Is pimping actually effective?

[odyssey2]

Pimping is an unpleasant and frequently embarrassing process for many, but is it actually effective? Whenever I would get stuck with an attending who believed in the “Socratic method” (read: pouncing on random students with questions and continue until they were sputtering) I would be so anxious about getting called on that I wasn’t paying attention to what was actually being taught. This teaching style also made me less likely to ask something I really needed to know for fear this would lead to public follow up questions which would expose my ignorance. I would be so grateful to attendings and residents who would just sit down and actually explain what we needed to know instead of turning it into a public show for the team, and I actually seemed to learn by being told what to do! Go figure!

Do you feel like being pimped was effective for any of you or just a pointlessly painful artifact of medical education?

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[theonlytycrane]

I intentionally omitted subtle information on my presentations to lay the trap for my attendings. When they jumped in with the most likely pimp questions I was already ready and relaxed w the answer. Gotta flip the script xD

jk, but foreal pimping is lame but you can usually avoid most of it and even look good if you thoroughly read a pt's chart / pay attention to the plan for the pt each day / and actively think about what the next steps for the pt might be

attendings usually smell blood and pick on the student / resident with the least thorough / least confident presentation, so just prepare well and fake it to make it

 

[Mad Jack]

Nothing reinforces memory like trauma

 

[thumbz]

I have to agree with Mad Jack - I remember the topics I got wrong (and especially those I got wrong in front of others in an embarrassing way) much more robustly than I remember the stuff I got right.

 

[fldoctorgirl]

Agree with the above. As much as it sucks feeling like you don't know something, I remember the things I was asked about and got incorrect/didn't know. I think a happy medium is an attending who asks you questions and pushes you, while maybe not doing the stereotypical "pimping" where you are belittled if you get it wrong. I enjoy being asked questions and having the correct answer/thought process explained to me when I know I'm not with an attending who is just trying to embarrass me and make me feel stupid in front of others.

 

[odyssey2]

Nothing reinforces memory like trauma

Right, that’s what I hear, but I feel like I remembered the feeling of embarrassment rather than what I was actually supposed to learn. And you may remember that one thing that tripped you up well, but if I’m in a situation we’re everyone’s getting pimped like crazy I’m not really paying attention to what’s being said, just anxious about being called on and relieved when I’m not. It may work for individual teaching points but I don’t think it’s an effective learning strategy overall.

 

[odyssey2]

Agree with the above. As much as it sucks feeling like you don't know something, I remember the things I was asked about and got incorrect/didn't know. I think a happy medium is an attending who asks you questions and pushes you, while maybe not doing the stereotypical "pimping" where you are belittled if you get it wrong. I enjoy being asked questions and having the correct answer/thought process explained to me when I know I'm not with an attending who is just trying to embarrass me and make me feel stupid in front of others.

I think it’s totally fine to do this as long as there’s some explanation involved at the end and the POINT isn’t to make you feel embarrassed but just to assess where your learning is. I wouldn’t really consider that pimping.

 

[7331poas]

pimping isnt about teaching, its about assessing knowledge level. I haven't really *learned* anything from clinical rotations throughout 3rd year.

 

[Medisaint]

I see being able to learn in different environments like having multiple streams of revenue. Pimping is an alternative learning tool just like classroom lectures, bedside tutorials, or learning by doing. Being able to recall information or formulate plans under mild stress is important skill. It also forces you to anticipate what types of questions might be asked and confront the limits of your knowledge about a subject. I agree that it should be done with constructive intent. And while I understand some attendings can use it to flex their egos, you throw the baby out with the 0.9% Na bathwater if you dismiss pimping outright.

Over a decade later, I can recall information I learned in med school that was cemented through various pimping encounters. Four signs/symptoms of bowel obstruction, consequences of low phosphorous in an ICU patient, interpretation of a hepatitis panel, Treatment for NSTEMI, PF ratio cutoffs in the Berlin Criteria etc, etc. etc.. Definitely worth the angst at the time.

 

[thepoopologist]

Pimping is an unpleasant and frequently embarrassing process for many, but is it actually effective? Whenever I would get stuck with an attending who believed in the “Socratic method” (read: pouncing on random students with questions and continue until they were sputtering) I would be so anxious about getting called on that I wasn’t paying attention to what was actually being taught. This teaching style also made me less likely to ask something I really needed to know for fear this would lead to public follow up questions which would expose my ignorance. I would be so grateful to attendings and residents who would just sit down and actually explain what we needed to know instead of turning it into a public show for the team, and I actually seemed to learn by being told what to do! Go figure!

Do you feel like being pimped was effective for any of you or just a pointlessly painful artifact of medical education?

Some rotations I had, I struck out and I remembered it. But I also remember a medicine rotation where the attending asked me like 20 questions in a row and I answered them all. I was left to my own devices afterward and that's the other positive of pimping.

 

[Mad Jack]

pimping isnt about teaching, its about assessing knowledge level. I haven't really *learned* anything from clinical rotations throughout 3rd year.

That's quite a bold statement. Either you're a terrible medical student, incredibly arrogant, or your program is terrible, given that basically all of the actual clinical practice of medicine is learned in third year

 

[deleted480308]

I only know pimpin’ ain’t easy

 

[jurassicpark]

Pimping can be effective. As others have stated out, you'll have a hard time forgetting that information. But I think it's in the manner as to which it is done. When I was a wee little med student, the Attendings that pimped me often had a good rapport with the team. It was not done to humiliate me, but to teach me and the team. If I got it wrong, there was no public-pantsing or any such tomfoolery, the most I could expect was an assignment.

As an Attending I try to do the same. I pimp out my med students (that sounds wrong now that I type it out) with at least what I consider high yield facts/knowledge so that they think about it, and remember it. And it's often not a one time factoid, if it comes back up again in the rotation will be asked again to make sure they remember. I don't humiliate them if they don't know. But I do find it absolutely adorable sometimes when the med students start freaking out if they don't know the answer, they're like a bunch of cute little puppies at this stage. Eager to please and still not sure if they pissed in the right spot.

 

[Goro]

Pimping is an unpleasant and frequently embarrassing process for many, but is it actually effective? Whenever I would get stuck with an attending who believed in the “Socratic method” (read: pouncing on random students with questions and continue until they were sputtering) I would be so anxious about getting called on that I wasn’t paying attention to what was actually being taught. This teaching style also made me less likely to ask something I really needed to know for fear this would lead to public follow up questions which would expose my ignorance. I would be so grateful to attendings and residents who would just sit down and actually explain what we needed to know instead of turning it into a public show for the team, and I actually seemed to learn by being told what to do! Go figure!

Do you feel like being pimped was effective for any of you or just a pointlessly painful artifact of medical education?

The value of pimping is to actually find out the deficits in your knowledge base.

40 years later, I can still remember the questions I got, and by God, I still know the difference between a nucleotide and nucleoside!

Not to Generation shame, but I think distaste for pimping has grown proportionally in the last decade, probably because some students take any hint that they don't know something as a personal affront.

 

[Tenk]

Pimping is ok but I prefer to just let students try to drive. I don’t give a crap about presentations and some random factoid, I just want to know what you want to do. Usually this starts out with uhhhhhhhhh and by the end of the rotation, students have a bit more confidence in decision making. That’s your job after all. MD = Makes Decisions.

 

[Matthew9Thirtyfive]

pimping isnt about teaching, its about assessing knowledge level. I haven't really *learned* anything from clinical rotations throughout 3rd year.

Either you or your school is doing something wrong then.

 

[Cranjis McBasketball]

pimping isnt about teaching, its about assessing knowledge level. I haven't really *learned* anything from clinical rotations throughout 3rd year.

Save some chicks for the rest of us, dude

 

[kopftonmd]

I kinda agree with @7331poas (about assessing knowledge level, not learning). More often than not, I've gotten the vibe that the attendings who are asking me questions are surprised that I know ~anything~. So it usually ends up as a good thing!

And like @Tenk I definitely prefer when they're just asking, "what do you wanna do," not "what's the sixth intermediate in glycolysis?" Ya know?

 

[odyssey2]

It just seems like so much of what I’ve been asked has been very esoteric stuff that has very little bearing on the day to day work I was there to learn about.
On the extreme end, I worked with a surgeon who was infamous for pimping students ruthlessly in the details of cancer statistics in the US. If you guessed wrong, she would leave you twisting in the wind until you eventually got it right, which could last the entire procedure, and she kept coming back to you to ask for an answer. The students eventually circulated a cheat sheet with a bunch of cancer statistics since she tended to ask the same questions for every student. She found out about this and got furious, and eventually changed her script so she could continue leaving students in knots. This was ridiculous because people actually learned what she wanted them to by reviewing the cheat sheet, but that didn’t pass muster with her.

 

[Chemist0157]

I think so.

 

[7331poas]

That's quite a bold statement. Either you're a terrible medical student, incredibly arrogant, or your program is terrible, given that basically all of the actual clinical practice of medicine is learned in third year

Not really, i know plenty of students at several other places that feel the same. Most rotations these days are shadowing. The only time I actually carried patients was internal med.

watching a surgery behind attending + fellow+ resident = no learning
never entering a room on obgyn because male med student = no learning
peds was mostly shadowing
psych was decently interesting, but even then no attending wants med students talking to their private schizophrenic patients.

Id say 90% of what ive learned on 3rd year is shelf studying. Pimping and attending "teaching" is a minimal contributor. Okay with those who disagree.

 

[ArteryStudyPainting]

I think pimping is used incorrectly. I think questions are fine. it's the way it's asked, etc. My hyperbole is that pimping is like when an attending doesn't get the answer they're looking for, a firm slap to the face is what you get. That, is to me, pimping. Not asking questions in front of others.

I do think communication is the root of every problem in history. Whether it's giving, taking, ignorance, etc., it's all communication. You didn't do the right thing? Well, you either didn't pay attention, the person didn't make it clear, or you were ignorant to ignore what you correctly heard in favor of something else.

So, I'm a firm believer in communication to stop pimping as it is taken by so many to mean, "they have it out for me, dang".

In the very beginning of the rotation, the group should be talked to about questioning, about what it means, how it should be used, about how it's to make everyone grow, it's teammates helping others, not backstabbing each other, etc.

No one should ever come away from that extensive talk w/o understanding that they're safe, their grades are safe, and that "pimping" as they assume it to be, is the last thing that they should think it's intending to be when the rotation starts. If they don't come away going, "ah, I feel safe when I'm going to get questioned", then the communication wasn't taken to be fleshed out as much as it should have been.

 

[Mad Jack]

Not really, i know plenty of students at several other places that feel the same. Most rotations these days are shadowing. The only time I actually carried patients was internal med.

watching a surgery behind attending + fellow+ resident = no learning
never entering a room on obgyn because male med student = no learning
peds was mostly shadowing
psych was decently interesting, but even then no attending wants med students talking to their private schizophrenic patients.

Id say 90% of what ive learned on 3rd year is shelf studying. Pimping and attending "teaching" is a minimal contributor. Okay with those who disagree.

Sounds pretty awful. I was carrying patients, writing notes, assisting in surgery, and doing Paps like a pro by the end of third year, and I graduated not even a handful of years back so I doubt things have changed that much

 

[ValeRx]

Pimping is the reason I carry around a bagel/muffin and when asked a question I act like I'm busy eating it and point at someone else.

 

[Chelsea FC]

"Pimping ain't easy" surprised nobody said that as yet lolz

 

[ValeRx]

"Pimping ain't easy" surprised nobody said that as yet lolz

sb247 did....

 

[Chelsea FC]

I only know pimpin’ ain’t easy

My apologies

 

[TelemarketingEnigma]

pimping isnt about teaching, its about assessing knowledge level. I haven't really *learned* anything from clinical rotations throughout 3rd year.

Not really, i know plenty of students at several other places that feel the same. Most rotations these days are shadowing. The only time I actually carried patients was internal med.

watching a surgery behind attending + fellow+ resident = no learning
never entering a room on obgyn because male med student = no learning
peds was mostly shadowing
psych was decently interesting, but even then no attending wants med students talking to their private schizophrenic patients.

Id say 90% of what ive learned on 3rd year is shelf studying. Pimping and attending "teaching" is a minimal contributor. Okay with those who disagree.

yikes, I'm sorry your rotations are so shadowing heavy. I know some rotations are better than others, but between just my psych and FM rotations so far I've gotten to carry patients, write notes, do complete psych evals, draw blood/give vaccines, lots of physical exam and interview practice... and learned way more useful things along the way than most of what I studied for step 1.

The most useful things I've learned from attendings aren't specific facts to be pimped on though, but approaches to management - I've learned a lot by just asking my attendings "So how would you approach [scenario]..."

 

[Ho0v-man]

yes and no.

I’ve had rotations where literally every single pimp question showed up on the shelf. So obviously useful.

There’s a surgical rotation at my school where an attending pimps students on rando facts that are exclusive to his podcast. Obviously worthless.

So as long as the content isn’t ridiculously stupid like that podcast example, yeah it’s useful. You learn a lot more struggling through something than someone just presenting information to you. I mean, that’s why people learn so much better ditching lecture and doing anki/questions in preclinical instead.

I’m honestly baffled that people get through boards without realizing there’s value to trying to answering questions under pressure.

 

[WheezyBaby]

I think students expand the definition of pimping to include the asking of any questions to students. To me, pimping is an on the fly verbal "pop quiz" of a trainee without purpose other than seeing if a trainee knows something. I ask questions to figure out trainees' understanding of a subject matter with the purpose of figuring out what to teach to expand on that knowledge base. I think this is what most people do that's interpreted as pimping. I'm just not in the business of wasting my breath waxing on about something you already know and wasting both of our time

 

[radsisrad]

Id say 90% of what ive learned on 3rd year is shelf studying. Pimping and attending "teaching" is a minimal contributor. Okay with those who disagree.

Correct. Purpose of M3 is to decide on a specialty and continue answering multiple-choice Qs well

 

[bananafish94]

In my experience it's pretty effective. I think it's important to not just memorize that we give drug X for condition Y because that's what we're "supposed" to do, but really understand why it's done. And increasingly difficult questions are generally a pretty good way of reinforcing that - you might not even think about some of these things until someone asks you. And then on another level I've found that while I'm obviously against malignant culture and mistreatment, when attendings have notoriously high expectations and you know you're going to get grilled on everything you say, I might be a little more inclined to read about everything in greater detail to try and anticipate the questions.

 

[doyouhaveaflag]

Getting pimped is how I learn best. I actually retain very little from people just telling me stuff. With some attendings it’s painful, but most of the time I treat it like a game. I say an answer that I think is reasonable and I’m not afraid to be wrong. Answer confidently! As long as you can explain why you answered the way you did, it typically goes over well.

 

[The Knife & Gun Club]

So the classic “hey Med student, name the bones of the wrist” is about as useless as actually knowing the names of the bones of the wrist.

But correctly done pimping works great. An attending asks you relevant details to a case or presentation, trying to locate and fill in knowledge gaps.

For example - I had an attending the other day ask our student for the differential diagnosis for chest pain, because the student was seeing a chest pain patient but hadn’t considered evaluating for pneumothorax in their plan.

 

[Dr. Rafiki]

Sounds pretty awful. I was carrying patients, writing notes, assisting in surgery, and doing Paps like a pro by the end of third year, and I graduated not even a handful of years back so I doubt things have changed that much

Highly school- and site-dependent. Our main hospital, in all their infinite wisdom, have decided that students don't need to write notes. Therefore, students get read-only access to charts. And even then, students can't read everything that an attending could read.

Our alumni have consistently said that writing notes was the hardest transition to residency as that was their first time doing it.

I agree with the rest of your sentiments, however, and I also mastered all the above procedures by the end of clinical rotations.

 

[Espressso]

I think students expand the definition of pimping to include the asking of any questions to students. To me, pimping is an on the fly verbal "pop quiz" of a trainee without purpose other than seeing if a trainee knows something. I ask questions to figure out trainees' understanding of a subject matter with the purpose of figuring out what to teach to expand on that knowledge base. I think this is what most people do that's interpreted as pimping. I'm just not in the business of wasting my breath waxing on about something you already know and wasting both of our time

I think this is a really really good take. In my experience it seems like a lot of the better attendings I've worked with use "pimping" not to disparage me or make me feel like an idiot, but to gage where I'm at in my learning and understanding. And if I answer a question right, they often keep going, until I hit a wall. Then they use that as a teaching point. Either go look it up or no this is actually why.

At first I thought this was cruel and their way of making me feel stupid (I felt stupid) but now I enjoy it and I do view it favorably. If i'm on a roll and answering a few questions right and then I get one wrong, it shows both the attending and myself, where my knowledge gaps are. That's the kind of challenge I like.

I definitely can see how some students hate this method, especially early in your third year. I find that medicine and surgery rotations are the two that use this the most and are most intense about it. But it is a game and you just have to play it. Same with presentations. You'll suck for a while first, but keep trying and be humble enough to admit when you're wrong.

Getting pimped is how I learn best. I actually retain very little from people just telling me stuff. With some attendings it’s painful, but most of the time I treat it like a game. I say an answer that I think is reasonable and I’m not afraid to be wrong. Answer confidently! As long as you can explain why you answered the way you did, it typically goes over well.

Same with this, another good take. The trick is to definitely not feel guilty about not knowing something. Once you realize as a third or fourth year student that everyone in medicine is still learning, event the old 70 yo attending, you realize that it's more than okay to not know and admit you're wrong. Answering confidently too, that's huge. Explain your reasoning, and make the conversation and discussion better for everyone at the table/rounds.

Another pro tip I think that comes with time is to start feeling out which questions you're going to get. Think two or three steps ahead. An attending who is obsessed with DVT prophylaxis on a medicine service? Always know your patients DVT prophylaxis. You know he's going to ask it, jot it down and have it ready. And if you forget, or get it wrong on a patient, write it down, and make sure to know it tomorrow.

As a fourth year doing all these medicine sub-i's and medicine rotations, it's all a game. You have to find the tricks and the strategy and play the game.