In “pimping in perspective“, we learnt that pimping is a bit like the Force, in that it has a dark side. What follows is a discussion of pimping etiquette, so that the pimper can be a Jedi-like positive pimper and avoid inadvertently (or otherwise) being a practitioner of the black art of pimping.
Positive pimping is all about learning, fun, and safety. These objectives can be achieved by following proper positive pimping etiquette. Once again Detsky lays the foundations for these rules:
Respect educational order
This is crucial, although critics may perceive it negatively as an imperialist tool designed to preserve the power structure of the medicine machine. When asking questions, according to Detsky, the pimper must:
..always start at the bottom of the educational chain and move serially up a level if no one at the first level has a correct answer (i.e. third-year students before fourth-year students, before interns, before residents). There is an important corollary for the junior residents and medical students: do not break ranks by showing up the senior resident on the team (or the junior resident or student’s next admission may be a very difficult patient).Detsky, AS. The art of pimping. JAMA. 2009; 301(13): 1379-81
Here Detsky emphasizes the importance of the pimper avoiding asking others of equal or ‘higher rank’ (e.g. consultants or professors) questions unless you are certain that they know the answer. However I would add that avoiding embarrassing pimpees of ‘lower rank’ is just as important. Robert M. Centor of DB’s Medical Rants does this by saying at the outset:
I have been an attending for over 20 years. I know a lot of questions. My job is to find out what you know, and what you do not know. I should focus on teaching you what you do not know. Teaching you what you already know is a waste of your time. I will make you slightly uncomfortable at times. When you start to get nervous, remember that learning is about to occur.Centor RM, “On medical pimping“
Involve practitioners of pimpee protectionism
The game of positive pimping needs participants. Thus the pimper must make defensive pimpees – especially the “eclipsers“, “camouflageurs“, “meditators“, and “muffin-eaters” – lower their guards and take part in the fun of learning. Detsky suggests a few strategies to achieve this:
Use humor to acknowledge that this form of teaching can be intimidating and state that your expectations are low (i.e. the question is difficult and you do not expect any of the pimpees to answer correctly).Detsky, AS. The art of pimping. JAMA. 2009;301(13):1379-81
If the pimper embarrasses or offends the pimpee (unintentionally of course!) then the pimper must apologize immediately and publicly (or at least tell a funny story about an even stupider act the pimper did earlier that morning…).
Pimpees will actually want to be pimped if they’re given appropriate public or private praise and feel like they’re learning. No brainer, eh.
Avoid stupid questions
Another ‘no brainer’ perhaps, but a rule that is rarely adhered to. The pimper should ask the pimpee questions that will enable them to usefully grow their knowledge and understanding of medicine. Most of the classic categories of ‘pumpfrage‘ do not have this key characteristic (e.g. ‘arcane points of history’, ‘the exceeding broad question’, ‘teleology and metaphysics’, ‘eponyms’, and ‘technical points of basic research’…)
And finally, the prospective pimper would do well to remember the ’10 Ps’ of positive pimping excellence:
Perfect Preparation & Practice Prevents Piss Poor Positive Pimping Performance (Probably…)
To paraphrase the words of Matthew Arnold, the function of the teacher is to teach and to propagate the best that is known and taught in the world. To teach the current knowledge of the subject he professes – sifting, analyzing, assorting, laying down principles. To propagate, i.e. to multiply, facts on which to base principles – experimenting, searching, testing. The best that is known and taught in the world – nothing less can satisfy a teacher worthy of the name.William Osler, from ‘Teacher and Student‘ in Aequanimitas)
This post is part 3 of a 4-part series. The final part will illustrate the lessons of the first 3 parts using my personal experience of pimping.
- 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.