P.ut I.n M.y P.lace

By Avni Loya

Teaching by humiliation, commonly termed “pimping” is a widespread practice in

medicine despite changes in systems and educational research. Although there isn't a

universal definition, “pimping” often refers to a practice in which attendings question

their trainees to establish an intellectual hierarchy. Often, “pimping” aims to cause

shame or frustration. An attending will ask the trainees questions that involve rapid-fire

factual recall rather than clinical understanding, and if they aren't able to answer, the

attending will show frustration toward the student in front of their peers.

There are reasons to believe this practice might improve memory or contribute to

intellectual understanding. Some argue increasing learner stress increases learning

outcomes, an idea introduced as the Yerkes-Dodson law, which states that any type of

performance increases with the arousal of stress. The law asserts that performance

reaches an apex with this method and then declines. Additionally, attendings also argue

that pimping worked for them. A study from 2019 found that 45% of medical attendings

agreed with the statement “being pimped by my teachers helped me learn when I was a

medical trainee.” Educators could also argue that “pimping” aligns with the Socratic

method, where Socrates asked his learners to rigorously question their theses and

beliefs to stimulate curiosity and intellectual growth. However, “pimping” is factual recall,

and rarely consists of clinical reasoning. Therefore, it should not be conflated with this

method.

According to the article Things We Do for No Reason™: Toxic quizzing in

medical education, “Despite centuries of use, there are no studies reporting meaningful

positive learning outcomes of toxic quizzing”. There is no objective evidence that this

practice improves recall or has any form of academic outcome. However, there is

evidence that this form of toxic quizzing causes harm. Several qualitative survey-based

studies have shown that students generally have discontent for “pimping”, and describe

it as “demoralizing, vindictive, anxiety‐provoking, and defeating.” In fact, two studies

that asked students to sketch their experiences depicted “pimping” as a traumatic

experience. The drawings will be disturbing, with students picturing themselves “being run

over by a truck, bound and interrogated, and burnt at the stake”