Part 3. Does Pimping Work?

Earlier this week, I spent a morning in clinic where instead of seeing patients and reviewing cases, I shadowed an attending physician and saw his patients together. For each visit, I was systematically bombarded with questions on whatever condition the patient had. If I was ever stumped or answered incorrectly (which was unsurprisingly often), he would jokingly quip back with something along the lines of “Oh good, you attended that lecture!” or “Aren’t you graduating medical school in a couple of months?” Essentially, I was being pimped.

I actually respond quite well to pimping. I tend to embrace the feeling of uncertainty when being ‘put on the spot’. This fuels my own competition, but admittedly, it’s not always a comfortable position to be in.  Fortunately in this instance, the staff was in no way demeaning or trying to enforce his superiority, but rather, the entire experience was jovial and low pressured. One can argue that it was also effective – he taught me some things that I’m unlikely to forget going forward. To reference my last post on qualities of an effective tutor, this staff certainly exhibited subject matter expertise but his social and cognitive congruence was arguably not to par.

Despite my experience, most medical students do not enjoy being pimped. The time-honoured tradition of aggressively testing one’s knowledge base, often in front of patients, is commonly seen as a ‘rite of passage’ for medical students as they advance in their training.

I argue, in the context of teaching, pimping — especially when done aggressively — does a poor job of evaluating clinical knowledge, overall clinical judgment, and identifying how well a student is improving.

Given the large amount of information in medicine, asking a few selected, random questions does not reflect the breadth of what a student knows and understands. The realistic consequence of pimping is that medical students tend to answer only those questions they are completely sure about and avoid speaking up when they are less sure. This reinforces the idea that mistakes are bad, rather than affording them an opportunity to learn from them.

I believe there is much value in answering a question incorrectly. An effective tutor identifies the error and teaches around it such that the student becomes a better doctor for it. The opportunity to ask questions without being ridiculed is also essential for learning. Ultimately, the culture in medicine needs to move away from pimping, and towards an environment where medical students feel safe to make mistakes. - AC