So…P*mping or Learning?

By: Laksha Muruganandam Improve Life PLLC Research Intern

In medical education, there is a controversial medical teaching practice which is known as “p*mping.” Well, a synonym is none other than “toxic quizzing” and is more widely known as that. This “p*mping” has been around for a long while despite it having a growing amount of criticism…and high controversy.

Usually, this teaching practice has instructors sort of asking trainees quick, honest, and difficult questions. These are usually asked in times of high pressure. Even though some educators may sort of back it up as a way to really benefit thinking and help prepare medical students for real-world situations where they may be severely stressed, such as future medical situations, this approach of teaching is actually extremely harmful.

It is starting to be known as a form of teaching that “aims to induce shame, humiliation, or distress” (Kinnear et al., 2022). Though the idea of preparing oneself for stress in the future is one thing for a long-term benefit, it really lowers one’s confidence and self-esteem. Confidence is something valuable in healthcare, and losing this key aspect from early on can make it harder to stand out in the healthcare field and succeed. Not only is confidence being affected, but since this teaching is focused highly on the idea of just recalling what was memorized rather than actually checking if someone understands it, it leaves medical practice at risk because not using proper critical thinking and reasoning can make thinking during complex medical situations hard and at the end even cause someone to take a risky action due to the lack of thinking.

Not only is it harmful to students in the long term, but it is starting to become less about teaching and way more about hierarchy. In literature, for example, it is “the practice of asking trainees questions in a manner that establishes and reinforces a dominant intellectual hierarchy and stresses the trainee”(Kinnear et al., 2022). Honestly, instead of creating a safe environment that can allow for students to really thrive and be confident in themselves and their answers, it just pushes them into this sort of uncomfortable sport where they are required to perform under pressure, which can really affect who they are as a person or even how they express themselves. This comes back to affecting confidence.

One may tend to argue that different people tend to react to stress differently. People who support “p*mping” may rather see the stress as a way of enhancing their learning and helping them succeed. However, research says otherwise, bringing up that “despite centuries of use, there are no studies reporting meaningful positive learning outcomes of toxic quizzing”(Kinnear et al., 2022). There is honestly no proof that this approach helps people become better doctors. What do you think, p*mping or learning?

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References 

Kinnear, B., DeCoursey, B., Caya, T., Baez, J., & Warm, E. J. (2022). Things We Do for No Reason^TM: Toxic quizzing in medical education. Journal of Hospital Medicine, 17(6), 481–484. https://doi.org/10.1002/jhm.12846