Sid’s right. When it’s showtime in the OR, whatever surprises the patient may have to offer, the one person who has got to be sure of every detail and have at his ready recall a full awareness of possible deviations from the expected and contingency plans for each is the surgeon. It is not like outpatient care nor is it anything like a committee where multiple observers might have something to contribute. And it is definitely not the sort of work that fits many (read most) doctors. Understanding this is one of the lessons of surgery training, both for the medical student, the resident and the attending. Having a ready working fund of knowledge is essential to being effective as a surgeon. Pimping, when done correctly, is meant to provoke thought, inspire recollection and invite a succession of contributors, usually starting from the least experienced member of a team and working up the ladder of experience to those more highly trained. It is sort of a performance art, and doing well at it requires some effort on the part of the examinee in trying to anticipate important questions and preparing to answer them. And it is also stressful, as most things that require effort and willingness to expand one’s abilities are.

Deciding when a trainee is fit to continue involves more than just being prepared for the OR and knowing the answers to questions. But those qualities are very important and are demonstrations of how well a trainee is focused on his work and how well he is preparing to do that work when no one is supervising. Like learning to land a plane, good surgery requires the kind of preparation where learning very well to do things right quickly and the first time is tremendously important.