For those of you who don’t know, PIMPING is a legitimate term used in the medical field, and is defined as a time when a attending physician (the Pimper) poses a series of very difficult questions to the student (the Pimpee). It’s a term that had been popularized by Dr.Brancati in his classic 1989 article “The Art of Pimping”. Those who are not in medicine may not appreciate the degree of distress in which pimping may cause among medical students. Nevertheless, each medical student eventually finds his/her own unique way of dealing with it. Some embrace it, some (the all-stars) thrive on it, some have evasive tendencies and avoid being picked on at all cost, and some are simply hopeless.

Just last year, Dr.Detsky published an article also titled “The Art of Pimping” in the Journal of American Medical Association to revist this deadly art that is so pervasive and ingrained in the culture of medical education. In the article, he offers advice for both the pimper and the pimpee on how to deal with each other. In my opinion, medical literature doesn't get any better than this :)

The Art of Pimping, 2009:

Advice for Pimpees to Avoid Pimping

Avoidance

Do not have visual contact with the teacher. There are several variations of this technique including (1) "eclipse" (make sure that another person's head is always in the direct sight line between student and teacher); (2) "camouflage" (the student sits very still, hoping the attending does not notice him or her); and (3) "meditation" (the student lowers his or her head, leans slightly forward and puts the palms of the hands together).

The Muffin

This technique is particularly useful for senior residents who are fearful that the attending physician will embarrass them with a question they should be able to answer but cannot. The resident holds a large muffin in the dominant hand with the elbow flexed, and slowly makes motions with the elbow that move the muffin toward and away from the mouth, somewhat like the graphical lines representing the attitudes of focus group members used by television networks while watching the recent presidential debates (ie, closer to the mouth if the resident does not know the answer, further if he or she does). If the resident feels that the teacher will call on him or her to answer a question to which he or she cannot respond, the muffin should be placed into the mouth. Most attendings will not ask residents or students to speak with their mouth full of food. If the attending does, the resident should pretend to choke, thus avoiding all future questions.

The Hostile Response

If a student is singled out to answer and is embarrassed because he or she cannot, the student should be sure to respond in a hostile fashion, both with the tone of voice and body language. Most teachers will refrain from asking that student questions in the future. An answer that always works is "I don't know," with a 1-second pause between each successively louder spoken word.

The List

If a list of answers is being compiled from several students (eg, what are the life-threatening causes of chest pain?) and the student does not have one, the student should just repeat the response given by a previous respondent and pretend he or she did not hear it. This is particularly effective if the student holds the patient list in front of him or her and looks like he or she is preoccupied with patient care responsibilities. The student or resident can amplify the sympathy by constantly checking his or her pager. (Who can blame anyone who puts patients first?)

Honorable Surrender

Tell the teacher you are uncomfortable. Few students try this, but sometimes the direct approach is best. Those who are uncomfortable being put on the spot in public should just say so. This can be done in the presence of the group or in private after the teaching session.

Pimp Back

The student or resident should find a knowledge area in which he or she has a comparative advantage over the teacher and turn the tables on him or her. In the era of increased subspecialization in which the teacher may not be familiar with the patient presented, this is not as difficult as it sounds. However, pimpers usually do not like to be pimped so be careful.

The Politician's Approach

Do not answer the question that the attending asked but talk straight to the audience (ie, ignore the pimper) by answering a question you would have preferred being asked. This is even more effective if combined with pimping back (see previous procedure).

Use PDA (personal digital assistant)

Modern students have an advantage: instant electronic mobile devices that, if used properly, can provide the answers in "real time." Pimpers might avoid students with visible PDAs because they know these students can pimp back.

Do Not Sulk/Cry

Students who answer incorrectly should not become overly discouraged. Attendings rarely remember students who give wrong answers (especially to difficult questions); they often remember those who lose their composure.

Advice to Pimpers for Good Pimping

There is proper etiquette that should be followed in teaching sessions that keep the good will of all participants.

-Respect educational order. Never ask a medical student to respond to a question after a resident has answered incorrectly. One way to avoid this faux pas: always start at the bottom of the educational chain and move serially up a level if no one at the first level has a correct answer (ie, third-year students before fourth-year students, before interns, before residents). There is an important corollary for the junior residents and medical students: do not break ranks by showing up the senior resident on the team (or the junior resident or student's next admission may be a very difficult patient).

-Do not embarrass other attending physicians. Never call on other attending physicians who are present unless you are sure they know the answer. Conversely, if a topic arises for which others know more than you, ask them to make comments so you do not embarrass yourself by saying something wrong (and having them point it out).

-Look for the eclipser, camouflageur, meditator, or muffin eater and use opportunities to comfortably draw them into the conversation. These include asking them the easiest possible questions so that they are less stressed. Use humor to acknowledge that this form of teaching can be intimidating and state that your expectations are low (ie, the question is difficult and you do not expect any of the medical students to answer correctly).

-The public apology. If you say something wrong or embarrass a student, use the next opportunity to publicly apologize. A teacher apologizing to a student always goes over well.

-Find an opportunity to provide praise, either in a public fashion (eg, a round of applause for a student for an especially good presentation) or privately. A compliment from the attending physician can be very powerful for the student or resident.

Some of the suggestions may seem ludicrous, and I certainly do not agree with some of the recommendations. However, the existence of this article goes to show how physicians can take pimping as such a light-hearted subject. This reflects a changing culture that is turning away from the old-school serious pimping into a new era of civilized pimping. Despite all of the horror stories, I’ve yet to encounter an ego-crushing pimp session during my time at med school. But then again I’m still only a pre-clerk who has yet to be tested in the wards…..