Wednesday, March 15, 2006
Education by intimidation
Pimping. It is the cornerstone of medical education, at least in most US medical schools. You learn the basic science in the normal classroom or lab setting, but when it comes time for the clinical education, didactic sessions become rare and most of the learning is hands on. This can be very beneficial, as this type of learning is often much more permanent. I assure you, when I think of diseases that I have encountered, I think of that patient and what their story was. The lesson sticks. It is much more meaningful than simply studying the pathophysiology from a book or lecture. However, hands on learning has also led to a unique style of education that I call education by intimidation. Enter the beloved practice of pimping. I don't know where they name came from, but it is pretty universal. Every medical student knows what it means to be pimped, and this crosses generations as well. Pimping can be hell. You are working 70-100 hours a week, trying to read in your "free-time", learning what you can. But, of course, you just can't learn it all. So there you are, in your patient's room, on rounds, a few other medical students with you, along with residents, your attending, maybe even the patient's family. And someone asks you a question. Not just a simple question. No, that is not what pimping is about. This is a hard question, an esoteric question. A question designed to make you sweat. If you are lucky, someone will help you reason through it, drop a hint or two along the way. But don't expect it. Expect to stand there, blush, sweat, feel your blood pressure and heart rate rise dramatically while you sputter. Lots of sputtering. Your attending looks at you with some indifference or annoyance that you are wasting his/her time. A resident may look at you with a degree of pity (depending on how far removed from your situation they are). That one jackass, know-it-all classmate who happens to be on the rotation with you looks at you with a satisfied smirk that you want to wipe off with a baseball bat. But the hardest part is the look the patient and their family give you. For days now, you have been expertly answering their questions. You have laughed, counseled, consoled, and established a solid rapport with them. They trust you, they like you, and now they are watching you sink. It sucks. Hard. Most of them understand. They look at you with real pity and sometimes even admiration. But occasionally there are those who just lost their confidence in you. One moment and *BAM*, your hours of previous work are washed away. All in the name of education. Ain't it great?