Focus on pimping


Category : Medical Rants


My many students (almost 30 years of ward attending experience) know that I love pimping.  Some have challenged my to come to a ceremony dressed up as a Pimp Master.  I have not written about pimping recently, although I just reread a post from 2003 (gee I have been blogging for a long time) that I really like – On medical pimping.

Two items stimulated my to write this post – Pimping in perspective (the first in a four part series!) and The Art of Pimping by Allan Detsky (JAMA article.)  We do clearly have a problem when we refer to pimping.  This term has many different connotations to students and residents.  Many students have told me that my pimping is benign – in contrast with malignant pimping.

I have written previously that perhaps I grill rather than pimp.  I try to be cognizant of the difficulty of my questions – often labeling them Medicine 101, 201, 301 or 401 questions.  Obviously I am delighted if a 3rd year knows the answer to a 301 or 401 question – but I do not expect it.  When I ask an obviously arcane question – e.g., what is a Carey Coombs murmur?  – I do so in the context of "no way you know the answer to this one" – and then I explain that I only know because I heard one when I was a 3rd year student.  But when I ask about the pathophysiology of acute coronary artery syndrome, I really do expect them to know.

Of course, as a benign pimper, I believe in question and rescue.  If a student obviously does not know the answer, I move to the next student, and down the line.  When several students do not know, I get excited and proclaim that now we have a great learning opportunity.  Of course, my philosophy (stated in the 2003 article) is to use questioning to gauge my teaching.  I try to focus on basics that I understand (and I freely admit when I need help – like the coagulation cascade which I can never remember) and try to explain them so that students, interns and residents will better remember them.

Yesterday, I moderated an M&M conference on a very complicated patient.  I had participated in her care during the first 3 (of over 40) days of her hospitalization.  During the conference we discussed her urinalysis which showed many WBCs, many RBCs, and a pH of 9.  So I asked the residents what the pH of 9 meant.  Many did not know – at least one knew.  I considered this a fair, difficult and important question.  When we saw the patient on the first day, I noticed the pH and we immediately picked antibiotics that covered Proteus (the organism most likely to cause a pH of 9).  I thought this was an important teaching point.  I pimped some residents to create just enough anxiety so that they would more likely remember that point – which clearly occurs in practice and has treatment implications.

The one problem with the term pimping is that it probably needs an adjective to clarify the meaning.  Imagine various pimp artists – benign, malignant, brutal, trivial, educational.  Pimping probably is too broad a word to capture the nuance of the varieties of pimping.

Perhaps we can start a new TV series – Pimp my medical student.

Comments (3)

There is an attending at our program who asks on the first day of each rotation, “Would you rather I pimp you, or teach at you?” People almost always choose the former, probably to look good. But he, too, is a benign pimper. He has said that the answer “I don’t know” is the end of it–no twisting the knife, so to speak–and he means it. Everybody gets a chance, but he says and seems to mean that if nobody knows the answer, he views it as a failure of the educator, and an opportunity for him to correct that failure.

I do not find it at all intimidating, but the challenge of finding the answer, of working the problem over in my mind, makes the information stick far better than if he “taught at me.”

Hostile pimping is not teaching–it is bullying. But benign pimping as you describe it is a wonderful way to learn and to teach. Most days I put my ignorance on full display, but on those glorious days when I have one answer after another, I go home beaming. It’s like that great shot on the golf course that brings you back again the next week…

I like to dress up as a pimp when I’m pimping

Still pimping from down under
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Thank you so much for your support
Mike Cadogan (@sandnsurf)

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