Pimping questions makes me want to quit

[bips]

Hey guys, so i had a really rough rotation where literally 4 people sat and fired random questions at me every ten minutes, peds questions, pyloric stenosis, Gilbert's dz, medullary sponge kidney, whats the mechanism of action for this heart drug. Is this normal? 

I'm going through PA school all alone basically and I'm so dumbfounded because idk if anyone else is experiencing this. is anyone else feeling like they shouldn't be in medicine after getting simple questions wrong? 

After the first three weeks I just started saying "i don't know" because i felt it was purposeful torture. one of them even said " just take a guess, i know you don't know it." pimped me even on  the last day, last hour. 

Now I'm not the best student but i get decent grades. some things aren't sticking, especially because I'm memorizing everything, i don't look up the patho stuff sometimes, even if i learned it i forget it, and theres no time to go over the basics. first year was just gobbling the info, now its sticking better but not all the way.  

I first want to know what you guys think if i should just give up, how to handle pimping? what am i doing wrong? Its terrible feeling like your preceptor thinks your an idiot who shouldn't be in medicine. 

How did you study for your rotations each week? was it before you started the rotation? during the last rotation? throughout? did you ever feel like you were not good enough? I've come a long way, but maybe I'm still not good enough.

[LT_Oneal_PAC]

Missing pimp questions is standard. While loathesome I find it a useful method of teaching, but I always told my students it wasn’t meant to be punitive or embarrassing. I use it because I can’t possible know what you know without asking, and I don’t want to go over something if it’s a waste of time. Some preceptors obviously use it as a way to make you seem small and themselves very smart.

First, usually you can fend these off by “punching the shark in the nose,” by saying something very smart about a disease or presentation. “I recommend Lung US to rule out PTX since it is more sensitive that CXR, though one could argue that a small PTX not evident on CXR is not clinically significant.” 

Also recognize that pimp questions you receive are likely ones they received. So honestly there are only so many pimp questions, except from the truly brilliant and up to date preceptors, but they usually aren’t the malignant type of preceptors you worry about. I recommend the medicine “secrets” series as it’s layout puts it in a typical pimp type format. If on your surgery rotation, a must is “surgical recall”. I don’t think I received a single question this book didn’t cover. Some surgeons thought I was a genius because of that book, when really  not the case.

lastly you can try some apps like palmEM, tarascon series so you quickly look something up right before the pumping starts so a few tidbits can be fresh.

anyways, wouldn’t let it get you down. It’s all apart of learning. 

[karebear12892]

3 minutes ago, LT_Oneal_PAC said:

 I recommend the medicine “secrets” series as it’s layout puts it in a typical pimp type format. If I’m your surgery rotation, a must is surgical recall. I don’t think I received a single question this book didn’t cover. Some surgeons thought I was a genius because of that book, when really  not the case.

Just finished my surgery rotation and Surgical Recall was very helpful. I'd also recommend Dr. Pesana's Surgery Notes.

Have you looked into the Case Files series? I've been reading these before/during each rotation and they have all been very useful, both for the actual rotation and the EOR exams.

I'd also suggest that if you don't know an answer, think out loud so your preceptor knows you are working through the problem and using critical thinking skills. I've found that if you say something like, "well I know it's not ___ because ____, but ____ is a possibility..." they'll usually help you figure out the answer they're looking for. Also, if the preceptor has a sense of humor and I don't know the answer to a question, sometimes I'll say, "can you make it multiple choice?" That usually gets a smile or a laugh out of them, and then they give me four or five options to pick from. 

You've worked so hard and you've made it this far - don't second guess yourself now! You deserve to be here! It will get better! 

[bips]

Thank you both for the advice! I'm in a really bad place right now and I and just trying to figure out how to swim again cuz I'm sinking. I'm paranoid too. I really appreciate that people can come out and help me on this forum, I really needed that support! 

[karebear12892]

Sure thing. You might consider talking to one of your faculty members as well. Maybe you have an advisor or a particular professor who you feel comfortable confiding in. I have found my PA program's faculty to be very approachable, willing to share advice, and always happy to listen. You aren't the first PA student to have doubts and you certainly won't be the last! 

[6oo6le]

I would say "I don't know but I'll look it up" and then proceed to look it up in front of them - it bought some time and showed them I wanted to learn .  Or you can be genuine and state "You know, I don't feel good about learning things this way - can we try a more productive less anxiety producing way?"  Then I would speak with a faculty member before it gets out of hand.  Because truth be told, once you get your license and start practicing, you're a professional just like them.  You both bleed the same - no need to be scared about another person who attempts to belittle you.  I haven't retained anything from being pimped but I sure remember lots when I was treated like an equal.  It's your future on the line - don't let someone be in control of that.  Talk back to them the way you would any other professional.  Stop being scared.  Express yo self!

As for memorizing, I think that's your downfall.  If you don't grasp the information now, you'll have a hard time studying/passing the PANCE.   

[EMEDPA]

I recommend the secrets series as well. I bought one for each rotation. they are basically all the pimp questions in each specialty. Just remmeber; you never lose. you win or you learn.

it is part of the process. Just stick it out. it is like basic training in the army. someday it will end.

[GetMeOuttaThisMess]

PGY2 resident in UTMB ED first week of first rotation (summer, so ED was blasted every day of rotation). “How long does it take for osteomyelitis changes to show up on plain films?” Huh? I’m doing good to remember what osteomyelitis is. Answer is six weeks btw with subtle periosteal elevation. Had this same resident every stinking shift that first week but I always made sure that I came back the next day with the correct answers (there were no personal PC’s or internet at that time). Left for a week to attend AAPA conference with a classmate in D.C. when we were selected to be our class reps. When I got back everything was peachy. Don’t know what I did or said but something between she and I clicked. Got an A on the rotation. Point is don’t back down or cower. You don’t know everything but you do have the resources to get the answer in a short period of time. Use it for what it is which is a learning experience. It’s not all about the knowledge but how to also play nice with others. See all the ED threads about bitchy specialty docs on call who won’t talk to us even though we may have more overall experience than they do!

 

[gbrothers98]

Pimping does not work unless the intent is to intimidate the pimpee.

Unfortunately, pimping continues due to it's prevalence in days past and new preceptors only have their own prior experiences to direct future interactions.

Pimping is nothing more than a skewed game of medical trivial pursuit, the pimper holds all the cards with the answers. Questions are specific bits of knowledge dependent upon recall, a lower learner function, instead of enabling a student to create and apply clinical reasoning. Sounds like the OP did not get his money worth from that rotation and may have been set back a step or two in the clinical phase process. Unfortunate given the amount of money being spent and the compressed timeline for obtaining skills, knowledge and attitude to enable transition to PA practice.

Likely there is a feedback mechanism to clinical faculty concerning the preceptors and experience. One of these questions should be 'did the preceptor enable acquisition of knowledge in the specialty?'. Pimpers should get a resounding no to this question. 

https://journals.lww.com/academicmedicine/Fulltext/2015/01000/Socrates_Was_Not_a_Pimp___Changing_the_Paradigm_of.11.aspx

Good luck.

George

 

[Kaepora]

I dunno. Pimping is a pretty good way to get your students to be interactive and to highlight what's important. Yes, a lot of medicine is rote memorization, but that's life. Students have to study and memorize before they can synthesize. "How do we classify CKD and what are the stages?" Pretty straight forward. Then you start asking higher level questions about electrolyte disturbances in CKD, metabolic acidosis, PTH levels, etc. How these patients present when uremic. How to treat and so on. If there is a point to it, a conversation, then its learning. If it's to embarrass on rounds then you're just being a douche.

[EMEDPA]

there are good and bad ways to be the pimp. I try to be gentle about it:

"Ok, so this is a meth user with a big abscess. what bugs are you most worried about and what antibiotics would you consider?"

if they get it, great. if not we discuss MRSA, abx selection, etc. win:win. I don't denigrate folks for wrong answers. I was treated that way along the way and know it isn't helpful.