Pimping Ain't Easy

And now, some humor. The use of the Socratic method on the Wards is commonly known as "pimping," as in the Attending "pimps" you with a series of questions to test your knowledge (or embarrass you in front of your colleagues, as the case may be). JAMA revisited the issue last month in "The Art of Pimping," by Allan S. Detsky. My favorite part includes a list of defenses against the pimp, especially the one about the muffin. So hilariously true. Take notes, dear Ricky. This will come in handy.

Box. Pimping Protection Procedures
Avoidance
Do not have visual contact with the teacher. There are several variations of this technique including (1) “eclipse” (make sure that another person’s head is always in the direct sight line between student and teacher); (2) “camouflage” (the student sits very still, hoping the attending does not notice him or her); and (3) “meditation” (the student lowers his or her head, leans slightly forward and puts the palms of the hands together).

The Muffin
This technique is particularly useful for senior residents who are fearful that the attending physician will embarrass them with a question they should be able to answer but cannot. The resident holds a large muffin in the dominant hand with the elbow flexed, and slowly makes motions with the elbow that move the muffin toward and away from the mouth, somewhat like
the graphical lines representing the attitudes of focus group members used by television networks while watching the recent presidential debates (ie, closer to the mouth if the resident does not know the answer, further if he or she does). If the resident feels that the teacher will call on him or her to answer a question to which he or she cannot respond, the muffin should be placed into the mouth. Most attendings will not ask residents or students to speak with their mouth full of food. If the attending does, the resident should pretend to choke, thus avoiding all future questions.

The Hostile Response
If a student is singled out to answer and is embarrassed because he or she cannot, the student should be sure to respond in a hostile fashion, both with the tone of voice and body language. Most teachers will refrain from asking that student questions in the future. An answer that always works is “I don’t know,” with a 1-second pause between each successively louder spoken word.

The List
If a list of answers is being compiled from several students (eg, what are the life-threatening causes of chest pain?) and the student does not have one, the student should just repeat the response given by a previous respondent and pretend he or she did not hear it. This is particularly effective if the student holds the patient list in front of him or her and looks like he or she is preoccupied with patient care responsibilities. The student or resident can amplify the sympathy by constantly checking his or her pager. (Who can blame anyone who puts patients first?)

Honorable Surrender
Tell the teacher you are uncomfortable. Few students try this, but sometimes the direct approach is best. Those who are uncomfortable being put on the spot in public should just say so. This can be done in the presence of the group or in private after the teaching session.

Pimp Back
The student or resident should find a knowledge area in which he or she has a comparative advantage over the teacher and turn the tables on him or her. In the era of increased
subspecialization in which the teacher may not be familiar with the patient presented, this is not as difficult as it sounds. However, pimpers usually do not like to be pimped so be careful.

The Politician’s Approach
Do not answer the question that the attending asked but talk straight to the audience (ie, ignore the pimper) by answering a question you would have preferred being asked. This is even more effective if combined with pimping back (see previous procedure).

Use PDA (personal digital assistant)
Modern students have an advantage: instant electronic mobile devices that, if used properly, can provide the answers in “real time. ” Pimpers might avoid students with visible PDAs because they know these students can pimp back.

Do Not Sulk/Cry
Students who answer incorrectly should not become overly discouraged. Attendings rarely remember students who give wrong answers (especially to difficult questions); they often remember those who lose their composure.