This discussion also reminds me of an older outlier internal medicine textbook, "The Principles and Practice of Medicine." This was the descendant of Sir William Osler's original text, and it was still being used in the '70s. Unlike, Harrison's and Cecil's, which were the most popular, P&PM focused less on minute details and more on understandable explanations of complex concepts. I particularly remember how clear and practical their discussion of acid/base balance was--I used it every day for as long as I needed to use such things. Unfortunately, this text has not been updated, although you can buy the edition I used for about $10.
The best professor in my medical school ('71-'74) was a notorious pimper. I took his elective anyway because I knew I would learn enough to justify the abuse. One day on rounds I actually answered a question correctly. He sneered at me and said, "See, you knew something after all."
We had the CIBA organ system collection in my med school library. It got me through the “organ system block”.
I think my favorite illustration was the “blue bloater” (the smoker with chronic bronchitis predominant COPD for those of you who havent been pimped”). I can still picture that poor fellow…
Would you extend your kindness and share what kind of info included in those cards. Do you include a one liner about the problem representation? do you include a detailed problem list ? active medications? unresolved issues that needs to be addressed?
Netter was one of the reasons I decided to come to US for residency. I studied from the old Russian Sinelnikov anatomy atlas and when I got my hands on Netter whole new world opened up. Things became easy and clear. Not that US residency was easy, but it was certainly clear and practical. I love it! Good post. Thanks
As usual, an excellent thought provoking piece where I, once again I learned a few new things. One is I became familiar with Sketchy and investigating it I find it’s been around about 10 years and appears that its populated with reliable information by credible human sources not utilizing a LLM. I imagine it’s use is pervasive as it’s not cheap and has longevity.
I also learned that, although for the past ten years I ‘ve been under the impression I’m old but today that was challenged. I’m VERY old.
Too funny- I subscribed to Merriam Websters "word of the day. " platform and recently came across a piece on current "Slang" words. The first was Gruzz = older people.
As an active young looking 65 year old; all I thought was sh*t!!
Fun read. I still have the sketchy alpha and beta receptor sketch picture perfect in my head. For pharmacology and microbiology the mental mapping and structure is fantastic for a lot of people, and makes learning them a little more enjoyable
I am old enough to cherish Netter and have expert facility in paper charts ,but I have to admit that I abandoned index cards in favor of the Epic shared group patient list with case information and " to do " sections that can be edited quickly in real time . Sign outs to rotating hospitalist partners ( we do 24 hr shifts ) are complete and in black and white - especially since the oncoming doc may not know the patient at all . As far as " pimping" - it's ok as long as you do it right - it's a teaching tool , not an opportunity to humiliate someone. Pointing out that in today's complex medical world being able to say " I don't know the answer, but I'll find out" is a valuable lesson . None of use can memorize masses of arcane details, and I would say it clutters up your brain to do so. Knowing how to find the answer to things you don't know or remember is the real skill.
I trained in the 70’s. “Pimping” simply meant intense questioning and exploring the boundaries of one’s knowledge but there were many instances when it crossed the border into bullying. Some Residents and Attendings were good at it and some were not. In my 3rd year of Med School I was in the MICU which was run by a martinet of an attending. My first morning rounds I witnessed a Resident get pimped, or rather, demolished by him. Watching this I decided to write down every question he asked and then, the following morning at handoff, be sure I could answer every one. When new questions were asked I wrote those down and made sure I could answer those. One week into a 6 week rotation I started generating my own questions. It is how I approached patient care for 40 years. Know what questions to ask.
“Running the list” has been abbreviated to RTL and this abbreviation has been turned into a verb. “Where’s the Fellow? She is RTLing with the residents.”
Pimping is highly frowned on in Peds because the residents say they feel uncomfortable and anxious when they don’t know the answer, especially in front of their peers. And we can’t have that.
Residents who have been “made” to feel uncomfortable write less-than-outstanding faculty evaluations. Since resident evaluations are the core of clinical faculty performance metrics, fear of these evaluations hold faculty back from pimping.
So pimping has vanished in Peds. Done well, Socratic teaching is very effective. Oh, well. Their loss, I guess.
Cold-calling is also now frowned upon at the undergraduate level because it can cause feelings of discomfort, which we all know never happens out in the real world.
I cherish my Netter set! Retired General Surgeon. Stick with the pimping also! Brings back memories for me thanks! When I was in medical school at univ of New Mexico we had Pimp block in our second year. Pathology/ immunology/ pharmacology and pathology. Thinned out the class
This discussion also reminds me of an older outlier internal medicine textbook, "The Principles and Practice of Medicine." This was the descendant of Sir William Osler's original text, and it was still being used in the '70s. Unlike, Harrison's and Cecil's, which were the most popular, P&PM focused less on minute details and more on understandable explanations of complex concepts. I particularly remember how clear and practical their discussion of acid/base balance was--I used it every day for as long as I needed to use such things. Unfortunately, this text has not been updated, although you can buy the edition I used for about $10.
The best professor in my medical school ('71-'74) was a notorious pimper. I took his elective anyway because I knew I would learn enough to justify the abuse. One day on rounds I actually answered a question correctly. He sneered at me and said, "See, you knew something after all."
You are Gen X all the way! Me too!
We had the CIBA organ system collection in my med school library. It got me through the “organ system block”.
I think my favorite illustration was the “blue bloater” (the smoker with chronic bronchitis predominant COPD for those of you who havent been pimped”). I can still picture that poor fellow…
As a former medical illustrator sketchy can’t hold a candle to Netter.
Would you extend your kindness and share what kind of info included in those cards. Do you include a one liner about the problem representation? do you include a detailed problem list ? active medications? unresolved issues that needs to be addressed?
We used to call it “card flip” rounds with our attendings. But I was house staff in the last century….
Netter was one of the reasons I decided to come to US for residency. I studied from the old Russian Sinelnikov anatomy atlas and when I got my hands on Netter whole new world opened up. Things became easy and clear. Not that US residency was easy, but it was certainly clear and practical. I love it! Good post. Thanks
Love that. Thanks.
As usual, an excellent thought provoking piece where I, once again I learned a few new things. One is I became familiar with Sketchy and investigating it I find it’s been around about 10 years and appears that its populated with reliable information by credible human sources not utilizing a LLM. I imagine it’s use is pervasive as it’s not cheap and has longevity.
I also learned that, although for the past ten years I ‘ve been under the impression I’m old but today that was challenged. I’m VERY old.
Too funny- I subscribed to Merriam Websters "word of the day. " platform and recently came across a piece on current "Slang" words. The first was Gruzz = older people.
As an active young looking 65 year old; all I thought was sh*t!!
Do I really have to learn a whole new vocabulary.
As a pediatrician I am in awe of the painting The Doctor by Lucas Fildes. This painting of medicine is transcendent.
Fun read. I still have the sketchy alpha and beta receptor sketch picture perfect in my head. For pharmacology and microbiology the mental mapping and structure is fantastic for a lot of people, and makes learning them a little more enjoyable
I am old enough to cherish Netter and have expert facility in paper charts ,but I have to admit that I abandoned index cards in favor of the Epic shared group patient list with case information and " to do " sections that can be edited quickly in real time . Sign outs to rotating hospitalist partners ( we do 24 hr shifts ) are complete and in black and white - especially since the oncoming doc may not know the patient at all . As far as " pimping" - it's ok as long as you do it right - it's a teaching tool , not an opportunity to humiliate someone. Pointing out that in today's complex medical world being able to say " I don't know the answer, but I'll find out" is a valuable lesson . None of use can memorize masses of arcane details, and I would say it clutters up your brain to do so. Knowing how to find the answer to things you don't know or remember is the real skill.
I trained in the 70’s. “Pimping” simply meant intense questioning and exploring the boundaries of one’s knowledge but there were many instances when it crossed the border into bullying. Some Residents and Attendings were good at it and some were not. In my 3rd year of Med School I was in the MICU which was run by a martinet of an attending. My first morning rounds I witnessed a Resident get pimped, or rather, demolished by him. Watching this I decided to write down every question he asked and then, the following morning at handoff, be sure I could answer every one. When new questions were asked I wrote those down and made sure I could answer those. One week into a 6 week rotation I started generating my own questions. It is how I approached patient care for 40 years. Know what questions to ask.
“Running the list” has been abbreviated to RTL and this abbreviation has been turned into a verb. “Where’s the Fellow? She is RTLing with the residents.”
Pimping is highly frowned on in Peds because the residents say they feel uncomfortable and anxious when they don’t know the answer, especially in front of their peers. And we can’t have that.
Residents who have been “made” to feel uncomfortable write less-than-outstanding faculty evaluations. Since resident evaluations are the core of clinical faculty performance metrics, fear of these evaluations hold faculty back from pimping.
So pimping has vanished in Peds. Done well, Socratic teaching is very effective. Oh, well. Their loss, I guess.
Cold-calling is also now frowned upon at the undergraduate level because it can cause feelings of discomfort, which we all know never happens out in the real world.
I cherish my Netter set! Retired General Surgeon. Stick with the pimping also! Brings back memories for me thanks! When I was in medical school at univ of New Mexico we had Pimp block in our second year. Pathology/ immunology/ pharmacology and pathology. Thinned out the class