Journal Club Article: Kost, A., & Chen, F. M. (2015). Socrates was not a pimp: changing the paradigm of questioning in medical education. Academic Medicine, 90(1), 20-24.
Socratic Method
Is a dialogue between teacher and students, instigated by the continual probing questions of the teacher, in a concerted effort to explore the underlying beliefs that shape the students views and opinions. Repeated questions: examining a claim, questioning that claim, and finding true knowledge.
Pimping
The history and definition of Pimping (note: we are just discussing the educational terminology only in this post) and it’s all written in jest, however with some powerful undertones that can still probably be related to.
As the bedside nurse, do you see during medical rounds the very tricky question posed to junior doctors and the endless silence, and just being glad its not you?
“Pimp questions” – “should come in rapid succession and be essentially unanswerable”
Brancati (1989).
“The Art of Pimping” by Detsky in 2009 further described how pimping cements the attending-resident-student hierarchy. In describing pimping etiquette for attending physicians, he states: “Respect educational order. Never ask a medical student to respond to a question after a resident has answered incorrectly”
This alludes to the historical approach of medicine and healthcare for that matter in all things hierachical in the approach to learning. And “they legitimize the place of pimping in medical education, while disregarding its negative effects, such as those relating to language and pedagogy.”
The Art in Medicine
The approach to questionning learners and my own reflections on reading this article of being on the end of tricky questions, and I probably have put others in this very position trying to challenge and bring out knowledge and understanding (Note: with well meaning intentions). Similarities in the learning of ‘the art of medicine’, is the same as the ‘the art of nursing’, and utilising all that theoretical knowledge into the clinical environment, gaining exposure and buidling experience.
Pimping as Learning
“Students divided pimping into ‘good’ and ‘malignant’ categories. ‘Good pimping’ actions included questioning that advanced or enhanced the learning process and also encouraged students to be proactive about their learning. For example, students would read about relevant anatomy the night before a surgery because they knew they would be asked about it the next day. ‘Malignant pimping’ frequently employed techniques designed to humiliate the learner.”
Changes to Questionning for the Educator
- Puposeful questionning with deliberate consideration of the goal for the learner.
- Utilisise Socratic method to encourage critical thinking skills (learner collaboration, interpretive questioning, and reflecting).
- Application of adult learning theory, consideration of formative and summative strategy, safe learning environment and learning is a lifelong event.
Ive never heard of this concept before, and had missed this use of questions on the ward round as reinforcing “putting people (medical students) in their place” with public embarrassment. I often tell the story of being a student nurse (2nd year) and being on a ward round during which the registrar asked what kind of head injury the patient had. It was, from my perspective, a very easy answer ( a contracoup) which I had learned about in first aid training years ago, in high school. When I answered, the Registered Nurse on the ward round leaned over and whispered in my ear ” we don’t speak on the ward round”. I found it truly shocking, as I had assumed that all students where in the academic hospital to learn. It was a huge lesson on the fact that nurses are always second class citizens. However, reading your article now I see that I missed the power dynamics between the medical students and doctors, completely. It adds an interesting layer and reminds me of medical student and doctor friends talking about how scary ward rounds were, with the risks of publically being embarrassed for not knowing something, a constant source of stress. Being a total outsider to their hierarchies and power dynamics, it was not at the forefront of my awareness. But on reflection we saw this playing out a lot in the wards. What a messed up system, with patients and families right at the bottom of this biotoxic system.