Medical Student 'Pimping': Valuable or Humiliating?

"Pimping" in medical schools — a controversial method of questioning used to teach students — is getting more attention.

It's not pimping as in prostitution, but it's pimping as in making someone feel small or insignificant.

According to a viewpoint published Tuesday in JAMA, "The term pimping was popularized following a 1989 JAMA article by [Federick Brancati, MD], which used the term to refer to 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."

JAMA also published a corresponding editorial on the topic, questioning its value as a teaching methodology.

Here are three pros and three cons of pimping, as presented by JAMA.

Pros

• Pimping can be benign, the editorial asserts. It says many assessments of the practice look only at the learner's reactions, not the outcomes in terms of learning or behavior.
• The method of teaching, when practiced in a benign way, can help a teacher assess a student's level of knowledge and gauge how to adjust their teaching accordingly.
• It helps students learn to think on their feet and handle pressure.

Cons

• Pimping can be malignant, depending on the motivation fueling it. If it is meant to cause discomfort, shame and humiliation rather than promote education, it is negative.
• The practice reinforces the hierarchy in medicine and can often only serve a teacher's ego.
• The practice can have an extremely negative affect on students, of which 40 percent reported they have experienced at least one form of mistreatment during their training.

Solutions

The JAMA coverage calls for more research into the practice of pimping to see if, when used appropriately, it is a valuable method for teaching.

The authors of the editorial note, "Teachers averse to challenging medical students out of fear of mistreating them deprive their students of vital sources of learning. With all the attention mistreatment has garnered, it is useful to remember that medical students are often tough and thrive on challenges."

However, this is tempered with examples of medical schools that have used strategies to address stress, burnout, and root structural traumas to medical students. It seems there is a fine line between the good and the bad when it comes to pimping, and medical schools must make sure they are creating a supportive learning environment for students.

Source