Ten years ago I flew from New Orleans to Dallas to take the ABEM recertification exam for the first time. The examiners seated us in a large room, filling every other chair. We used pencil and paper. God help you if you accidently skipped a question and the numbers went out of sequence. I remember being reasonably nervous – uptight but not diaphoretic. This was likely related to memories of the initial certification examination I had taken 10 years before. There was a sense of camaraderie in the shared suffering.

Before the examination, the proctor asked for a show of hands regarding our place in the spectrum of test takers. Most of the hands were raised for those who were recertifying for the first time. Only a handful of doctors were taking it for the second time. There was a brief round of applause for them. These docs had taken the original certification exam and had been practicing for much more than 20 years. I’m sure that many of the larger group wondered if they would be around to take the test again in 10 years.

I began studying about 9 months before I took the recertification exam for the second time this fall. I purchased a two-volume written study guide from Ohio ACEP and read it cover to cover. That description does not really do it justice.

The thing dwarfs the New York City phone book. There are 2,500 pages of densely packed information. I could endure about 20 pages in a sitting before crushing depression would start to set in.

I usually took a volume to work with me and would read a few pages between patients. My colleague, Catherine Marco, asked me one day, in the middle of the summer, why I was studying. “The exam is not that difficult.”

Maybe not for her.

Dr. Marco is the equivalent of the high school class valedictorian telling you that the SAT is a breeze. If she had been talking about an algebra quiz, I might have considered blowing off studying to watch a baseball game. Failing the boards has a bit more implications than flagging a math test, so I kept studying.

After finishing the tome, I started answering review questions. I borrowed two books (from my friend the valedictorian) and started with the post tests. I hated both of the books because there was an abundance of what I can best describe as PIMP questions. I found myself in a bad mood each time I completed a few pages.

Pimp, of course, in this setting has nothing to do with prostitution but takes its origin from the term that is commonly associated with the world’s oldest profession. Or is that politics?
Who can tell them apart?

A PIMP Question asks the reader to know some obscure fact or make a ridiculous choice between two correct answers.

Anyway, the etymology of the term “pimp” goes back to the 1600s when it appeared in an English book by Thomas Middleton. It is derived from the French word pimper, which means to dress elegantly. Eventually, pimp took on a third meaning: abusing or treating badly. Thus, its use in medical circles.

Interestingly, PIMP is also an acronym for Put In My Place. I could find no connection between this acronym and the use of pimp in medical circles.

My definition of a PIMP question is one that either asks the reader to know some obscure fact that would normally be easily found in a reference or one that requires the reader to make a ridiculous choice between two correct answers. You are supposed to choose the one that is most correct. How this helps determine who is competent to practice our specialty and who is not, I am not certain.

As the time to take the test approached, I stopped doing the questions because it was making me grumpy and I was developing a fear that the test would be populated by one PIMP question after another. I thought about the popular expression that originated in an incident with a student at the University of Florida in 2007. He was being subdued by a police officer and he yelled, “Don’t tase me, bro!”

I prepared well, but I feared that I might be asked a bunch of obscure questions, the answers to which only savants can remember.

Don’t PIMP me, bro.

I am pleased to report that no travel was required for this exam. The fee is expensive enough. I had no desire to travel again to take a test. I have nothing against Dallas; however, I was pleased to see the Lions beat the Cowboys this year in an epic comeback.

The testing center, which is 15 minutes away from my home, is a clean and quiet place with about a dozen computer testing stations. They give multiple kinds of exams simultaneously. Three of us were there for ABEM. I shot the breeze with my friend, Jessica, while they checked identification and scanned everyone’s palms. It’s all very high-tech now.

I liked taking the test on the computer. Flagging questions and reviewing them at the end made it easier to move through the questions. Most of the photos and EKGs were crisp images. I’m happy to say that there was a minimum of pimping and overall it seemed to be a fair test.

I’m glad that I studied, as there was a significant number of questions that I knew because I had studied. I believed that I passed. At least I’ll live with that delusion until the results come in the mail in 90 days.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo (Ohio) Medical Center. Your feedback is welcome. Write to him at David.Baehren@utoledo.edu.