"Pimping": Not About Sex-- About Medical Education"

This cartoon below is certainly a good example of "pimping" which has been for years, really generations a technique of medical education. I recently wrote the following to a professional medical educator's listserv:

The December 8 2015 issue of JAMA (Volume 314 No. 22) presents a Viewpoint article which I believe challenges us medical school teachers to find evidence of educational value in a practice carried out by medical school teachers and attendings  which is apparently not rarely applied to their students.  The practice is "pimping"  and is defined in the article by referring to an 1989 JAMA article by Brancati: "a series of difficult and often intentionally unanswerable questions posed to a medical student or house staff in quick succession.  The objective of pimping is to teach, motivate, and involve the learner in clinical rounds while maintaining a dominant hierarchy and cultivating humility by ridding the learner of egotism."

So what we must decide is whether this "pimping" is an effective and benign form of Socratic teaching or in most cases really a form of medical student "mistreatment"

To learn more about "pimping" in medical education, read this outline of the practice in eTalk.

The cartoon also brings up another issue as to whether "pimping" medical students, interns and medical residents not only may intimidate and emotionally "harm" them but could this behavior eventually harm the patient.  A second year medical student writing in the Pulse website describes not only her own "pimping" but also witnessing her teacher "pimping" a clinic patient. 

However, a surgical resident who read the Pulse story wrote me the following:

I may be in the minority when I say, I'm "pro"-pimping/Socratic method. I didn't think it was a fair analogy for the student to compare herself to the patient--the patient is not a medical professional. Making decisions with incomplete information is part of all of our jobs.  I say this from the perspective of someone that still has to take written and oral boards as part of my board certification process.  Practicing for oral boards is serial escalation of difficult questions.

Pimping exposes the things that "I don't know that I don't know".  It is normal to feel defensive when you don't know the answer to a question and pimping teaches you to repress the "fight or flight" response, to acknowledge gaps in understanding, to maintain humility and to remain poised in the face of uncertainty.  I consider pimping the surgical love language. How else does the attending quickly assess where deficiencies lie? How do you otherwise also motivate the student that gets great scores on standardized exams to keep studying?  You don't take the time to pimp people when you're not invested in their education.You just ignore them. 

My favorite attendings can always find me in a crowd of residents and call me out--it's how I know they still care. 

So, what do you think about this form of "pimping"?  Have you experienced such questioning as part of your own occupation or experience?  If you are or were a medical educator would you use this technique to educate your students or could this really be only a form of self-interest on the part of the physician educator and intimidation of the student of any sort should not be part of the education process.  Let's hear from you on this behavior. ..Maurice.

Graphic: From Google Images. Referred source: https://euuuh.com/

Patient Modesty: Volume 74

Throughout the entire discussion about the issue of patient modesty there is one issue that still hasn't been resolved.  That issue is: within the "doctor-patient relationship" is there really any balance existing or required between the "needs" of the patient and the "needs" of the physician?  Yes, there is imbalance in favor of the physician with regard to medical education and medical/surgical skills and the need to apply this knowledge and skills effectively for the patient. However, since it is the patient who has the illness and who is about to be diagnosed and treated should the balance with regard to "needs" be loaded on the patient's side because it is the patient who is ill and because  the patient should have the primary interest and concern which then includes all matters of modesty? The physician's "needs", such as facilitation of time spent with the patient, assistance by others (which might include gender other than that of the patient) during interaction with the patient or other physician professional but self-interest demands, should bear far less weight on balance than the patient's modesty needs. On the other hand, shouldn't the goal be an attempt to balance the "needs" to provide a safe and effective outcome of any doctor-patient relationship?  And, yes, in that balance some matters of patient modesty might be affected.  I speak as the blog moderator and not as a physician as I present this issue of balance for discussion.  ..Maurice.


Graphic: Balance--from Google Images


NOTICE: As of  March 14 2016, Volume 74 is now CLOSED to further Comments. Go to "Patient Modesty: Volume 75" to continue posting.