Pimpin’ Ain’t Easy, But Is It Necessary?

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George Willis
Asst. program director and medical student director, which means he loves to teach at all levels! Lover of all things MedEd. Focus on feedback and teaching on the run. Former D1 football player but now lives out his football dreams vicariously through his sons.

The Pre-brief

Many things strike fear into the heart of a learner, but few things bring palpitations as pimping does.  Pimping refers to the round of incessant rapid-fire questions directed to learners in an attempt to evaluate their knowledge level.  According to Brancati’s 1989 article, the word “pimp” actually derived from the German word “pumpfrage” which means to pump questions and was supposedly utilized in medical education for centuries.  Whether that is accurate or not, the art of questioning in rapid-fire succession has been a tool used by medical educators and a subsequent source of controversy for many years.  

The term “pimp” has so many negative connotations.  It truly embodies the paternalistic nature of medical education as a, usually, male attending will exert their power over a student or a resident by “pimping” them to show their superior medical knowledge.  I absolutely abhor the word, so let’s get rid of the word and we will call it “rapid-fire questioning” or RFQ for short.  Some like to term it also as the Socratic method of teaching where questions are asked of the students rather than providing answers.  

The controversies surrounding RFQ are pretty sound.  Let’s start with the obvious: the establishment of the pecking order in medical education.  A lot of respect and deference is already given to the most senior medical officer as they are at the top of the educational food chain.  Therefore, the need to increase that level of respect by firing questions at a learner is unnecessary.  Additionally, there is an element of appeasement that the learner feels they must achieve in order to stop the RFQ.  Lastly, as with all things in education, RFQ performed inappropriately can leave a learner feeling inadequate and outright abused.

However, RFQ used appropriately can be a valuable resource for teaching in a busy clinical environment.  It quickly assesses the learner’s level of knowledge to know where teaching can begin.  It is a fantastic way to find that learnable moment where the learner is uncomfortable yet receptive to teaching. 

Here are some tips on how to use RFQ for teaching in a busy clinical environment:

1) Start slow. If the goal is to assess where they are, starting with questions that are above their level will only frustrate them and potentially make them less receptive to any further teaching you may have. So start slow with softballs.  Then increase the difficulty until they are teetering on that line of “I know it” and “I have no freaking clue.”  They will usually say something to the effect of “Oh crap, I know this.  Give me a second.”  Learnable moment.

2) Statistics are not for RFQ.  Asking questions like mortality rate or sensitivity/specificity will get answers of either 80 or 20.  You all remember that feeling where as long as you were close, you were probably right.  Chances are, your statistics will likely be from one journal article and they will read a different one and get a different number.  So use statistics in your post-RFQ teaching session.  At that point, they will be much more likely to remember your statistic than if they are randomly guessing it to answer your question.

3) Be careful with hierarchies. This occurs when you have learners of different levels.  In this situation, start with asking the lower levels and work up.  It can be embarrassing if an upper-level learner is shown up by a lower-level learner by asking in reverse order.  The caveat to this is if the lower-level learner volunteers the answer.  Be sure to praise the answerer of the question but certainly do not criticize the upper-level learner for being shown up by the lower-level learner.  Instead, inquire where they got their information.  It may turn out that the lower-level learner had recently read an article or took care of a patient-relevant to the question.  

4) Follow RFQ with some formal teaching.  Asking questions alone is not a great way to increase retention.  So follow up the RFQ session with a mini-lecturette or a recap to accentuate any points you would like them to remember.  

5) Increase the edutainment.  One of the things I have employed with RFQ sessions is to make them fun.  Haney Mallemat showed me a few iPhone apps that have game show sounds.  So I’ll ask a question and they’ll get a “ding” if correct and an “ahnt” if incorrect.  The learners feel like they are in a fun learning environment instead of a classroom.  Obviously, use situational awareness around critically ill patients and sensitive situations.  

The Debrief

Certainly, consider the use of RFQ, formerly known as pimping, on your next shift, and consider using some of the pro tips above to increase the learning opportunities and decrease the negatives associated with this teaching style.

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