An appreciation of different learning styles, the incorporation
of technology into everyday learning, and an explosion in
the amount of knowledge that must be mastered by the
medical student has changed how learning occurs today.
who successfully navigate the blurred line between
the Socratic method and pimping should consider
the varying views of each generation of learners on
topics ranging from career goals to core values (see
Table 1, page 26). The pimping technique has many
benefits. How can it be updated to apply to today’s
generation of learners?
The positives of pimping
More than 2,000 years ago, Aristotle wrote, “
Exercise in repeatedly recalling a thing strengthens the
5 Since then, psychologists and neurobiolo-gists have conducted numerous studies supporting a
phenomenon known as the testing effect. The testing
effect posits that the retrieval of information produces
better retention than restudying the same information for an equivalent period of time.
5, 6 Researchers
who study this approach postulate that the active
recall of information from memory creates retrieval
routes, improving the likelihood that the information can be successfully retrieved in the future. The
success of creating such retrieval routes is thought to
relate to the amount of effort required to reprocess
each memory, with more extensive and more difficult reprocessing correlated with greater retention.
Another critical component of information
recall is instructor feedback. Receiving feedback
after attempted memory retrieval, regardless of
how detailed a student’s information recall is at that
moment, improves the likelihood of successful future
5, 7 Timing of feedback is important, with immediate feedback, rather than delayed feedback, leading
to improved future performance.
Pimping, as often performed in the modern era
of medical education, requires the ultimate form
of active recall. Pimping requires a learner to dig
into his or her knowledge base to search for the
appropriate response on the spot. While potentially
stressful, the everything-is-fair-game nature of this
technique creates a high-pressure situation ideal for
augmenting the learning process. Individuals who
have been “pimped” can often recall the details of
the situation and their response (correct or incorrect)
months after the event. By providing immediate
feedback, the ideal “pimper” is engaged in the stu-
dent’s learning and seeks to provide guidance and
impart additional knowledge as needed, further
In its purest form, this technique allows the
instructor to ask scaffolding questions, which involves
asking more difficult questions or questions that
encompass an increasingly greater span of knowl-
edge in a sequential order to ascertain the limits of the
student’s understanding. This is a powerful tool when
performed without judgment. It allows the teacher
to tailor instruction to the student’s current level of
knowledge rather than simply reiterating what the
student already knows or lecturing above the stu-
dent’s current level of understanding.
Notably, pimping allows students to acquire and
apply knowledge in clinically relevant situations.
The constructivist theory of active learning, initially
described by American psychologist John Dewey, is
based on the idea that learning occurs most naturally
in the context of problem solving and immersion in
the learning experience.
9 Pimping acts as an extension
of this theory by presenting the learner with a problem
regarding a clinical scenario. If executed successfully,
this contextual questioning prepares the student for
Like many aspects of surgical training, pimping has
its share of detractors and has recently come under
attack as an educational tool that is past its prime.
In fact, some institutions prohibit the practice altogether.
10 Students have traditionally reacted poorly
to pimping for several reasons: it promotes an old-fashioned hierarchy, it creates a stressful learning
environment, and it may be perceived as humiliating or embarrassing by some students. Furthermore,
pimping is often used as a narrative foil to highlight
actual humiliation in the clinical setting, which is,
of course, not to be tolerated.