Recently, two excellent bloggers have commented on pimping. For those readers who have never experienced medical school and residency, we must discuss the definition of pimping first. I must disclose at this time that I pride myself on pimping, and consider this a positive term. Hopefully my exposition will clarify my position here.

According to one MEDICAL STUDENT DICTIONARY

Pimping: (verb) The act whereby students are quizzed on minutiae and medical trivia during rounds or class (i.e. “Which 19th Century Prussian scientist discovered?”). This activity is usually reserved for the Attending or residents and fellows with attitude.

This source clearly defines pimping negatively.

A medical student provides a more balanced discussion – Clinical Pimping

Presenting can be nerve-wracking, because some attendings (generally not at the volunteer clinics), do something called “pimping”.

“Pimping” is the term used when attendings ask students questions. Stickler questions. Random questions. Difficult questions. Obscure questions. Not just one. Many.

“Pimping”, if done with good intentions, is meant to teach and reinforce information. It is usually gentle, constructive, and purposeful.

“Pimping”, if done maliciously, is meant to humiliate and publicly embarrass the student. “Ha ha… I know more than you and I want you to remember that.”

No, I’m not making it up. Fraternities have hazing, and so do medical schools. Some attendings actually do it for sport.

I like this discussion very much. Pimping comes in varieties. Let me digress and contrast pimping styles.

A patient is admitted to our service with abnormal liver tests. As the attending I start asking questions. I ask the students and then the interns to develop an exhaustive list of the causes of abnormal liver tets. We use that list to sort through the likely possibilities for the patient’s presentation. The process of asking the questions is called pimping. If done right, pimping accomplishes much. When we discuss pimping in polite company, we state that we use the Socratic method in our teaching.

One of my heroes is Kelley Skeff. He helped teach me how to teach – Demystifying Teaching. One thing that he taught me that has always stuck is that we must create mild anxiety in the learner so that learning can occur. I believe that I should ask questions which the learner understands that he/she should know. The process of exposing them to their incomplete knowledge should cause them to focus and seek to complete their information.

This process is tricky. While we try to create mild anxiety, we also want to maintain a positive learning environment. Hopefully, we can accomplish this with positive feedback and a lack of dwelling on incorrect answers.

I often start a ward teaching month with a brief speech. “I have been an attending for over 20 years. I know a lot of questions. My job is to find out what you know, and what you do not know. I should focus on teaching you what you do not know. Teaching you what you already know is a waste of your time. I will make you slightly uncomfortable at times. When you start to get nervous, remember that learning is about to occur.”

When done right, pimping as an art. The key to righteous pimping is in the pimper’s attitude. When pimping, one must always remember one’s days as a student and resident. As one remembers that, one can pimp with respect.

This obviously does not always translate into a positive experience. The Art of Pimping

For the uninitiated, “pimping occurs whenever an attending poses a series of very difficult questions to an intern or student.” It is the principal tool by which the shame-based motivational system of medical education is applied. This article is unquestionably a masterpiece.

Force of Mouth (the blog) introduces what is clearly a sarcastic humorous description of pimping as if it were a serious exposition. One must read the article with tongue firmly in cheek.

Finally, we get the surgical view (and for those who have never gone through a medical school surgery rotation, surgeon’s are not known for gentle pimping). Pimping, Surgeon Style

Well, time to quit typing. I have to read some medical trivia so that later today I can transform into my alter ego – Pimp Master!!!