Today I want to talk about a four-letter word. Pimp. Well, at least in medicine it's like a four-letter word. No, no, no, you see, I don't, I don't mean pimping like the way Snoop Dogg talks about it. I'm talking about the kind of pimping that you see on Grey's Anatomy. Name the common causes of post-op fever. Uh, yes, from your head, not from a book. Or how about scrubs? You're off the hook if you can tell me what to look for in a uremic patient. Or one of my favorites, house. Differential diagnosis, people, if it's not a tumor, one of the suspects? Why couldn't she talk? So doctors around the world learn a lot about clinical medicine from this style of teaching. And we call it pimping, pimp questions. It's that constant barrage of clinical questions from whoever you're learning from, and we continue to use it because we believe that you'll never forget something. And if you get it wrong, you'll never forget it. When I get a question wrong, like that's something I'll never forget. So that's good, right? I mean, you don't want your doctors to forget stuff. Well, not quite, because sometimes pimping can be pretty anxiety producing. In fact, one study from several years ago found that yes. You can increase retention with your line of questioning, but if they got too scared, it decreased their retention. There's definitely an art to it, a fine line to good and bad pimping. Todd and I decided for this episode, why don't we just take it back? And figure out. Where this all came from, why we use this style of teaching, and why is it even called pimping? So let's talk. About the history of pimping. Yeah, I, first of all, I remember the first time I heard the term, I couldn't tell if that was like some weird way that the, the, my chief resident came up with that word or if that was really a thing. And then I found out that like everyone uses this term pimping. That's Todd Ponsky. He's a pediatric surgeon at Cincinnati Children's Hospital. He loves using pimping to teach and also for himself to learn. So we wanted to figure out where this came from. He's got a handful of medical students and we kind of turned the tables. We had them teach us about. Where this word and style of teaching came from. Turns out it goes way back, like this century BC. So basically it kind of dates back to like the 5th century with Socrates, who's a Greek philosopher. That's Sanjana Datla, one of Todd's med students, and he'd engage in dialogue with another person in like a question and answer format to kind of challenge them and allow them to do some critical thinking. You would ask the students questions and explain answers through like a teachback method. OK, a, a teach back method. I can see how modern day pimping is, is rooted in that Socratic method. Kind of like pimping, but I think there are some key differences. OK, like what? Power hierarchy that like the people like the attendings are like up here and then the students are like the bottom of like the food chains, like those are the ones that get pimped and Socratic method, the optimal teaching method is kind of a one on one more scenario, whereas pimping. At least most of the time when I've been pinned, it's like me being pinned in front of like other students, residents, fellows attending, so it's like me versus like a lot of other people, so. OK, so, Socrates created this method. It's a little bit different because they're teaching philosophers one on one. But who brought it to medicine? So, it's first mentioned in literature in like around 1628, and how it's used is basically um William Harvey wrote um that they know nothing of natural philosophies, these pinheads, junkyard slots, their bellies filled with meat and ale, oh, that I might see them pimped. That's Kritika Sundaram, she's another medical student. She's talking about the first time that the word pimp was used in medical literature, but then it kind of disappears, and without a trace, we really don't know where that word came from, but there is a thought that it came from German, because years later, It showed up in the literature again. In 1889, Cooke recorded a series of pum rage, and he would use it in rounds in Heidelberg. So this is like basically the first medical use of the word. OK, so from Greece to Germany. Yeah. So, so what most people probably think like I do, is that somehow this was a derogatory term having somehow to relate to prostitution. It comes from pumpffragen, which means pump questions. Uh, it kind of migrated to the, like, North America in the 20th century, I would say. That's Varun Ataraju. And what happened was William Osler, who's a Canadian physician, one of the four founding professors at Johns Hopkins, started pimping his, his students in his residents at Johns Hopkins, and Flexner was noticing this, and he, he's actually uh responsible for the Flexner Report, which is a book said to reform the nature and process of medical education in the United States and, and Canada and was said to be the gold standard for how medical training was practiced at the time. Side note, Flexner was also a racist, but we can get into that another time. And so Flexler noted this um practice and and put it in the Flexor report, and it really got popular from then on, and so it was Osler that that started changing the U to an I, which has a very different meaning, but he started, he went from pump frogging to pimping. I guess the students called it pimping like. Like, so students changed the name, yeah. So the medical students changed the name, or at least that's what we can gather from a quote that another one of Todd's medical students was able to dig up. This is Van Avisarala. Rounded with also today riddles, house officers with questions like a gatling gun. Welch says students call it pimping, delightful, and he kind of said that in a sarcastic tone. I wonder if the students had some sarcasm with it, because around that time, maybe it started to bring some bad vibes with it as well. Um, the problem is when trainees are pimped on information that's irrelevant. That's Prachi Lele. Such as history or eponyms, and then um information may not necessarily improve their clinical skills or knowledge, and then instead pimping should be used to gauge the trainees level of knowledge and push their knowledge even further. So it doesn't have to be used for embarrassment. It could be used for educational purposes. Another study I was looking at found that 83% of a population of about 146 med students had witnessed teaching by humiliation, but 50% of these students still considered this to be a useful technique for learning. So, are medical students and medical trainees just gluttons for punishment? I mean, on one hand, you're like, oh, this is humiliating. On the other hand, you're like, uh, well, it kind of works though. I have a feeling it's maybe a little bit of both, because we're not taught how to pimp, it's not standardized. Every attending you've come across probably does it a little bit differently. It's all in how it's done. I will tell you that that's the only way I teach. And the reason is, the learning will be so fun, and, and no one gets scared, and no one gets put on the spot. It's, we're laughing. It's done in such a fun way. I don't call on people, and it's so much better than me standing there going, let me talk to you about the blah, blah, blah, blah blah blah, blah. The nurses on the floor all come and stand around and they're involved in the discussion. Sometimes I even involve the parents in the discussion of the patients. I said, do you know? And unfortunately, it is the only assessment tool we have. Kartika brought up a really good question at the end of our discussion. And relate, like relating to pimping, like, do you think, cause like the problem isn't with the practice, they like they were saying, like, some of the problem isn't with the practice, it's with the actual word. It has that negative connotation that makes people think it's bad. So you think making like changing the word would help people have like more of like a positive outlook towards it? Maybe. What do you think, Rod? Yeah, I think so. I think that in, in language, words don't exist in a vacuum. Words have connotation. Words have meanings that transcend the word itself, the letters itself on paper. I think so. I don't know what the word would be, but I think changing the. Word would do a lot. I never felt it was bad. Um, I'm a gamer. I like anything that's related to a game. Like I would love it as long as they weren't jerks about it, but if it was a fun pimping session, to me, it, it has a positive memory, which is so funny. Um, it was, it was gamification of rounds. So what kind of resident or attending are you when you're on rounds? Are you a firing squad of questions or are you more fun? Do you have some memories of getting pimped, from back when you were a medical student, maybe something embarrassing, or maybe something really positive, like you learned something on rounds that ended up saving another patient's life. If you're listening to this in the Stay Current app, go ahead and leave a comment below about those experiences and start a discussion with another pediatric surgeon. Or watch videos, listen to other podcasts, try out our new interactive cases that we call story casts. It's all there in the new stay current in pediatric surgery app, but until next time, I'm Roger Arder from Cincinnati Children's, and remember, knowledge should be free.
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