task is to keep learners involved and confident when
they are mistaken. When a student is unable to provide the correct answer, diagnosis, or treatment, it
can be helpful to take a step back in the questioning
and start with more basic questions that will help
the student arrive at the correct answer as he thinks
through the problem.
For example, if a student is unable to recall the
correct treatment for cholangitis, the instructor can
take a step back and ask the learner to describe the
primary problem in cholangitis. If the student is able
to identify that an obstruction resulting in infection
is the root of the problem, the student may be able to
recognize that relieving the obstruction with decompression will be the treatment. Using this method,
not only will the student have thought through the
problem and reached the correct answer independently, but the student also will gain confidence in
his ability to solve clinical problems.
Undoubtedly, many practicing surgeons recall
their experiences with being pimped as trainees with
a fond nostalgia, as a rite of passage, and many also
would likely agree that it was an invaluable part of
their training and education. It is important that,
as surgical education strives to keep pace with new
methods of transmitting information, the tried-and-true methods continue to be applied—but perhaps
with some updating and forethought in order to
engage all generations of learners.
The time-honored tradition of questioning and
“high stakes” learning that motivated each of us to
take an active part in the learning process cannot be
underestimated. It is this type of education that prepares medical students and residents for the true high
stakes to come as they advance in their careers. ♦
1. Zou L, King A, Soman S, et al. Medical students’
preferences in radiology education: A comparison between
the Socratic and didactic methods utilizing PowerPoint
features in radiology education. Acad Radiol. 2011;18:253-
2. Oh RC, Reamy BV. The Socratic method and pimping:
Optimizing the use of stress and fear in instruction. Virtual
Mentor. 2014; 16( 3):182-186.
3. Brancati FL. The art of pimping. JAMA. 1989;262( 1): 89-90.
4. Healy JM, Yoo PS. In defense of “pimping.” J Surg Educ.
2015; 72( 1):176-177.
5. Roediger HL, Butler AC. The critical role of retrieval
practice in long-term retention. Trends in Cog Sci.
2011; 15( 1): 20-27.
6. Karpicke JD, Roediger HL. The critical importance of
retrieval for learning. Science. 2008;319(5865):966-968.
7. Kang SH, McDermott KB, Roediger HL. Test format and
corrective feedback modifying the effect of testing on long-term retention. Eur J Cog Psychol. 2007; 19(4/5):528-558.
8. Kulik JA, Kulik CC. Timing of feedback and verbal learning.
Review of Educational Research. 1988; 58( 1):79-97.
9. Kolb AY, Kolb DA. Learning styles and learning spaces:
Enhancing experiential learning in higher education. Acad
Manag Learn Edu. 2005; 4( 2):193-212.
10. van Schaik KD. A piece of my mind. Pimping Socrates.
JAMA. 2014;311( 14):1401-1402.
11. Burcher P. Pimping: Report or do nothing? Virtual Mentor.
2014; 16( 3):161-164.
12. Anderson J. Can “pimping” kill? The potential effect
of disrespectful behavior on patient safety. JAAPA.
2013; 26( 4): 53-56.
13. Kost A, Chen FM. Socrates was not a pimp: Changing the
paradigm of questioning in medical education. Acad Med.
2015; 90( 1): 20-24.
14. McCarthy CP, McEvoy JW. Pimping in medical education:
Lacking evidence and under threat. JAMA. 2015;314( 22):2347-
15. Wear D, Kokinova M, Keck C, Aultman J. Pimping:
Perspectives of 4th year medical students. Teach Learn Med.
2005; 17( 2);184-191.