Pimping Med Students

Dr Shock
May 7, 2009

thunderbirds

The art of Pimping: pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee).

Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care.

So what is the cure?

  • Avoidance, Do not have visual contact with the teacher
  • The Muffin, the pimpee 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 pimpee does not know the answer, further if he or she does)
  • The Hostile Response, respond in a hostile fashion, both with the tone of voice and body language. Most pimpers don’t like taht and refrain from further questioning at that instance and near future
  • The Pimpee should just repeat the response given by a previous respondent and pretend he or she did not hear it
  • Honorable Surrender, tell the pimper you are uncomfortable
  • Pimp Back, 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
  • Pimpers might avoid students with visible PDAs because they know these students can pimp back
  • Do Not Sulk/Cry, pimpees who answer incorrectly should not become overly discouraged. Pimpers rarely remember students who give wrong answers (especially to difficult questions); they often remember those who lose their composure

This article also has advice for pimpers but they can find out themselves, besides they are the one’s abusing their position.

The lesson is to not take pimping too seriously and remember that often more can be learned from incorrect answers than from correct ones.

What do you think, does Pimping still appears and is it useful in medical education?

ResearchBlogging.org
Detsky, A. (2009). The Art of Pimping JAMA: The Journal of the American Medical Association, 301 (13), 1379-1381 DOI: 10.1001/jama.2009.247

 

13 Responses to “Pimping Med Students”

  1. Pimping does occur and over the course of medical school I have, through trial and error, developed each one of your cures :-). In general, I favor “avoidance” and “the muffin” as a first line and the “politician’s approach” as a second line.

    Pimping does occur but in my experience it occurs in two forms. (1) is the attending who is genuinely using it as a tool to teach. (2) is the attending who is using it as a tool to make medical students feel bad. The forms are often indistinguishable except that the attending who is trying to degrade is often considerably more disdainful in their manner of speech.

    One of the attendings who I am closest to used to barrage me with questions that I could not answer to the point where it hurt. But it was always for purposes of teaching since I would go look those questions up later and move on to more advanced topics on the next go around.

    Take in contrast an attending who found out I had just come back from my PhD, would take me into patients’ rooms and pimp me on (in hindsight) pretty advanced topics that I either had not relearned yet or had never learned altogether. As the pimping never occured without patients present and there was never any teaching whatsoever, I very quickly realized what the purpose of the pimping was. As a side note, I resolved the situation by quickly saying “I don’t know” when pimped on something I couldn’t answer. Once I stopped struggling in front of the patients to come up with an answer I didn’t know, the attending stopped pimping me.

    Take that how you will. One attending has become a lifelong mentor and friend: writing many papers together, having beers and bbq-ing together. One attending, well, I don’t even know what happened to that attending.

  2. mudphudder on May 7th, 2009 at 4:21 pm
  3. I think learning to say “I don’t know” quickly (when you actually don’t know the answer) will decrease any pain that is associated with pimping.

  4. DrBadger on May 7th, 2009 at 5:13 pm
  5. I don’t necessarily agree with Dr. Badger. I think in situations where the purpose of the pimping is for learning purposes, sometimes it is worth trying to verbally reason out the answer. Even if one doesn’t know the exact answer, I’ve found that getting into the ballpark through reasoning can score a lot of points and demonstrate one’s strength of mind, if not one’s fund of knowledge. I don’t think one should be averse to the pain of pimping because that pain is a good motivator for learning. Moreover, that pain has permanently scarred the answer to many of those questions on my brain :-)

    In a no-win situation though, where the point of the pimping is to cause embarassment and belittle the student–i.e. there is no point to drag out the process–then a quick “I don’t know” is in order (in my opinion).

  6. mudphudder on May 7th, 2009 at 6:13 pm
  7. @mudphudder No pain is needed, questions can be put politely and on topic, most attending try to find very difficult questions mostly what they have recently discovered. They have no clue as to which phase the younger doctor is in in his education. Questions are there for learning not embarrassing.
    Take care Dr Shock
    P.S how is the headache?

  8. Dr Shock on May 7th, 2009 at 6:29 pm
  9. I think your explanation is based on that of a reasonable person. You are reasonable and you understand that pain is not needed. You also have a standard way of coming up with questions for pimping.
    However, not everyone is like you. More so, but still not everyone. There are unreasonable attendings out there. And some who occasionally (or more often) want to bring on the pain through pimping. To use my personal example, when I tell an attending that I just came back from several years of graduate school and am currently trying to catch back up, I highly doubt anyone would expect me to know about the latest study in last month’s issue of the Journal of Something-ology. So to ask those kinds of things in front of patients serves no other purpose but to cause embarassment.
    But for the purposes of learning, I don’t think a little pain, with good intentions, is a bad thing.

    p.s. I actually don’t get headaches (although I do experience other symptoms) so I’m okay in that regard. But thank you for asking :-)

  10. mudphudder on May 7th, 2009 at 6:52 pm
  11. Love it. I start my clinical rotations in the middle of June, and I’m personally petrified of getting pimped. Yes, it still happens. I got pimped on an H&P visit a month ago. Anyway, posts like this really make me smile. Well done. :)

  12. ChristinePAS on May 7th, 2009 at 7:06 pm
  13. Ok, I’ll confess, I pimp clerks, interns and residents, but there are always clearly articulated rules when we start:

    1) If you really don’t know, just say so
    2) If you partially know, do try and struggle toward the answer from first principles
    3) If you get part way and hit a plateau, you are invited to “call a friend,” usually the next more senior member of the house staff
    4) Pimping ends immediately if the house staff appear visibly anxious about the process to a degree that seems disorganizing
    5) The attending staff will riff on the topic at the end to fill in the holes and move the process toward the “Ah ha!” moment of seeing the penny drop for the house staff

  14. Epictetus on May 7th, 2009 at 7:41 pm
  15. Mostly stolen from this excellent article in JAMA. Kind regards Dr Shock

  16. Dr Shock on May 7th, 2009 at 8:43 pm
  17. I agree with you, mudphudder, if you can come up with a partial answer, go ahead and try to come up with something. But if you really don’t know, I don’t think it’s worth struggling. So really, Epictetus is on the mark (or at least that’s what I will aim for when I return to the clinics next month).

  18. DrBadger on May 7th, 2009 at 11:26 pm
  19. [...] Dr. Shock, Dr. Walter van den Broek gives a humorous jab at the practice of “pimping” by doctors trying [...]

  20. Grand Rounds « See First Blog on May 26th, 2009 at 1:31 pm
  21. [...] Pimping Med Students AKPC_IDS += “3507,”;Popularity: unranked [?]SHARETHIS.addEntry({ title: “Medical Slang Explained”, url: “http://www.shockmd.com/2009/08/10/medical-slang-explained/” }); Filed in: General Medicine [...]

  22. Medical Slang Explained | Dr Shock MD PhD on August 10th, 2009 at 8:58 am
  23. [...] This is also known as The art of Pimping: pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. More on pimping med students. [...]

  24. The Hidden Curriculum in Medical Education | Dr Shock MD PhD on October 28th, 2010 at 8:54 am
  25. [...] word is chill.  So far there are no big, ball-busting blowhards like you see on TV, no one “pimping” the students.  From what I hear, that’s way more the style of [...]

  26. Hospital Rotations Begin: Inpatient Medicine – Day 1 on January 24th, 2012 at 8:11 am
  1. Pimping does occur and over the course of medical school I have, through trial and error, developed each one of your cures :-). In general, I favor “avoidance” and “the muffin” as a first line and the “politician’s approach” as a second line.

    Pimping does occur but in my experience it occurs in two forms. (1) is the attending who is genuinely using it as a tool to teach. (2) is the attending who is using it as a tool to make medical students feel bad. The forms are often indistinguishable except that the attending who is trying to degrade is often considerably more disdainful in their manner of speech.

    One of the attendings who I am closest to used to barrage me with questions that I could not answer to the point where it hurt. But it was always for purposes of teaching since I would go look those questions up later and move on to more advanced topics on the next go around.

    Take in contrast an attending who found out I had just come back from my PhD, would take me into patients’ rooms and pimp me on (in hindsight) pretty advanced topics that I either had not relearned yet or had never learned altogether. As the pimping never occured without patients present and there was never any teaching whatsoever, I very quickly realized what the purpose of the pimping was. As a side note, I resolved the situation by quickly saying “I don’t know” when pimped on something I couldn’t answer. Once I stopped struggling in front of the patients to come up with an answer I didn’t know, the attending stopped pimping me.

    Take that how you will. One attending has become a lifelong mentor and friend: writing many papers together, having beers and bbq-ing together. One attending, well, I don’t even know what happened to that attending.

  2. mudphudder on May 7th, 2009 at 4:21 pm
  3. I think learning to say “I don’t know” quickly (when you actually don’t know the answer) will decrease any pain that is associated with pimping.

  4. DrBadger on May 7th, 2009 at 5:13 pm
  5. I don’t necessarily agree with Dr. Badger. I think in situations where the purpose of the pimping is for learning purposes, sometimes it is worth trying to verbally reason out the answer. Even if one doesn’t know the exact answer, I’ve found that getting into the ballpark through reasoning can score a lot of points and demonstrate one’s strength of mind, if not one’s fund of knowledge. I don’t think one should be averse to the pain of pimping because that pain is a good motivator for learning. Moreover, that pain has permanently scarred the answer to many of those questions on my brain :-)

    In a no-win situation though, where the point of the pimping is to cause embarassment and belittle the student–i.e. there is no point to drag out the process–then a quick “I don’t know” is in order (in my opinion).

  6. mudphudder on May 7th, 2009 at 6:13 pm
  7. @mudphudder No pain is needed, questions can be put politely and on topic, most attending try to find very difficult questions mostly what they have recently discovered. They have no clue as to which phase the younger doctor is in in his education. Questions are there for learning not embarrassing.
    Take care Dr Shock
    P.S how is the headache?

  8. Dr Shock on May 7th, 2009 at 6:29 pm
  9. I think your explanation is based on that of a reasonable person. You are reasonable and you understand that pain is not needed. You also have a standard way of coming up with questions for pimping.
    However, not everyone is like you. More so, but still not everyone. There are unreasonable attendings out there. And some who occasionally (or more often) want to bring on the pain through pimping. To use my personal example, when I tell an attending that I just came back from several years of graduate school and am currently trying to catch back up, I highly doubt anyone would expect me to know about the latest study in last month’s issue of the Journal of Something-ology. So to ask those kinds of things in front of patients serves no other purpose but to cause embarassment.
    But for the purposes of learning, I don’t think a little pain, with good intentions, is a bad thing.

    p.s. I actually don’t get headaches (although I do experience other symptoms) so I’m okay in that regard. But thank you for asking :-)

  10. mudphudder on May 7th, 2009 at 6:52 pm
  11. Love it. I start my clinical rotations in the middle of June, and I’m personally petrified of getting pimped. Yes, it still happens. I got pimped on an H&P visit a month ago. Anyway, posts like this really make me smile. Well done. :)

  12. ChristinePAS on May 7th, 2009 at 7:06 pm
  13. Ok, I’ll confess, I pimp clerks, interns and residents, but there are always clearly articulated rules when we start:

    1) If you really don’t know, just say so
    2) If you partially know, do try and struggle toward the answer from first principles
    3) If you get part way and hit a plateau, you are invited to “call a friend,” usually the next more senior member of the house staff
    4) Pimping ends immediately if the house staff appear visibly anxious about the process to a degree that seems disorganizing
    5) The attending staff will riff on the topic at the end to fill in the holes and move the process toward the “Ah ha!” moment of seeing the penny drop for the house staff

  14. Epictetus on May 7th, 2009 at 7:41 pm
  15. Mostly stolen from this excellent article in JAMA. Kind regards Dr Shock

  16. Dr Shock on May 7th, 2009 at 8:43 pm
  17. I agree with you, mudphudder, if you can come up with a partial answer, go ahead and try to come up with something. But if you really don’t know, I don’t think it’s worth struggling. So really, Epictetus is on the mark (or at least that’s what I will aim for when I return to the clinics next month).

  18. DrBadger on May 7th, 2009 at 11:26 pm
  19. [...] Dr. Shock, Dr. Walter van den Broek gives a humorous jab at the practice of “pimping” by doctors trying [...]

  20. Grand Rounds « See First Blog on May 26th, 2009 at 1:31 pm
  21. [...] Pimping Med Students AKPC_IDS += “3507,”;Popularity: unranked [?]SHARETHIS.addEntry({ title: “Medical Slang Explained”, url: “http://www.shockmd.com/2009/08/10/medical-slang-explained/” }); Filed in: General Medicine [...]

  22. Medical Slang Explained | Dr Shock MD PhD on August 10th, 2009 at 8:58 am
  23. [...] This is also known as The art of Pimping: pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. More on pimping med students. [...]

  24. The Hidden Curriculum in Medical Education | Dr Shock MD PhD on October 28th, 2010 at 8:54 am
  25. [...] word is chill.  So far there are no big, ball-busting blowhards like you see on TV, no one “pimping” the students.  From what I hear, that’s way more the style of [...]

  26. Hospital Rotations Begin: Inpatient Medicine – Day 1 on January 24th, 2012 at 8:11 am
  1. Pimping does occur and over the course of medical school I have, through trial and error, developed each one of your cures :-). In general, I favor “avoidance” and “the muffin” as a first line and the “politician’s approach” as a second line.

    Pimping does occur but in my experience it occurs in two forms. (1) is the attending who is genuinely using it as a tool to teach. (2) is the attending who is using it as a tool to make medical students feel bad. The forms are often indistinguishable except that the attending who is trying to degrade is often considerably more disdainful in their manner of speech.

    One of the attendings who I am closest to used to barrage me with questions that I could not answer to the point where it hurt. But it was always for purposes of teaching since I would go look those questions up later and move on to more advanced topics on the next go around.

    Take in contrast an attending who found out I had just come back from my PhD, would take me into patients’ rooms and pimp me on (in hindsight) pretty advanced topics that I either had not relearned yet or had never learned altogether. As the pimping never occured without patients present and there was never any teaching whatsoever, I very quickly realized what the purpose of the pimping was. As a side note, I resolved the situation by quickly saying “I don’t know” when pimped on something I couldn’t answer. Once I stopped struggling in front of the patients to come up with an answer I didn’t know, the attending stopped pimping me.

    Take that how you will. One attending has become a lifelong mentor and friend: writing many papers together, having beers and bbq-ing together. One attending, well, I don’t even know what happened to that attending.

  2. mudphudder on May 7th, 2009 at 4:21 pm
  3. I think learning to say “I don’t know” quickly (when you actually don’t know the answer) will decrease any pain that is associated with pimping.

  4. DrBadger on May 7th, 2009 at 5:13 pm
  5. I don’t necessarily agree with Dr. Badger. I think in situations where the purpose of the pimping is for learning purposes, sometimes it is worth trying to verbally reason out the answer. Even if one doesn’t know the exact answer, I’ve found that getting into the ballpark through reasoning can score a lot of points and demonstrate one’s strength of mind, if not one’s fund of knowledge. I don’t think one should be averse to the pain of pimping because that pain is a good motivator for learning. Moreover, that pain has permanently scarred the answer to many of those questions on my brain :-)

    In a no-win situation though, where the point of the pimping is to cause embarassment and belittle the student–i.e. there is no point to drag out the process–then a quick “I don’t know” is in order (in my opinion).

  6. mudphudder on May 7th, 2009 at 6:13 pm
  7. @mudphudder No pain is needed, questions can be put politely and on topic, most attending try to find very difficult questions mostly what they have recently discovered. They have no clue as to which phase the younger doctor is in in his education. Questions are there for learning not embarrassing.
    Take care Dr Shock
    P.S how is the headache?

  8. Dr Shock on May 7th, 2009 at 6:29 pm
  9. I think your explanation is based on that of a reasonable person. You are reasonable and you understand that pain is not needed. You also have a standard way of coming up with questions for pimping.
    However, not everyone is like you. More so, but still not everyone. There are unreasonable attendings out there. And some who occasionally (or more often) want to bring on the pain through pimping. To use my personal example, when I tell an attending that I just came back from several years of graduate school and am currently trying to catch back up, I highly doubt anyone would expect me to know about the latest study in last month’s issue of the Journal of Something-ology. So to ask those kinds of things in front of patients serves no other purpose but to cause embarassment.
    But for the purposes of learning, I don’t think a little pain, with good intentions, is a bad thing.

    p.s. I actually don’t get headaches (although I do experience other symptoms) so I’m okay in that regard. But thank you for asking :-)

  10. mudphudder on May 7th, 2009 at 6:52 pm
  11. Love it. I start my clinical rotations in the middle of June, and I’m personally petrified of getting pimped. Yes, it still happens. I got pimped on an H&P visit a month ago. Anyway, posts like this really make me smile. Well done. :)

  12. ChristinePAS on May 7th, 2009 at 7:06 pm
  13. Ok, I’ll confess, I pimp clerks, interns and residents, but there are always clearly articulated rules when we start:

    1) If you really don’t know, just say so
    2) If you partially know, do try and struggle toward the answer from first principles
    3) If you get part way and hit a plateau, you are invited to “call a friend,” usually the next more senior member of the house staff
    4) Pimping ends immediately if the house staff appear visibly anxious about the process to a degree that seems disorganizing
    5) The attending staff will riff on the topic at the end to fill in the holes and move the process toward the “Ah ha!” moment of seeing the penny drop for the house staff

  14. Epictetus on May 7th, 2009 at 7:41 pm
  15. Mostly stolen from this excellent article in JAMA. Kind regards Dr Shock

  16. Dr Shock on May 7th, 2009 at 8:43 pm
  17. I agree with you, mudphudder, if you can come up with a partial answer, go ahead and try to come up with something. But if you really don’t know, I don’t think it’s worth struggling. So really, Epictetus is on the mark (or at least that’s what I will aim for when I return to the clinics next month).

  18. DrBadger on May 7th, 2009 at 11:26 pm
  19. [...] Dr. Shock, Dr. Walter van den Broek gives a humorous jab at the practice of “pimping” by doctors trying [...]

  20. Grand Rounds « See First Blog on May 26th, 2009 at 1:31 pm
  21. [...] Pimping Med Students AKPC_IDS += “3507,”;Popularity: unranked [?]SHARETHIS.addEntry({ title: “Medical Slang Explained”, url: “http://www.shockmd.com/2009/08/10/medical-slang-explained/” }); Filed in: General Medicine [...]

  22. Medical Slang Explained | Dr Shock MD PhD on August 10th, 2009 at 8:58 am
  23. [...] This is also known as The art of Pimping: pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. More on pimping med students. [...]

  24. The Hidden Curriculum in Medical Education | Dr Shock MD PhD on October 28th, 2010 at 8:54 am
  25. [...] word is chill.  So far there are no big, ball-busting blowhards like you see on TV, no one “pimping” the students.  From what I hear, that’s way more the style of [...]

  26. Hospital Rotations Begin: Inpatient Medicine – Day 1 on January 24th, 2012 at 8:11 am
  1. Pimping does occur and over the course of medical school I have, through trial and error, developed each one of your cures :-). In general, I favor “avoidance” and “the muffin” as a first line and the “politician’s approach” as a second line.

    Pimping does occur but in my experience it occurs in two forms. (1) is the attending who is genuinely using it as a tool to teach. (2) is the attending who is using it as a tool to make medical students feel bad. The forms are often indistinguishable except that the attending who is trying to degrade is often considerably more disdainful in their manner of speech.

    One of the attendings who I am closest to used to barrage me with questions that I could not answer to the point where it hurt. But it was always for purposes of teaching since I would go look those questions up later and move on to more advanced topics on the next go around.

    Take in contrast an attending who found out I had just come back from my PhD, would take me into patients’ rooms and pimp me on (in hindsight) pretty advanced topics that I either had not relearned yet or had never learned altogether. As the pimping never occured without patients present and there was never any teaching whatsoever, I very quickly realized what the purpose of the pimping was. As a side note, I resolved the situation by quickly saying “I don’t know” when pimped on something I couldn’t answer. Once I stopped struggling in front of the patients to come up with an answer I didn’t know, the attending stopped pimping me.

    Take that how you will. One attending has become a lifelong mentor and friend: writing many papers together, having beers and bbq-ing together. One attending, well, I don’t even know what happened to that attending.

  2. mudphudder on May 7th, 2009 at 4:21 pm
  3. I think learning to say “I don’t know” quickly (when you actually don’t know the answer) will decrease any pain that is associated with pimping.

  4. DrBadger on May 7th, 2009 at 5:13 pm
  5. I don’t necessarily agree with Dr. Badger. I think in situations where the purpose of the pimping is for learning purposes, sometimes it is worth trying to verbally reason out the answer. Even if one doesn’t know the exact answer, I’ve found that getting into the ballpark through reasoning can score a lot of points and demonstrate one’s strength of mind, if not one’s fund of knowledge. I don’t think one should be averse to the pain of pimping because that pain is a good motivator for learning. Moreover, that pain has permanently scarred the answer to many of those questions on my brain :-)

    In a no-win situation though, where the point of the pimping is to cause embarassment and belittle the student–i.e. there is no point to drag out the process–then a quick “I don’t know” is in order (in my opinion).

  6. mudphudder on May 7th, 2009 at 6:13 pm
  7. @mudphudder No pain is needed, questions can be put politely and on topic, most attending try to find very difficult questions mostly what they have recently discovered. They have no clue as to which phase the younger doctor is in in his education. Questions are there for learning not embarrassing.
    Take care Dr Shock
    P.S how is the headache?

  8. Dr Shock on May 7th, 2009 at 6:29 pm
  9. I think your explanation is based on that of a reasonable person. You are reasonable and you understand that pain is not needed. You also have a standard way of coming up with questions for pimping.
    However, not everyone is like you. More so, but still not everyone. There are unreasonable attendings out there. And some who occasionally (or more often) want to bring on the pain through pimping. To use my personal example, when I tell an attending that I just came back from several years of graduate school and am currently trying to catch back up, I highly doubt anyone would expect me to know about the latest study in last month’s issue of the Journal of Something-ology. So to ask those kinds of things in front of patients serves no other purpose but to cause embarassment.
    But for the purposes of learning, I don’t think a little pain, with good intentions, is a bad thing.

    p.s. I actually don’t get headaches (although I do experience other symptoms) so I’m okay in that regard. But thank you for asking :-)

  10. mudphudder on May 7th, 2009 at 6:52 pm
  11. Love it. I start my clinical rotations in the middle of June, and I’m personally petrified of getting pimped. Yes, it still happens. I got pimped on an H&P visit a month ago. Anyway, posts like this really make me smile. Well done. :)

  12. ChristinePAS on May 7th, 2009 at 7:06 pm
  13. Ok, I’ll confess, I pimp clerks, interns and residents, but there are always clearly articulated rules when we start:

    1) If you really don’t know, just say so
    2) If you partially know, do try and struggle toward the answer from first principles
    3) If you get part way and hit a plateau, you are invited to “call a friend,” usually the next more senior member of the house staff
    4) Pimping ends immediately if the house staff appear visibly anxious about the process to a degree that seems disorganizing
    5) The attending staff will riff on the topic at the end to fill in the holes and move the process toward the “Ah ha!” moment of seeing the penny drop for the house staff

  14. Epictetus on May 7th, 2009 at 7:41 pm
  15. Mostly stolen from this excellent article in JAMA. Kind regards Dr Shock

  16. Dr Shock on May 7th, 2009 at 8:43 pm
  17. I agree with you, mudphudder, if you can come up with a partial answer, go ahead and try to come up with something. But if you really don’t know, I don’t think it’s worth struggling. So really, Epictetus is on the mark (or at least that’s what I will aim for when I return to the clinics next month).

  18. DrBadger on May 7th, 2009 at 11:26 pm
  19. [...] Dr. Shock, Dr. Walter van den Broek gives a humorous jab at the practice of “pimping” by doctors trying [...]

  20. Grand Rounds « See First Blog on May 26th, 2009 at 1:31 pm
  21. [...] Pimping Med Students AKPC_IDS += “3507,”;Popularity: unranked [?]SHARETHIS.addEntry({ title: “Medical Slang Explained”, url: “http://www.shockmd.com/2009/08/10/medical-slang-explained/” }); Filed in: General Medicine [...]

  22. Medical Slang Explained | Dr Shock MD PhD on August 10th, 2009 at 8:58 am
  23. [...] This is also known as The art of Pimping: pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. More on pimping med students. [...]

  24. The Hidden Curriculum in Medical Education | Dr Shock MD PhD on October 28th, 2010 at 8:54 am
  25. [...] word is chill.  So far there are no big, ball-busting blowhards like you see on TV, no one “pimping” the students.  From what I hear, that’s way more the style of [...]

  26. Hospital Rotations Begin: Inpatient Medicine – Day 1 on January 24th, 2012 at 8:11 am
  1. Pimping does occur and over the course of medical school I have, through trial and error, developed each one of your cures :-). In general, I favor “avoidance” and “the muffin” as a first line and the “politician’s approach” as a second line.

    Pimping does occur but in my experience it occurs in two forms. (1) is the attending who is genuinely using it as a tool to teach. (2) is the attending who is using it as a tool to make medical students feel bad. The forms are often indistinguishable except that the attending who is trying to degrade is often considerably more disdainful in their manner of speech.

    One of the attendings who I am closest to used to barrage me with questions that I could not answer to the point where it hurt. But it was always for purposes of teaching since I would go look those questions up later and move on to more advanced topics on the next go around.

    Take in contrast an attending who found out I had just come back from my PhD, would take me into patients’ rooms and pimp me on (in hindsight) pretty advanced topics that I either had not relearned yet or had never learned altogether. As the pimping never occured without patients present and there was never any teaching whatsoever, I very quickly realized what the purpose of the pimping was. As a side note, I resolved the situation by quickly saying “I don’t know” when pimped on something I couldn’t answer. Once I stopped struggling in front of the patients to come up with an answer I didn’t know, the attending stopped pimping me.

    Take that how you will. One attending has become a lifelong mentor and friend: writing many papers together, having beers and bbq-ing together. One attending, well, I don’t even know what happened to that attending.

  2. mudphudder on May 7th, 2009 at 4:21 pm
  3. I think learning to say “I don’t know” quickly (when you actually don’t know the answer) will decrease any pain that is associated with pimping.

  4. DrBadger on May 7th, 2009 at 5:13 pm
  5. I don’t necessarily agree with Dr. Badger. I think in situations where the purpose of the pimping is for learning purposes, sometimes it is worth trying to verbally reason out the answer. Even if one doesn’t know the exact answer, I’ve found that getting into the ballpark through reasoning can score a lot of points and demonstrate one’s strength of mind, if not one’s fund of knowledge. I don’t think one should be averse to the pain of pimping because that pain is a good motivator for learning. Moreover, that pain has permanently scarred the answer to many of those questions on my brain :-)

    In a no-win situation though, where the point of the pimping is to cause embarassment and belittle the student–i.e. there is no point to drag out the process–then a quick “I don’t know” is in order (in my opinion).

  6. mudphudder on May 7th, 2009 at 6:13 pm
  7. @mudphudder No pain is needed, questions can be put politely and on topic, most attending try to find very difficult questions mostly what they have recently discovered. They have no clue as to which phase the younger doctor is in in his education. Questions are there for learning not embarrassing.
    Take care Dr Shock
    P.S how is the headache?

  8. Dr Shock on May 7th, 2009 at 6:29 pm
  9. I think your explanation is based on that of a reasonable person. You are reasonable and you understand that pain is not needed. You also have a standard way of coming up with questions for pimping.
    However, not everyone is like you. More so, but still not everyone. There are unreasonable attendings out there. And some who occasionally (or more often) want to bring on the pain through pimping. To use my personal example, when I tell an attending that I just came back from several years of graduate school and am currently trying to catch back up, I highly doubt anyone would expect me to know about the latest study in last month’s issue of the Journal of Something-ology. So to ask those kinds of things in front of patients serves no other purpose but to cause embarassment.
    But for the purposes of learning, I don’t think a little pain, with good intentions, is a bad thing.

    p.s. I actually don’t get headaches (although I do experience other symptoms) so I’m okay in that regard. But thank you for asking :-)

  10. mudphudder on May 7th, 2009 at 6:52 pm
  11. Love it. I start my clinical rotations in the middle of June, and I’m personally petrified of getting pimped. Yes, it still happens. I got pimped on an H&P visit a month ago. Anyway, posts like this really make me smile. Well done. :)

  12. ChristinePAS on May 7th, 2009 at 7:06 pm
  13. Ok, I’ll confess, I pimp clerks, interns and residents, but there are always clearly articulated rules when we start:

    1) If you really don’t know, just say so
    2) If you partially know, do try and struggle toward the answer from first principles
    3) If you get part way and hit a plateau, you are invited to “call a friend,” usually the next more senior member of the house staff
    4) Pimping ends immediately if the house staff appear visibly anxious about the process to a degree that seems disorganizing
    5) The attending staff will riff on the topic at the end to fill in the holes and move the process toward the “Ah ha!” moment of seeing the penny drop for the house staff

  14. Epictetus on May 7th, 2009 at 7:41 pm
  15. Mostly stolen from this excellent article in JAMA. Kind regards Dr Shock

  16. Dr Shock on May 7th, 2009 at 8:43 pm
  17. I agree with you, mudphudder, if you can come up with a partial answer, go ahead and try to come up with something. But if you really don’t know, I don’t think it’s worth struggling. So really, Epictetus is on the mark (or at least that’s what I will aim for when I return to the clinics next month).

  18. DrBadger on May 7th, 2009 at 11:26 pm
  19. [...] Dr. Shock, Dr. Walter van den Broek gives a humorous jab at the practice of “pimping” by doctors trying [...]

  20. Grand Rounds « See First Blog on May 26th, 2009 at 1:31 pm
  21. [...] Pimping Med Students AKPC_IDS += “3507,”;Popularity: unranked [?]SHARETHIS.addEntry({ title: “Medical Slang Explained”, url: “http://www.shockmd.com/2009/08/10/medical-slang-explained/” }); Filed in: General Medicine [...]

  22. Medical Slang Explained | Dr Shock MD PhD on August 10th, 2009 at 8:58 am
  23. [...] This is also known as The art of Pimping: pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. More on pimping med students. [...]

  24. The Hidden Curriculum in Medical Education | Dr Shock MD PhD on October 28th, 2010 at 8:54 am
  25. [...] word is chill.  So far there are no big, ball-busting blowhards like you see on TV, no one “pimping” the students.  From what I hear, that’s way more the style of [...]

  26. Hospital Rotations Begin: Inpatient Medicine – Day 1 on January 24th, 2012 at 8:11 am
  1. Pimping does occur and over the course of medical school I have, through trial and error, developed each one of your cures :-). In general, I favor “avoidance” and “the muffin” as a first line and the “politician’s approach” as a second line.

    Pimping does occur but in my experience it occurs in two forms. (1) is the attending who is genuinely using it as a tool to teach. (2) is the attending who is using it as a tool to make medical students feel bad. The forms are often indistinguishable except that the attending who is trying to degrade is often considerably more disdainful in their manner of speech.

    One of the attendings who I am closest to used to barrage me with questions that I could not answer to the point where it hurt. But it was always for purposes of teaching since I would go look those questions up later and move on to more advanced topics on the next go around.

    Take in contrast an attending who found out I had just come back from my PhD, would take me into patients’ rooms and pimp me on (in hindsight) pretty advanced topics that I either had not relearned yet or had never learned altogether. As the pimping never occured without patients present and there was never any teaching whatsoever, I very quickly realized what the purpose of the pimping was. As a side note, I resolved the situation by quickly saying “I don’t know” when pimped on something I couldn’t answer. Once I stopped struggling in front of the patients to come up with an answer I didn’t know, the attending stopped pimping me.

    Take that how you will. One attending has become a lifelong mentor and friend: writing many papers together, having beers and bbq-ing together. One attending, well, I don’t even know what happened to that attending.

  2. mudphudder on May 7th, 2009 at 4:21 pm
  3. I think learning to say “I don’t know” quickly (when you actually don’t know the answer) will decrease any pain that is associated with pimping.

  4. DrBadger on May 7th, 2009 at 5:13 pm
  5. I don’t necessarily agree with Dr. Badger. I think in situations where the purpose of the pimping is for learning purposes, sometimes it is worth trying to verbally reason out the answer. Even if one doesn’t know the exact answer, I’ve found that getting into the ballpark through reasoning can score a lot of points and demonstrate one’s strength of mind, if not one’s fund of knowledge. I don’t think one should be averse to the pain of pimping because that pain is a good motivator for learning. Moreover, that pain has permanently scarred the answer to many of those questions on my brain :-)

    In a no-win situation though, where the point of the pimping is to cause embarassment and belittle the student–i.e. there is no point to drag out the process–then a quick “I don’t know” is in order (in my opinion).

  6. mudphudder on May 7th, 2009 at 6:13 pm
  7. @mudphudder No pain is needed, questions can be put politely and on topic, most attending try to find very difficult questions mostly what they have recently discovered. They have no clue as to which phase the younger doctor is in in his education. Questions are there for learning not embarrassing.
    Take care Dr Shock
    P.S how is the headache?

  8. Dr Shock on May 7th, 2009 at 6:29 pm
  9. I think your explanation is based on that of a reasonable person. You are reasonable and you understand that pain is not needed. You also have a standard way of coming up with questions for pimping.
    However, not everyone is like you. More so, but still not everyone. There are unreasonable attendings out there. And some who occasionally (or more often) want to bring on the pain through pimping. To use my personal example, when I tell an attending that I just came back from several years of graduate school and am currently trying to catch back up, I highly doubt anyone would expect me to know about the latest study in last month’s issue of the Journal of Something-ology. So to ask those kinds of things in front of patients serves no other purpose but to cause embarassment.
    But for the purposes of learning, I don’t think a little pain, with good intentions, is a bad thing.

    p.s. I actually don’t get headaches (although I do experience other symptoms) so I’m okay in that regard. But thank you for asking :-)

  10. mudphudder on May 7th, 2009 at 6:52 pm
  11. Love it. I start my clinical rotations in the middle of June, and I’m personally petrified of getting pimped. Yes, it still happens. I got pimped on an H&P visit a month ago. Anyway, posts like this really make me smile. Well done. :)

  12. ChristinePAS on May 7th, 2009 at 7:06 pm
  13. Ok, I’ll confess, I pimp clerks, interns and residents, but there are always clearly articulated rules when we start:

    1) If you really don’t know, just say so
    2) If you partially know, do try and struggle toward the answer from first principles
    3) If you get part way and hit a plateau, you are invited to “call a friend,” usually the next more senior member of the house staff
    4) Pimping ends immediately if the house staff appear visibly anxious about the process to a degree that seems disorganizing
    5) The attending staff will riff on the topic at the end to fill in the holes and move the process toward the “Ah ha!” moment of seeing the penny drop for the house staff

  14. Epictetus on May 7th, 2009 at 7:41 pm
  15. Mostly stolen from this excellent article in JAMA. Kind regards Dr Shock

  16. Dr Shock on May 7th, 2009 at 8:43 pm
  17. I agree with you, mudphudder, if you can come up with a partial answer, go ahead and try to come up with something. But if you really don’t know, I don’t think it’s worth struggling. So really, Epictetus is on the mark (or at least that’s what I will aim for when I return to the clinics next month).

  18. DrBadger on May 7th, 2009 at 11:26 pm
  19. [...] Dr. Shock, Dr. Walter van den Broek gives a humorous jab at the practice of “pimping” by doctors trying [...]

  20. Grand Rounds « See First Blog on May 26th, 2009 at 1:31 pm
  21. [...] Pimping Med Students AKPC_IDS += “3507,”;Popularity: unranked [?]SHARETHIS.addEntry({ title: “Medical Slang Explained”, url: “http://www.shockmd.com/2009/08/10/medical-slang-explained/” }); Filed in: General Medicine [...]

  22. Medical Slang Explained | Dr Shock MD PhD on August 10th, 2009 at 8:58 am
  23. [...] This is also known as The art of Pimping: pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. More on pimping med students. [...]

  24. The Hidden Curriculum in Medical Education | Dr Shock MD PhD on October 28th, 2010 at 8:54 am
  25. [...] word is chill.  So far there are no big, ball-busting blowhards like you see on TV, no one “pimping” the students.  From what I hear, that’s way more the style of [...]

  26. Hospital Rotations Begin: Inpatient Medicine – Day 1 on January 24th, 2012 at 8:11 am
  1. Pimping does occur and over the course of medical school I have, through trial and error, developed each one of your cures :-). In general, I favor “avoidance” and “the muffin” as a first line and the “politician’s approach” as a second line.

    Pimping does occur but in my experience it occurs in two forms. (1) is the attending who is genuinely using it as a tool to teach. (2) is the attending who is using it as a tool to make medical students feel bad. The forms are often indistinguishable except that the attending who is trying to degrade is often considerably more disdainful in their manner of speech.

    One of the attendings who I am closest to used to barrage me with questions that I could not answer to the point where it hurt. But it was always for purposes of teaching since I would go look those questions up later and move on to more advanced topics on the next go around.

    Take in contrast an attending who found out I had just come back from my PhD, would take me into patients’ rooms and pimp me on (in hindsight) pretty advanced topics that I either had not relearned yet or had never learned altogether. As the pimping never occured without patients present and there was never any teaching whatsoever, I very quickly realized what the purpose of the pimping was. As a side note, I resolved the situation by quickly saying “I don’t know” when pimped on something I couldn’t answer. Once I stopped struggling in front of the patients to come up with an answer I didn’t know, the attending stopped pimping me.

    Take that how you will. One attending has become a lifelong mentor and friend: writing many papers together, having beers and bbq-ing together. One attending, well, I don’t even know what happened to that attending.

  2. mudphudder on May 7th, 2009 at 4:21 pm
  3. I think learning to say “I don’t know” quickly (when you actually don’t know the answer) will decrease any pain that is associated with pimping.

  4. DrBadger on May 7th, 2009 at 5:13 pm
  5. I don’t necessarily agree with Dr. Badger. I think in situations where the purpose of the pimping is for learning purposes, sometimes it is worth trying to verbally reason out the answer. Even if one doesn’t know the exact answer, I’ve found that getting into the ballpark through reasoning can score a lot of points and demonstrate one’s strength of mind, if not one’s fund of knowledge. I don’t think one should be averse to the pain of pimping because that pain is a good motivator for learning. Moreover, that pain has permanently scarred the answer to many of those questions on my brain :-)

    In a no-win situation though, where the point of the pimping is to cause embarassment and belittle the student–i.e. there is no point to drag out the process–then a quick “I don’t know” is in order (in my opinion).

  6. mudphudder on May 7th, 2009 at 6:13 pm
  7. @mudphudder No pain is needed, questions can be put politely and on topic, most attending try to find very difficult questions mostly what they have recently discovered. They have no clue as to which phase the younger doctor is in in his education. Questions are there for learning not embarrassing.
    Take care Dr Shock
    P.S how is the headache?

  8. Dr Shock on May 7th, 2009 at 6:29 pm
  9. I think your explanation is based on that of a reasonable person. You are reasonable and you understand that pain is not needed. You also have a standard way of coming up with questions for pimping.
    However, not everyone is like you. More so, but still not everyone. There are unreasonable attendings out there. And some who occasionally (or more often) want to bring on the pain through pimping. To use my personal example, when I tell an attending that I just came back from several years of graduate school and am currently trying to catch back up, I highly doubt anyone would expect me to know about the latest study in last month’s issue of the Journal of Something-ology. So to ask those kinds of things in front of patients serves no other purpose but to cause embarassment.
    But for the purposes of learning, I don’t think a little pain, with good intentions, is a bad thing.

    p.s. I actually don’t get headaches (although I do experience other symptoms) so I’m okay in that regard. But thank you for asking :-)

  10. mudphudder on May 7th, 2009 at 6:52 pm
  11. Love it. I start my clinical rotations in the middle of June, and I’m personally petrified of getting pimped. Yes, it still happens. I got pimped on an H&P visit a month ago. Anyway, posts like this really make me smile. Well done. :)

  12. ChristinePAS on May 7th, 2009 at 7:06 pm
  13. Ok, I’ll confess, I pimp clerks, interns and residents, but there are always clearly articulated rules when we start:

    1) If you really don’t know, just say so
    2) If you partially know, do try and struggle toward the answer from first principles
    3) If you get part way and hit a plateau, you are invited to “call a friend,” usually the next more senior member of the house staff
    4) Pimping ends immediately if the house staff appear visibly anxious about the process to a degree that seems disorganizing
    5) The attending staff will riff on the topic at the end to fill in the holes and move the process toward the “Ah ha!” moment of seeing the penny drop for the house staff

  14. Epictetus on May 7th, 2009 at 7:41 pm
  15. Mostly stolen from this excellent article in JAMA. Kind regards Dr Shock

  16. Dr Shock on May 7th, 2009 at 8:43 pm
  17. I agree with you, mudphudder, if you can come up with a partial answer, go ahead and try to come up with something. But if you really don’t know, I don’t think it’s worth struggling. So really, Epictetus is on the mark (or at least that’s what I will aim for when I return to the clinics next month).

  18. DrBadger on May 7th, 2009 at 11:26 pm
  19. [...] Dr. Shock, Dr. Walter van den Broek gives a humorous jab at the practice of “pimping” by doctors trying [...]

  20. Grand Rounds « See First Blog on May 26th, 2009 at 1:31 pm
  21. [...] Pimping Med Students AKPC_IDS += “3507,”;Popularity: unranked [?]SHARETHIS.addEntry({ title: “Medical Slang Explained”, url: “http://www.shockmd.com/2009/08/10/medical-slang-explained/” }); Filed in: General Medicine [...]

  22. Medical Slang Explained | Dr Shock MD PhD on August 10th, 2009 at 8:58 am
  23. [...] This is also known as The art of Pimping: pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. More on pimping med students. [...]

  24. The Hidden Curriculum in Medical Education | Dr Shock MD PhD on October 28th, 2010 at 8:54 am
  25. [...] word is chill.  So far there are no big, ball-busting blowhards like you see on TV, no one “pimping” the students.  From what I hear, that’s way more the style of [...]

  26. Hospital Rotations Begin: Inpatient Medicine – Day 1 on January 24th, 2012 at 8:11 am
  1. Pimping does occur and over the course of medical school I have, through trial and error, developed each one of your cures :-). In general, I favor “avoidance” and “the muffin” as a first line and the “politician’s approach” as a second line.

    Pimping does occur but in my experience it occurs in two forms. (1) is the attending who is genuinely using it as a tool to teach. (2) is the attending who is using it as a tool to make medical students feel bad. The forms are often indistinguishable except that the attending who is trying to degrade is often considerably more disdainful in their manner of speech.

    One of the attendings who I am closest to used to barrage me with questions that I could not answer to the point where it hurt. But it was always for purposes of teaching since I would go look those questions up later and move on to more advanced topics on the next go around.

    Take in contrast an attending who found out I had just come back from my PhD, would take me into patients’ rooms and pimp me on (in hindsight) pretty advanced topics that I either had not relearned yet or had never learned altogether. As the pimping never occured without patients present and there was never any teaching whatsoever, I very quickly realized what the purpose of the pimping was. As a side note, I resolved the situation by quickly saying “I don’t know” when pimped on something I couldn’t answer. Once I stopped struggling in front of the patients to come up with an answer I didn’t know, the attending stopped pimping me.

    Take that how you will. One attending has become a lifelong mentor and friend: writing many papers together, having beers and bbq-ing together. One attending, well, I don’t even know what happened to that attending.

  2. mudphudder on May 7th, 2009 at 4:21 pm
  3. I think learning to say “I don’t know” quickly (when you actually don’t know the answer) will decrease any pain that is associated with pimping.

  4. DrBadger on May 7th, 2009 at 5:13 pm
  5. I don’t necessarily agree with Dr. Badger. I think in situations where the purpose of the pimping is for learning purposes, sometimes it is worth trying to verbally reason out the answer. Even if one doesn’t know the exact answer, I’ve found that getting into the ballpark through reasoning can score a lot of points and demonstrate one’s strength of mind, if not one’s fund of knowledge. I don’t think one should be averse to the pain of pimping because that pain is a good motivator for learning. Moreover, that pain has permanently scarred the answer to many of those questions on my brain :-)

    In a no-win situation though, where the point of the pimping is to cause embarassment and belittle the student–i.e. there is no point to drag out the process–then a quick “I don’t know” is in order (in my opinion).

  6. mudphudder on May 7th, 2009 at 6:13 pm
  7. @mudphudder No pain is needed, questions can be put politely and on topic, most attending try to find very difficult questions mostly what they have recently discovered. They have no clue as to which phase the younger doctor is in in his education. Questions are there for learning not embarrassing.
    Take care Dr Shock
    P.S how is the headache?

  8. Dr Shock on May 7th, 2009 at 6:29 pm
  9. I think your explanation is based on that of a reasonable person. You are reasonable and you understand that pain is not needed. You also have a standard way of coming up with questions for pimping.
    However, not everyone is like you. More so, but still not everyone. There are unreasonable attendings out there. And some who occasionally (or more often) want to bring on the pain through pimping. To use my personal example, when I tell an attending that I just came back from several years of graduate school and am currently trying to catch back up, I highly doubt anyone would expect me to know about the latest study in last month’s issue of the Journal of Something-ology. So to ask those kinds of things in front of patients serves no other purpose but to cause embarassment.
    But for the purposes of learning, I don’t think a little pain, with good intentions, is a bad thing.

    p.s. I actually don’t get headaches (although I do experience other symptoms) so I’m okay in that regard. But thank you for asking :-)

  10. mudphudder on May 7th, 2009 at 6:52 pm
  11. Love it. I start my clinical rotations in the middle of June, and I’m personally petrified of getting pimped. Yes, it still happens. I got pimped on an H&P visit a month ago. Anyway, posts like this really make me smile. Well done. :)

  12. ChristinePAS on May 7th, 2009 at 7:06 pm
  13. Ok, I’ll confess, I pimp clerks, interns and residents, but there are always clearly articulated rules when we start:

    1) If you really don’t know, just say so
    2) If you partially know, do try and struggle toward the answer from first principles
    3) If you get part way and hit a plateau, you are invited to “call a friend,” usually the next more senior member of the house staff
    4) Pimping ends immediately if the house staff appear visibly anxious about the process to a degree that seems disorganizing
    5) The attending staff will riff on the topic at the end to fill in the holes and move the process toward the “Ah ha!” moment of seeing the penny drop for the house staff

  14. Epictetus on May 7th, 2009 at 7:41 pm
  15. Mostly stolen from this excellent article in JAMA. Kind regards Dr Shock

  16. Dr Shock on May 7th, 2009 at 8:43 pm
  17. I agree with you, mudphudder, if you can come up with a partial answer, go ahead and try to come up with something. But if you really don’t know, I don’t think it’s worth struggling. So really, Epictetus is on the mark (or at least that’s what I will aim for when I return to the clinics next month).

  18. DrBadger on May 7th, 2009 at 11:26 pm
  19. [...] Dr. Shock, Dr. Walter van den Broek gives a humorous jab at the practice of “pimping” by doctors trying [...]

  20. Grand Rounds « See First Blog on May 26th, 2009 at 1:31 pm
  21. [...] Pimping Med Students AKPC_IDS += “3507,”;Popularity: unranked [?]SHARETHIS.addEntry({ title: “Medical Slang Explained”, url: “http://www.shockmd.com/2009/08/10/medical-slang-explained/” }); Filed in: General Medicine [...]

  22. Medical Slang Explained | Dr Shock MD PhD on August 10th, 2009 at 8:58 am
  23. [...] This is also known as The art of Pimping: pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. More on pimping med students. [...]

  24. The Hidden Curriculum in Medical Education | Dr Shock MD PhD on October 28th, 2010 at 8:54 am
  25. [...] word is chill.  So far there are no big, ball-busting blowhards like you see on TV, no one “pimping” the students.  From what I hear, that’s way more the style of [...]

  26. Hospital Rotations Begin: Inpatient Medicine – Day 1 on January 24th, 2012 at 8:11 am
  1. Pimping does occur and over the course of medical school I have, through trial and error, developed each one of your cures :-). In general, I favor “avoidance” and “the muffin” as a first line and the “politician’s approach” as a second line.

    Pimping does occur but in my experience it occurs in two forms. (1) is the attending who is genuinely using it as a tool to teach. (2) is the attending who is using it as a tool to make medical students feel bad. The forms are often indistinguishable except that the attending who is trying to degrade is often considerably more disdainful in their manner of speech.

    One of the attendings who I am closest to used to barrage me with questions that I could not answer to the point where it hurt. But it was always for purposes of teaching since I would go look those questions up later and move on to more advanced topics on the next go around.

    Take in contrast an attending who found out I had just come back from my PhD, would take me into patients’ rooms and pimp me on (in hindsight) pretty advanced topics that I either had not relearned yet or had never learned altogether. As the pimping never occured without patients present and there was never any teaching whatsoever, I very quickly realized what the purpose of the pimping was. As a side note, I resolved the situation by quickly saying “I don’t know” when pimped on something I couldn’t answer. Once I stopped struggling in front of the patients to come up with an answer I didn’t know, the attending stopped pimping me.

    Take that how you will. One attending has become a lifelong mentor and friend: writing many papers together, having beers and bbq-ing together. One attending, well, I don’t even know what happened to that attending.

  2. mudphudder on May 7th, 2009 at 4:21 pm
  3. I think learning to say “I don’t know” quickly (when you actually don’t know the answer) will decrease any pain that is associated with pimping.

  4. DrBadger on May 7th, 2009 at 5:13 pm
  5. I don’t necessarily agree with Dr. Badger. I think in situations where the purpose of the pimping is for learning purposes, sometimes it is worth trying to verbally reason out the answer. Even if one doesn’t know the exact answer, I’ve found that getting into the ballpark through reasoning can score a lot of points and demonstrate one’s strength of mind, if not one’s fund of knowledge. I don’t think one should be averse to the pain of pimping because that pain is a good motivator for learning. Moreover, that pain has permanently scarred the answer to many of those questions on my brain :-)

    In a no-win situation though, where the point of the pimping is to cause embarassment and belittle the student–i.e. there is no point to drag out the process–then a quick “I don’t know” is in order (in my opinion).

  6. mudphudder on May 7th, 2009 at 6:13 pm
  7. @mudphudder No pain is needed, questions can be put politely and on topic, most attending try to find very difficult questions mostly what they have recently discovered. They have no clue as to which phase the younger doctor is in in his education. Questions are there for learning not embarrassing.
    Take care Dr Shock
    P.S how is the headache?

  8. Dr Shock on May 7th, 2009 at 6:29 pm
  9. I think your explanation is based on that of a reasonable person. You are reasonable and you understand that pain is not needed. You also have a standard way of coming up with questions for pimping.
    However, not everyone is like you. More so, but still not everyone. There are unreasonable attendings out there. And some who occasionally (or more often) want to bring on the pain through pimping. To use my personal example, when I tell an attending that I just came back from several years of graduate school and am currently trying to catch back up, I highly doubt anyone would expect me to know about the latest study in last month’s issue of the Journal of Something-ology. So to ask those kinds of things in front of patients serves no other purpose but to cause embarassment.
    But for the purposes of learning, I don’t think a little pain, with good intentions, is a bad thing.

    p.s. I actually don’t get headaches (although I do experience other symptoms) so I’m okay in that regard. But thank you for asking :-)

  10. mudphudder on May 7th, 2009 at 6:52 pm
  11. Love it. I start my clinical rotations in the middle of June, and I’m personally petrified of getting pimped. Yes, it still happens. I got pimped on an H&P visit a month ago. Anyway, posts like this really make me smile. Well done. :)

  12. ChristinePAS on May 7th, 2009 at 7:06 pm
  13. Ok, I’ll confess, I pimp clerks, interns and residents, but there are always clearly articulated rules when we start:

    1) If you really don’t know, just say so
    2) If you partially know, do try and struggle toward the answer from first principles
    3) If you get part way and hit a plateau, you are invited to “call a friend,” usually the next more senior member of the house staff
    4) Pimping ends immediately if the house staff appear visibly anxious about the process to a degree that seems disorganizing
    5) The attending staff will riff on the topic at the end to fill in the holes and move the process toward the “Ah ha!” moment of seeing the penny drop for the house staff

  14. Epictetus on May 7th, 2009 at 7:41 pm
  15. Mostly stolen from this excellent article in JAMA. Kind regards Dr Shock

  16. Dr Shock on May 7th, 2009 at 8:43 pm
  17. I agree with you, mudphudder, if you can come up with a partial answer, go ahead and try to come up with something. But if you really don’t know, I don’t think it’s worth struggling. So really, Epictetus is on the mark (or at least that’s what I will aim for when I return to the clinics next month).

  18. DrBadger on May 7th, 2009 at 11:26 pm
  19. [...] Dr. Shock, Dr. Walter van den Broek gives a humorous jab at the practice of “pimping” by doctors trying [...]

  20. Grand Rounds « See First Blog on May 26th, 2009 at 1:31 pm
  21. [...] Pimping Med Students AKPC_IDS += “3507,”;Popularity: unranked [?]SHARETHIS.addEntry({ title: “Medical Slang Explained”, url: “http://www.shockmd.com/2009/08/10/medical-slang-explained/” }); Filed in: General Medicine [...]

  22. Medical Slang Explained | Dr Shock MD PhD on August 10th, 2009 at 8:58 am
  23. [...] This is also known as The art of Pimping: pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. More on pimping med students. [...]

  24. The Hidden Curriculum in Medical Education | Dr Shock MD PhD on October 28th, 2010 at 8:54 am
  25. [...] word is chill.  So far there are no big, ball-busting blowhards like you see on TV, no one “pimping” the students.  From what I hear, that’s way more the style of [...]

  26. Hospital Rotations Begin: Inpatient Medicine – Day 1 on January 24th, 2012 at 8:11 am
  1. Pimping does occur and over the course of medical school I have, through trial and error, developed each one of your cures :-). In general, I favor “avoidance” and “the muffin” as a first line and the “politician’s approach” as a second line.

    Pimping does occur but in my experience it occurs in two forms. (1) is the attending who is genuinely using it as a tool to teach. (2) is the attending who is using it as a tool to make medical students feel bad. The forms are often indistinguishable except that the attending who is trying to degrade is often considerably more disdainful in their manner of speech.

    One of the attendings who I am closest to used to barrage me with questions that I could not answer to the point where it hurt. But it was always for purposes of teaching since I would go look those questions up later and move on to more advanced topics on the next go around.

    Take in contrast an attending who found out I had just come back from my PhD, would take me into patients’ rooms and pimp me on (in hindsight) pretty advanced topics that I either had not relearned yet or had never learned altogether. As the pimping never occured without patients present and there was never any teaching whatsoever, I very quickly realized what the purpose of the pimping was. As a side note, I resolved the situation by quickly saying “I don’t know” when pimped on something I couldn’t answer. Once I stopped struggling in front of the patients to come up with an answer I didn’t know, the attending stopped pimping me.

    Take that how you will. One attending has become a lifelong mentor and friend: writing many papers together, having beers and bbq-ing together. One attending, well, I don’t even know what happened to that attending.

  2. mudphudder on May 7th, 2009 at 4:21 pm
  3. I think learning to say “I don’t know” quickly (when you actually don’t know the answer) will decrease any pain that is associated with pimping.

  4. DrBadger on May 7th, 2009 at 5:13 pm
  5. I don’t necessarily agree with Dr. Badger. I think in situations where the purpose of the pimping is for learning purposes, sometimes it is worth trying to verbally reason out the answer. Even if one doesn’t know the exact answer, I’ve found that getting into the ballpark through reasoning can score a lot of points and demonstrate one’s strength of mind, if not one’s fund of knowledge. I don’t think one should be averse to the pain of pimping because that pain is a good motivator for learning. Moreover, that pain has permanently scarred the answer to many of those questions on my brain :-)

    In a no-win situation though, where the point of the pimping is to cause embarassment and belittle the student–i.e. there is no point to drag out the process–then a quick “I don’t know” is in order (in my opinion).

  6. mudphudder on May 7th, 2009 at 6:13 pm
  7. @mudphudder No pain is needed, questions can be put politely and on topic, most attending try to find very difficult questions mostly what they have recently discovered. They have no clue as to which phase the younger doctor is in in his education. Questions are there for learning not embarrassing.
    Take care Dr Shock
    P.S how is the headache?

  8. Dr Shock on May 7th, 2009 at 6:29 pm
  9. I think your explanation is based on that of a reasonable person. You are reasonable and you understand that pain is not needed. You also have a standard way of coming up with questions for pimping.
    However, not everyone is like you. More so, but still not everyone. There are unreasonable attendings out there. And some who occasionally (or more often) want to bring on the pain through pimping. To use my personal example, when I tell an attending that I just came back from several years of graduate school and am currently trying to catch back up, I highly doubt anyone would expect me to know about the latest study in last month’s issue of the Journal of Something-ology. So to ask those kinds of things in front of patients serves no other purpose but to cause embarassment.
    But for the purposes of learning, I don’t think a little pain, with good intentions, is a bad thing.

    p.s. I actually don’t get headaches (although I do experience other symptoms) so I’m okay in that regard. But thank you for asking :-)

  10. mudphudder on May 7th, 2009 at 6:52 pm
  11. Love it. I start my clinical rotations in the middle of June, and I’m personally petrified of getting pimped. Yes, it still happens. I got pimped on an H&P visit a month ago. Anyway, posts like this really make me smile. Well done. :)

  12. ChristinePAS on May 7th, 2009 at 7:06 pm
  13. Ok, I’ll confess, I pimp clerks, interns and residents, but there are always clearly articulated rules when we start:

    1) If you really don’t know, just say so
    2) If you partially know, do try and struggle toward the answer from first principles
    3) If you get part way and hit a plateau, you are invited to “call a friend,” usually the next more senior member of the house staff
    4) Pimping ends immediately if the house staff appear visibly anxious about the process to a degree that seems disorganizing
    5) The attending staff will riff on the topic at the end to fill in the holes and move the process toward the “Ah ha!” moment of seeing the penny drop for the house staff

  14. Epictetus on May 7th, 2009 at 7:41 pm
  15. Mostly stolen from this excellent article in JAMA. Kind regards Dr Shock

  16. Dr Shock on May 7th, 2009 at 8:43 pm
  17. I agree with you, mudphudder, if you can come up with a partial answer, go ahead and try to come up with something. But if you really don’t know, I don’t think it’s worth struggling. So really, Epictetus is on the mark (or at least that’s what I will aim for when I return to the clinics next month).

  18. DrBadger on May 7th, 2009 at 11:26 pm
  19. [...] Dr. Shock, Dr. Walter van den Broek gives a humorous jab at the practice of “pimping” by doctors trying [...]

  20. Grand Rounds « See First Blog on May 26th, 2009 at 1:31 pm
  21. [...] Pimping Med Students AKPC_IDS += “3507,”;Popularity: unranked [?]SHARETHIS.addEntry({ title: “Medical Slang Explained”, url: “http://www.shockmd.com/2009/08/10/medical-slang-explained/” }); Filed in: General Medicine [...]

  22. Medical Slang Explained | Dr Shock MD PhD on August 10th, 2009 at 8:58 am
  23. [...] This is also known as The art of Pimping: pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. More on pimping med students. [...]

  24. The Hidden Curriculum in Medical Education | Dr Shock MD PhD on October 28th, 2010 at 8:54 am
  25. [...] word is chill.  So far there are no big, ball-busting blowhards like you see on TV, no one “pimping” the students.  From what I hear, that’s way more the style of [...]

  26. Hospital Rotations Begin: Inpatient Medicine – Day 1 on January 24th, 2012 at 8:11 am
  1. Pimping does occur and over the course of medical school I have, through trial and error, developed each one of your cures :-). In general, I favor “avoidance” and “the muffin” as a first line and the “politician’s approach” as a second line.

    Pimping does occur but in my experience it occurs in two forms. (1) is the attending who is genuinely using it as a tool to teach. (2) is the attending who is using it as a tool to make medical students feel bad. The forms are often indistinguishable except that the attending who is trying to degrade is often considerably more disdainful in their manner of speech.

    One of the attendings who I am closest to used to barrage me with questions that I could not answer to the point where it hurt. But it was always for purposes of teaching since I would go look those questions up later and move on to more advanced topics on the next go around.

    Take in contrast an attending who found out I had just come back from my PhD, would take me into patients’ rooms and pimp me on (in hindsight) pretty advanced topics that I either had not relearned yet or had never learned altogether. As the pimping never occured without patients present and there was never any teaching whatsoever, I very quickly realized what the purpose of the pimping was. As a side note, I resolved the situation by quickly saying “I don’t know” when pimped on something I couldn’t answer. Once I stopped struggling in front of the patients to come up with an answer I didn’t know, the attending stopped pimping me.

    Take that how you will. One attending has become a lifelong mentor and friend: writing many papers together, having beers and bbq-ing together. One attending, well, I don’t even know what happened to that attending.

  2. mudphudder on May 7th, 2009 at 4:21 pm
  3. I think learning to say “I don’t know” quickly (when you actually don’t know the answer) will decrease any pain that is associated with pimping.

  4. DrBadger on May 7th, 2009 at 5:13 pm
  5. I don’t necessarily agree with Dr. Badger. I think in situations where the purpose of the pimping is for learning purposes, sometimes it is worth trying to verbally reason out the answer. Even if one doesn’t know the exact answer, I’ve found that getting into the ballpark through reasoning can score a lot of points and demonstrate one’s strength of mind, if not one’s fund of knowledge. I don’t think one should be averse to the pain of pimping because that pain is a good motivator for learning. Moreover, that pain has permanently scarred the answer to many of those questions on my brain :-)

    In a no-win situation though, where the point of the pimping is to cause embarassment and belittle the student–i.e. there is no point to drag out the process–then a quick “I don’t know” is in order (in my opinion).

  6. mudphudder on May 7th, 2009 at 6:13 pm
  7. @mudphudder No pain is needed, questions can be put politely and on topic, most attending try to find very difficult questions mostly what they have recently discovered. They have no clue as to which phase the younger doctor is in in his education. Questions are there for learning not embarrassing.
    Take care Dr Shock
    P.S how is the headache?

  8. Dr Shock on May 7th, 2009 at 6:29 pm
  9. I think your explanation is based on that of a reasonable person. You are reasonable and you understand that pain is not needed. You also have a standard way of coming up with questions for pimping.
    However, not everyone is like you. More so, but still not everyone. There are unreasonable attendings out there. And some who occasionally (or more often) want to bring on the pain through pimping. To use my personal example, when I tell an attending that I just came back from several years of graduate school and am currently trying to catch back up, I highly doubt anyone would expect me to know about the latest study in last month’s issue of the Journal of Something-ology. So to ask those kinds of things in front of patients serves no other purpose but to cause embarassment.
    But for the purposes of learning, I don’t think a little pain, with good intentions, is a bad thing.

    p.s. I actually don’t get headaches (although I do experience other symptoms) so I’m okay in that regard. But thank you for asking :-)

  10. mudphudder on May 7th, 2009 at 6:52 pm
  11. Love it. I start my clinical rotations in the middle of June, and I’m personally petrified of getting pimped. Yes, it still happens. I got pimped on an H&P visit a month ago. Anyway, posts like this really make me smile. Well done. :)

  12. ChristinePAS on May 7th, 2009 at 7:06 pm
  13. Ok, I’ll confess, I pimp clerks, interns and residents, but there are always clearly articulated rules when we start:

    1) If you really don’t know, just say so
    2) If you partially know, do try and struggle toward the answer from first principles
    3) If you get part way and hit a plateau, you are invited to “call a friend,” usually the next more senior member of the house staff
    4) Pimping ends immediately if the house staff appear visibly anxious about the process to a degree that seems disorganizing
    5) The attending staff will riff on the topic at the end to fill in the holes and move the process toward the “Ah ha!” moment of seeing the penny drop for the house staff

  14. Epictetus on May 7th, 2009 at 7:41 pm
  15. Mostly stolen from this excellent article in JAMA. Kind regards Dr Shock

  16. Dr Shock on May 7th, 2009 at 8:43 pm
  17. I agree with you, mudphudder, if you can come up with a partial answer, go ahead and try to come up with something. But if you really don’t know, I don’t think it’s worth struggling. So really, Epictetus is on the mark (or at least that’s what I will aim for when I return to the clinics next month).

  18. DrBadger on May 7th, 2009 at 11:26 pm
  19. [...] Dr. Shock, Dr. Walter van den Broek gives a humorous jab at the practice of “pimping” by doctors trying [...]

  20. Grand Rounds « See First Blog on May 26th, 2009 at 1:31 pm
  21. [...] Pimping Med Students AKPC_IDS += “3507,”;Popularity: unranked [?]SHARETHIS.addEntry({ title: “Medical Slang Explained”, url: “http://www.shockmd.com/2009/08/10/medical-slang-explained/” }); Filed in: General Medicine [...]

  22. Medical Slang Explained | Dr Shock MD PhD on August 10th, 2009 at 8:58 am
  23. [...] This is also known as The art of Pimping: pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. More on pimping med students. [...]

  24. The Hidden Curriculum in Medical Education | Dr Shock MD PhD on October 28th, 2010 at 8:54 am
  25. [...] word is chill.  So far there are no big, ball-busting blowhards like you see on TV, no one “pimping” the students.  From what I hear, that’s way more the style of [...]

  26. Hospital Rotations Begin: Inpatient Medicine – Day 1 on January 24th, 2012 at 8:11 am
  1. Pimping does occur and over the course of medical school I have, through trial and error, developed each one of your cures :-). In general, I favor “avoidance” and “the muffin” as a first line and the “politician’s approach” as a second line.

    Pimping does occur but in my experience it occurs in two forms. (1) is the attending who is genuinely using it as a tool to teach. (2) is the attending who is using it as a tool to make medical students feel bad. The forms are often indistinguishable except that the attending who is trying to degrade is often considerably more disdainful in their manner of speech.

    One of the attendings who I am closest to used to barrage me with questions that I could not answer to the point where it hurt. But it was always for purposes of teaching since I would go look those questions up later and move on to more advanced topics on the next go around.

    Take in contrast an attending who found out I had just come back from my PhD, would take me into patients’ rooms and pimp me on (in hindsight) pretty advanced topics that I either had not relearned yet or had never learned altogether. As the pimping never occured without patients present and there was never any teaching whatsoever, I very quickly realized what the purpose of the pimping was. As a side note, I resolved the situation by quickly saying “I don’t know” when pimped on something I couldn’t answer. Once I stopped struggling in front of the patients to come up with an answer I didn’t know, the attending stopped pimping me.

    Take that how you will. One attending has become a lifelong mentor and friend: writing many papers together, having beers and bbq-ing together. One attending, well, I don’t even know what happened to that attending.

  2. mudphudder on May 7th, 2009 at 4:21 pm
  3. I think learning to say “I don’t know” quickly (when you actually don’t know the answer) will decrease any pain that is associated with pimping.

  4. DrBadger on May 7th, 2009 at 5:13 pm
  5. I don’t necessarily agree with Dr. Badger. I think in situations where the purpose of the pimping is for learning purposes, sometimes it is worth trying to verbally reason out the answer. Even if one doesn’t know the exact answer, I’ve found that getting into the ballpark through reasoning can score a lot of points and demonstrate one’s strength of mind, if not one’s fund of knowledge. I don’t think one should be averse to the pain of pimping because that pain is a good motivator for learning. Moreover, that pain has permanently scarred the answer to many of those questions on my brain :-)

    In a no-win situation though, where the point of the pimping is to cause embarassment and belittle the student–i.e. there is no point to drag out the process–then a quick “I don’t know” is in order (in my opinion).

  6. mudphudder on May 7th, 2009 at 6:13 pm
  7. @mudphudder No pain is needed, questions can be put politely and on topic, most attending try to find very difficult questions mostly what they have recently discovered. They have no clue as to which phase the younger doctor is in in his education. Questions are there for learning not embarrassing.
    Take care Dr Shock
    P.S how is the headache?

  8. Dr Shock on May 7th, 2009 at 6:29 pm
  9. I think your explanation is based on that of a reasonable person. You are reasonable and you understand that pain is not needed. You also have a standard way of coming up with questions for pimping.
    However, not everyone is like you. More so, but still not everyone. There are unreasonable attendings out there. And some who occasionally (or more often) want to bring on the pain through pimping. To use my personal example, when I tell an attending that I just came back from several years of graduate school and am currently trying to catch back up, I highly doubt anyone would expect me to know about the latest study in last month’s issue of the Journal of Something-ology. So to ask those kinds of things in front of patients serves no other purpose but to cause embarassment.
    But for the purposes of learning, I don’t think a little pain, with good intentions, is a bad thing.

    p.s. I actually don’t get headaches (although I do experience other symptoms) so I’m okay in that regard. But thank you for asking :-)

  10. mudphudder on May 7th, 2009 at 6:52 pm
  11. Love it. I start my clinical rotations in the middle of June, and I’m personally petrified of getting pimped. Yes, it still happens. I got pimped on an H&P visit a month ago. Anyway, posts like this really make me smile. Well done. :)

  12. ChristinePAS on May 7th, 2009 at 7:06 pm
  13. Ok, I’ll confess, I pimp clerks, interns and residents, but there are always clearly articulated rules when we start:

    1) If you really don’t know, just say so
    2) If you partially know, do try and struggle toward the answer from first principles
    3) If you get part way and hit a plateau, you are invited to “call a friend,” usually the next more senior member of the house staff
    4) Pimping ends immediately if the house staff appear visibly anxious about the process to a degree that seems disorganizing
    5) The attending staff will riff on the topic at the end to fill in the holes and move the process toward the “Ah ha!” moment of seeing the penny drop for the house staff

  14. Epictetus on May 7th, 2009 at 7:41 pm
  15. Mostly stolen from this excellent article in JAMA. Kind regards Dr Shock

  16. Dr Shock on May 7th, 2009 at 8:43 pm
  17. I agree with you, mudphudder, if you can come up with a partial answer, go ahead and try to come up with something. But if you really don’t know, I don’t think it’s worth struggling. So really, Epictetus is on the mark (or at least that’s what I will aim for when I return to the clinics next month).

  18. DrBadger on May 7th, 2009 at 11:26 pm
  19. [...] Dr. Shock, Dr. Walter van den Broek gives a humorous jab at the practice of “pimping” by doctors trying [...]

  20. Grand Rounds « See First Blog on May 26th, 2009 at 1:31 pm
  21. [...] Pimping Med Students AKPC_IDS += “3507,”;Popularity: unranked [?]SHARETHIS.addEntry({ title: “Medical Slang Explained”, url: “http://www.shockmd.com/2009/08/10/medical-slang-explained/” }); Filed in: General Medicine [...]

  22. Medical Slang Explained | Dr Shock MD PhD on August 10th, 2009 at 8:58 am
  23. [...] This is also known as The art of Pimping: pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. More on pimping med students. [...]

  24. The Hidden Curriculum in Medical Education | Dr Shock MD PhD on October 28th, 2010 at 8:54 am
  25. [...] word is chill.  So far there are no big, ball-busting blowhards like you see on TV, no one “pimping” the students.  From what I hear, that’s way more the style of [...]

  26. Hospital Rotations Begin: Inpatient Medicine – Day 1 on January 24th, 2012 at 8:11 am
  1. Pimping does occur and over the course of medical school I have, through trial and error, developed each one of your cures :-). In general, I favor “avoidance” and “the muffin” as a first line and the “politician’s approach” as a second line.

    Pimping does occur but in my experience it occurs in two forms. (1) is the attending who is genuinely using it as a tool to teach. (2) is the attending who is using it as a tool to make medical students feel bad. The forms are often indistinguishable except that the attending who is trying to degrade is often considerably more disdainful in their manner of speech.

    One of the attendings who I am closest to used to barrage me with questions that I could not answer to the point where it hurt. But it was always for purposes of teaching since I would go look those questions up later and move on to more advanced topics on the next go around.

    Take in contrast an attending who found out I had just come back from my PhD, would take me into patients’ rooms and pimp me on (in hindsight) pretty advanced topics that I either had not relearned yet or had never learned altogether. As the pimping never occured without patients present and there was never any teaching whatsoever, I very quickly realized what the purpose of the pimping was. As a side note, I resolved the situation by quickly saying “I don’t know” when pimped on something I couldn’t answer. Once I stopped struggling in front of the patients to come up with an answer I didn’t know, the attending stopped pimping me.

    Take that how you will. One attending has become a lifelong mentor and friend: writing many papers together, having beers and bbq-ing together. One attending, well, I don’t even know what happened to that attending.

  2. mudphudder on May 7th, 2009 at 4:21 pm
  3. I think learning to say “I don’t know” quickly (when you actually don’t know the answer) will decrease any pain that is associated with pimping.

  4. DrBadger on May 7th, 2009 at 5:13 pm
  5. I don’t necessarily agree with Dr. Badger. I think in situations where the purpose of the pimping is for learning purposes, sometimes it is worth trying to verbally reason out the answer. Even if one doesn’t know the exact answer, I’ve found that getting into the ballpark through reasoning can score a lot of points and demonstrate one’s strength of mind, if not one’s fund of knowledge. I don’t think one should be averse to the pain of pimping because that pain is a good motivator for learning. Moreover, that pain has permanently scarred the answer to many of those questions on my brain :-)

    In a no-win situation though, where the point of the pimping is to cause embarassment and belittle the student–i.e. there is no point to drag out the process–then a quick “I don’t know” is in order (in my opinion).

  6. mudphudder on May 7th, 2009 at 6:13 pm
  7. @mudphudder No pain is needed, questions can be put politely and on topic, most attending try to find very difficult questions mostly what they have recently discovered. They have no clue as to which phase the younger doctor is in in his education. Questions are there for learning not embarrassing.
    Take care Dr Shock
    P.S how is the headache?

  8. Dr Shock on May 7th, 2009 at 6:29 pm
  9. I think your explanation is based on that of a reasonable person. You are reasonable and you understand that pain is not needed. You also have a standard way of coming up with questions for pimping.
    However, not everyone is like you. More so, but still not everyone. There are unreasonable attendings out there. And some who occasionally (or more often) want to bring on the pain through pimping. To use my personal example, when I tell an attending that I just came back from several years of graduate school and am currently trying to catch back up, I highly doubt anyone would expect me to know about the latest study in last month’s issue of the Journal of Something-ology. So to ask those kinds of things in front of patients serves no other purpose but to cause embarassment.
    But for the purposes of learning, I don’t think a little pain, with good intentions, is a bad thing.

    p.s. I actually don’t get headaches (although I do experience other symptoms) so I’m okay in that regard. But thank you for asking :-)

  10. mudphudder on May 7th, 2009 at 6:52 pm
  11. Love it. I start my clinical rotations in the middle of June, and I’m personally petrified of getting pimped. Yes, it still happens. I got pimped on an H&P visit a month ago. Anyway, posts like this really make me smile. Well done. :)

  12. ChristinePAS on May 7th, 2009 at 7:06 pm
  13. Ok, I’ll confess, I pimp clerks, interns and residents, but there are always clearly articulated rules when we start:

    1) If you really don’t know, just say so
    2) If you partially know, do try and struggle toward the answer from first principles
    3) If you get part way and hit a plateau, you are invited to “call a friend,” usually the next more senior member of the house staff
    4) Pimping ends immediately if the house staff appear visibly anxious about the process to a degree that seems disorganizing
    5) The attending staff will riff on the topic at the end to fill in the holes and move the process toward the “Ah ha!” moment of seeing the penny drop for the house staff

  14. Epictetus on May 7th, 2009 at 7:41 pm
  15. Mostly stolen from this excellent article in JAMA. Kind regards Dr Shock

  16. Dr Shock on May 7th, 2009 at 8:43 pm
  17. I agree with you, mudphudder, if you can come up with a partial answer, go ahead and try to come up with something. But if you really don’t know, I don’t think it’s worth struggling. So really, Epictetus is on the mark (or at least that’s what I will aim for when I return to the clinics next month).

  18. DrBadger on May 7th, 2009 at 11:26 pm
  19. [...] Dr. Shock, Dr. Walter van den Broek gives a humorous jab at the practice of “pimping” by doctors trying [...]

  20. Grand Rounds « See First Blog on May 26th, 2009 at 1:31 pm
  21. [...] Pimping Med Students AKPC_IDS += “3507,”;Popularity: unranked [?]SHARETHIS.addEntry({ title: “Medical Slang Explained”, url: “http://www.shockmd.com/2009/08/10/medical-slang-explained/” }); Filed in: General Medicine [...]

  22. Medical Slang Explained | Dr Shock MD PhD on August 10th, 2009 at 8:58 am
  23. [...] This is also known as The art of Pimping: pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. More on pimping med students. [...]

  24. The Hidden Curriculum in Medical Education | Dr Shock MD PhD on October 28th, 2010 at 8:54 am
  25. [...] word is chill.  So far there are no big, ball-busting blowhards like you see on TV, no one “pimping” the students.  From what I hear, that’s way more the style of [...]

  26. Hospital Rotations Begin: Inpatient Medicine – Day 1 on January 24th, 2012 at 8:11 am

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