship. If they don't pimp you at all, then they wouldn't be able to fill out their evaluation form.

 

[f_w]

Hey, you asked him, he didn't know. Rather than simply tell him you asked him to research it. Then you had the bad manners to put him on the spot the next day. He either looked it up or he didn't but that's his lookout and his shelf exam scores will tell you all you need to know.

Actually, I just commented on an incident reported by someone else here.

Still, with the passive aggressive lazy refusal to look something up, this medstudent also deprived the other students on the team of the opportunity to learn something. Unwillingness to learn is a type of stupidity.

(full-frontal lectures and learning from manuals might work if all you have to do is teach someone how to drop a grenade into a tube without blowing himself up. In medicine, if you want to be anything but checklist based ordering automaton it helps to learn things to a bit more depth than the multiple choice exams require it)

 

[Stable asystole]

I've been pimped a whole lot as a med student and it bothered me at first but after awhile, it didn't. I started getting comfortable with saying "I don't know." The knowledge deficits and the "many I don't know's" also motivated me to study harder and learn more. When I get pimped, I remember things better anyway. Most of the pimping goes on during surgery, internal medicine, OB-GYN. I think that pimping is fine - if not in excess. Instead of thinking of it as pimping, I started thinking of it more as the socratic method. There were a few rotations where residents and the attendings didn't pimp at all. It was very boring for me because they didn't do much teaching either. The ones who pimp (or use the Socratic Method) often are the ones who do more teaching. I think that the pimping sessions also made me stronger. I'm not as scared about being humiliated or when I get yelled at by difficult and mean patients. Being pimped a whole lot also helps you to develop a thick skin. You either fall apart and become vulnerable, or you develop a thick skin - which I think is crucial in medicine. Also, the more you ask questions and show that you're really interested in learning, the less likely you are to get pimp. I also started thinking of pimping as more of a way to start a discussion on something. I wouldn't get too offended by it. It started with me losing confidence in my skills and capabilities at first, but then I started learning more and more with the pimping sessions and started piecing things together. Also, I'd rather be pimped (in a fun manner) than spend the whole day in clinic, ER, or on the wards without having been taught nothing. If you change your perspective a little bit and focus on learning as much as you can to provide the best care for your pts, it will only get better. Also, the pimping itself isn't that bad. It's how you deal with it - i.e. is it better to spend time getting upset or to do something productive like reading? Also, most docs who pimp me are not the insecure, incompetent ones but are the really smart, confident ones. They know a whole lot. Pimping is also necessary because they need to give you a grade at the end of the clerkship. If they don't pimp you at all, then they wouldn't be able to fill out their evaluation form.

Amen

 

[Dr. V]

Actually I always liked to be pimped because it taught me alot and it revealed my weaknesses.

I am the type of person that isn't the greatest at retaining the minute details if I do alot of reading, the idea sticks but not the details, UNLESS I am tested on it. Then I remember it fairly well.

I guess I hate to be embarrassed so much that when I get a question wrong in front of everyone it burns it in my mind and I remember it from then on, don't know.

I do also think it serves a purpose. I would hate to think some standardized test determined who was and was not a physician. We already have enough jerks out there that only want to be 9-5ers and punch a clock and piss on the patient.

I have never given anything but good evals to the students that I have had, and they earned them. I would not hesitate to give an F if I thought someone was unfit to progress. (meaning attitude and professionalism, not knowledge because as someone else stated that is tested quite a bit already).

One resident eval wouldn't hurt you too bad in our program (the sum of the residents evals are a large portion of the grade, something like 20-25% but one wouldn't make the sum change that much). But, I assure you that as laid back as I am if you did something to cause me to give you a bad eval then you would be absolutely scalped by the rest LOL.

Personally I think it looks good on the resident to have prepared the students well so I try and tell them what the attending expects, what questions he might ask in the OR, what they like to see in their notes etc.

 

[toofache32]

...Still, with the passive aggressive lazy refusal to look something up, this medstudent also deprived the other students on the team of the opportunity to learn something. Unwillingness to learn is a type of stupidity....

Oh Puhhhhleeeeese.

 

[Entei]

I start to understand where the 'checkbox medicine' physicians come from that I deal with on a day to day basis.

I start to understand where the 'power-tripping' residents that pay lip service to teaching come from that I've had to deal with on occasion.

 

[YouDontKnowJack]

next time, have some thick skin, and act like you're about to cry. start sniffling, make a funny looking sad face.

That might shut the pimp up and make your fellow students chuckle.

 

[cowbell]

Hey, you asked him, he didn't know. Rather than simply tell him you asked him to research it. Then you had the bad manners to put him on the spot the next day. He either looked it up or he didn't but that's his lookout and his shelf exam scores will tell you all you need to know. My attendings suggest certain readings and articles and by God I look them up and read them because they are sincerely interested in education and not on some power trip...

...If you really wanted to teach residency programs would devote more time to didactics and less to scutwork...

I'm with elizabeth5863. In a learning environment, what's wrong with asking your student or trainee about the basic questions that should be running across everyone's mind, such as a patient's signs and symptoms, salient distillation of presentation, a differential diagnosis, diagnostic approach, therapeutics, relevant studies, pitfalls, and walkaway points? Not everyone enjoys learning from didactics. And in fact, many consider didactics a poor way to learn medicine. I'd argue that if someone couldn't answer the question "on-the-fly", he/she wasn't familiar enough with the topic.

I do agree that pimping on really obscure stuff is worthless and a waste of time.

 

[8744]

Actually, I just commented on an incident reported by someone else here.

Still, with the passive aggressive lazy refusal to look something up, this medstudent also deprived the other students on the team of the opportunity to learn something. Unwillingness to learn is a type of stupidity.

(full-frontal lectures and learning from manuals might work if all you have to do is teach someone how to drop a grenade into a tube without blowing himself up. In medicine, if you want to be anything but checklist based ordering automaton it helps to learn things to a bit more depth than the multiple choice exams require it)

First of all, "depriving other students on the team of an opportunity to learn" is a pretty weak charge and it would never stick. I suppose he's to be held responsible if they screw up their shelf exams? I understand that medicine is a team sport nowadays but this is ridiculous. The poor guy is just following along, minding his own business, keeping his eyes and ears open and you are bound and determined to make it even more of an ordeal for him.

You have a lot of faith in your pimping skills if you believe random questions indiscriminantly fired on the wards are a better way to teach than a conference, a lecture, or reading. By definition pimping is without any depth whatsoever.

You drop mortar rounds in tubes, not grenades. A grenade would just kind of sit at the bottom of the tube until it detonated. Infantry combat and war in general is a good deal more complex than you imagine, by the way, and requires a good critical thinking skills, judgement, and (something medicine does not) physical and moral courage. Medicine lends itself more to "check boxes" than infantry operations.

 

[8744]

You really don't put stock in the value of patient management to medical education? Lectures are necessary to an extent, but I've really bought into the older docs' argument that the more time you hang around patients, the more likely bad things will happen, and the more you learn. I, for one, can't stand lectures, and have had enough of them. I'll take clinical time over lectures any day of the week, even if it means getting the uppers coffee and dealing with periodic pimp-fests and abuse.

Sure I do. But unless your program has formal lectures and conferences, you are going to be cheated out of some of your medical education because a lot of what you will do in the hospital is mindless scutwork of a type that they don't even do in non-academic hospitals and could be done by a clerk if it really had to be.

As a resident, you are just cheap labor after you learn enough to start being useful. As for medical school, our medical education model is all wrong and driven by the needs of the hospital, not the students. It would be better to spend less time on the wards in third and fourth year and more time in lectures because, and I defy anyone to say otherwise, a good portion of your time in third and fourth year is spent wandering around the hospital doing essentially nothing with the occasional interruption for useful information. And it takes up so much of your time that you don't have that much time (or energy) to read on your own.

In the Pandaverse, before every third year block, you would have two weeks of lectures to reinforce what you learned in second and third year as well as to teach the nuts and bolts of the rotations, things you only get haphazardly in the current model.

It will never happen, of course, because academic hospitals are set up to move the meat as quickly as possible and you could not get enough physicians to lecture. maybe the current system is unavoidable and the best that can be done but let's not pretend it's efficient or optimal

 

[f_w]

I understand that medicine is a team sport nowadays

Learning in medicine has allways been a teamsport.

By definition pimping is without any depth whatsoever.

I guess we are back to the definition of pimping. I agree, random irrelevant questions solely designed to embarass the victim are useless. But the idea that any knowledge related question asked by a teacher (resident or attending) is inappropriate and that everything 'will be asked on the shelf' just sells people short on their education.

You drop mortar rounds in tubes, not grenades. A grenade would just kind of sit at the bottom of the tube until it detonated.

I guess I get a fail on 'weapons system terminology'....
(whatever you drop in there, in the end it hopefully goes 'boom')

and requires a good critical thinking skills, judgement, and (something medicine does not) physical and moral courage.

Except for the physical part, medicine requires all those skills. Unfortunately few of them are taught in medschool.