Prof Koelmeyer, who I wrote of in great detail in “The Breakfast Club“, was a master of positive pimping. It helped that the pimpee couldn’t get away – the pimpee had to stand within the bounds of a small circle drawn on the floor (‘the spot’) until he or she’d answered at least one probing question to a standard that satisfied the Prof. A correct answer (usually thanks to appropriate use of ‘the sieve‘) earned effusive praise and an escape from the dreaded ‘spot’. An incorrect answer earned a comical punishment that ensured the pimpee would never, ever, forget the newly acquired and hard won scrap of medical knowledge… Sometimes this involved the wearing of a dunce’s hat, facing the wall and (in my case) repeating three times, “I, Scum, am a dumb f?ck”, being assigned homework to present the next day, or simply the gut wrench of witnessing Koelmeyer’s disappointed facial expression and forlorn sigh.
But not everyone could cope with these tried and true methods. I believe the there is an art to being a good pimpee. At the core of this art is the absence of ego. Pimpees must develop humility and have a strong sense of purpose. They must be able to display their ignorance in front of their peers yet not think less of themselves for not knowing. The masterful pimpee knows that with every public confession of ignorance their skill and knowledge will grow. Thus anyone who stands before their peers to answer a question, whether or not they prove to be correct, deserves the deepest respect.
The man who confesses his ignorance shows it once; he who conceals it shows it many times.Japanese Proverb. Quoted in Talley, NJ and O’Connor S. Examination Medicine (5th edition)
“I have learned since to be a better student, and to be ready to say to my fellow students “I do not know”William Osler, from ‘After twenty-five years’ in Aequanimitas
I’ve been the pimpee in a few pimping sessions where things did not go well. While a medical student, I was once asked to describe a murmur and replied with commendable honesty and accuracy:
“Kind of like the sound of a basket-ball bouncing on wooden floorboards in a gymnasium”
For this response my teacher christened me “ineducable”.
On another occasion, myself (still a medical student), an intern, and a registrar were huddled around a respiratory physician at a patient’s bedside. After a pimping session that didn’t yield a single correct answer from any of us, the physician turned to the patient in exasperation and asked: “Are you a smoker?”, to which the patient replied, “yes doctor”. In return the respiratory physician exclaimed,” Right, in that case, this is the first time I’ve been able to say with absolute certainty that I am completely surrounded by idiots!”.
In an attempt to learn from these pimping failures, I have tried other strategies. One is the ‘preemptive strike‘, with which I can only claim mixed success – needless to say, it helps if the pimper has a well developed and forgiving sense of humour. Basically the approach is to attack the pimper while he or she is unprepared and to appear to be enough of a smart arse that he or she won’t want to have any further verbal interaction with you. This is how one such episode played out:
The professor arrived on the ward where the students were assembled.
Other student: “Oh Prof, you’ve had a haircut – it looks great.”
Prof: “Yes, yes, I’m surprised you noticed. All part of getting ready for the tennis season…”
[Prof swings an imaginary tennis racket]
Me: “Yeah Prof, it sure is a bugger when your fringe gets so long that you can’t see the TV…”
These days I still get to play the pimpee now and then, but I also have the opportunity to be the pimper. Either way, if done with a sense of fun and in the spirit of learning, the experience is a good one. However, If I’m being severely pimped I’ve learned to rely on a fool-proof strategy – the use of the ‘Get Out Of Jail Card‘ – although, to be honest, I’m a little reluctant to share my secret with the eyes and ears of the entire Internet…
What is this strategy? Well, here is an example of this ‘smart bomb’ of the pimping world being deployed:
Prof: “What are the manifestations of Carini’s syndrome?”
[thinking: damn it, the ‘eclipse‘ failed and I don’t have a muffin handy – I will have to say something…]
“Sorry, Prof, can you repeat the question, I may have misheard you…”
[Note the skillful use of ‘the stall‘]
Prof: “Carini’s syndrome… What are its manifestations?”
[While the question is repeated I wink and nod at anyone nearby to start searching their PDA‘s for me….]
Me: “Oh yes, Carini’s syndrome…”
[no one has found it on their PDAs yet… I try ‘the meditation‘ without effect… I can’t think of a good ‘pimp back‘ and ‘the politician’s approach‘ is against my religion…]
[Another expert delivery of ‘the stall‘ – it’s time to use the old ‘Get Out of Jail Card‘]
“Excuse me Prof…. But you seem to have something stuck between your teeth.”
Prof: “Oh! Do I?…”
[The prof starts picking at his teeth, while the audience stand by like stunned mullets – “what a display of genius” they must be thinking…]
“Have I got it?”
Me: “Almost, Prof, almost. Try again…”
[I peer forwards examining the Prof’s pearly whites]
Prof: “How about now?”
[The Prof looks more and more distressed – his blushing cheeks have raised the room temperature by more than 2 degrees centigrade – he’s not going to cry is he?]
Me: “Yes, well done! You got it…”
[Fist raised triumphantly]
Prof: “Great! Thank you! Thanks for that, I’ve got an important meeting in an hour, and that would have been most embarrassing. Anyway, let’s move onto the next patient…”
[The Prof is forever in my debt as he eyes the other students suspiciously – he must be thinking “how long did I have that unsightly morsel between my teeth? And no one had the decency to tell me…”]
- Brancati, FL. The art of pimping. JAMA. 1989; 262(1): 89
- Detsky, AS. The art of pimping. JAMA. 2009;301(13):1379-81
- Wear D, Kokinova M, Keck-McNulty C, Aultman J. Pimping: perspectives of 4th year medical students. Teach Learn Med. 2005;17(2):184-91
- DrOttematic ‘Pimping (in Medicine): the delicate art of making someone feel small‘
Life in the Fast Lane Pimping Posts
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.