• Attending Physicians Prioritize Efficiency Over Pimping: Attendings generally do not “pimp” residents unnecessarily; if a resident demonstrates strong clinical reasoning in discussions, rounds are more efficient and educational questioning is minimal.
• Educational Gaps Trigger Questioning: When an attending notices a resident who appears unprepared or disengaged, they may ask assertive questions to ensure patient safety and verify the resident’s clinical knowledge.
• Knowledge Deficiencies Can Have Serious Consequences: Lack of understanding in critical areas—such as empiric antibiotic selection, renal and cardio-protective medications, and contraindications in pregnancy—can lead to serious patient harm.
Residents : attendings don’t want to pimp you. It wastes time , generally speaking if the educational goals are demonstrated in discussion there is no need to confront residents and ask a ton of questions in rounds.
I’m sure you’ve seen a group of your program’s best residents rounding , the knowledge just oozes from those residents, studies are discussed freely, the why is known as much as the what, and rounds is much abbreviated as the attending is happy with the treatment of patients.
It’s when your attending notices an ill prepared resident: one who is just trying to get by and go home when an educational “pimping” session may arise. The attending may see the need to ask somewhat assertive questions In order to ascertain that the patient is in good hands.
Some examples of this that I have become aware of over the years (program redacted and not necessarily my own) are the one resident halfheartedly putting in a jugular central line without a follow up X ray and causing a pneumothorax as well as frank crepitus in the neck that went unnoticed all night. The residents that failed to know or practice the following:
- Renal protective blood pressure meds that diabetics should be on to inhibit diabetic nephropathy.
- Cardio protective meds post NSTEMI.
- Empiric antibiotic treatment for diabetic foot infection with and without purulent discharge.
- Community acquired pneumonia empiric antibiotics with and without aspiration: taking into account recent hospital stay, pseudomonas risk.
- Meningitis empiric antibiotics.
- Class D and X medication list to avoid in pregnant patients—major lawsuit if birth defect occurs.
These are omissions that have long term effects and the attending needs to be sure the information is covered for the patients sake.
Our platform allows for storage and rapid recollection of assessment plans, medication choices, key notes on medication side effects, studies, all easily shareable within program and beyond. Early users have access to review attending level assessment+plans for top IM admission diagnoses used during testing.
Although this is not a recommendation to treat specific patients , the information is useful to the residents for educational reference. Save and customize to your liking and show the attending the patient is in good hands.
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