Pimping: useful exercise or outdated practice?

“Tell me the number one cause of malignant hypertension,” Dr. HPK asked me, on the first day of clinic. To be honest, I wasn’t sure. But I put forward my very best guess. I went home that night and, although I probably should have been reading about the causes of hypertensive emergencies, I found myself thinking about the art of pimping.

I came across an interesting article by Brancati, published in JAMA in 1989, on the purpose of pimping. He suggests that “the deeper motivation [for pimping], however, is political. Proper pimping inculcates the intern with a profound and abiding respect for his attending physician while ridding the intern of needless self-esteem.”

I completely disagree. From my own experience, pimping is much more about identifying knowledge gaps and subject areas that need further work. I also find that the practice helps me remember cases and notable findings. Personally, I find it to be an important and useful pedagogical tool, not to mention an enjoyable exercise. I think that when learners hate pimping, it has more to do with the pimp than with the practice itself. Dr. HPK has a wonderful way of asking questions that seems supportive and helpful. I think that pimping can be a really good learning tool if it is respectful to students.

I also found myself wondering why the information gathered through pimping is so much better recalled by the student. I went back to an old lecture on memory delivered by Dr. Bonta in my first year of medical school. He taught us about the integral role of the amygdala as a modulator of memory. He explained that emotionally charged events lead to an increase in glucocorticoids which eventually lead to better recall of the events through the amygdala. It seems to me that pimping produces just the right emotionally charged event for the student (who is fearful of getting the answer wrong) to facilitate the best recall of the case or learning point.

As I reflect upon my role as a future learner and teacher, I can definitely see a role for pimping. As long as the pimp is supportive and respectful but can produce enough of an emotionally charged response from the student, it can be a useful teaching tool. The question at this point is how to teach teachers how to pimp.

-Carolyn