‘Demoralizing’: Why ‘pimping’ aka toxic quizzing in medical education is harmful

Despite it being a longstanding practice in medical education, there’s no evidence to show that “pimping,” the industry colloquialism for quizzing students impromptu on medical facts, is at all helpful.That’s according to an article from the “Things We Do For No Reason,” a series published in the Journal of Hospital Medicine that “reviews practices that have become common parts of hospital care but may provide little value to our patients.” The authors, who favour the term “toxic quizzing” over “pimping,” explained that the practice has been in use for centuries and remains in widespread use. It often involves asking trainees difficult questions, sometimes in rapid succession, “about recall of facts rather than clinical reasoning.”This method “establishes and reinforces a dominant intellectual hierarchy and stresses the trainee” with the aim of inducing shame, humiliation or distress, the authors wrote.In multiple qualitative studies, students have described toxic quizzing as “demoralizing, vindictive, anxiety-provoking and defeating,” the authors wrote. Some students reported regretting their decision to pursue a medical career as a result of toxic quizzing.This is not to say that educators shouldn’t ask questions of their students, or that any stress put upon students is harmful for learning. Answering questions is a form of “retrieval practice,” the authors noted, which does help with retaining information. “Educators can effectively push learners to the limits of their abilities, and hence cause stress. However, it must be done in a supportive learning environment that fosters a growth mindset, which is antithetical to intimidation and hierarchy-reinforcing techniques,” the authors wrote.They explained that the key to making question-asking “fruitful” in a learning environment is to create educational safety, especially if there is a hierarchy in place.Educational safety is a “subjective state of feeling freed from a sense of judgement by others such that learners can authentically and wholeheartedly concentrate on engaging with a learning task without a perceived need to self-monitor their projected image,” as defined in a study on psychological safety in medical education, the authors referenced. Here are a few ways educators can foster educational safety, according to the authors:Interact with students in a way that is friendly, caring and non-judgmental.Frequently check in with students to gauge whether they do or do not feel like they are in a safe learning environment.When students disclose or demonstrate weaknesses or knowledge gaps, don’t use those moments as “points of emphasis for purposes of humiliation.” Rather, it should be reinforced that these are learning opportunities, “not deficits to hide.”Educators can ask their students or trainees questions that they themselves do not know the answers to, in order to role model curiosity, self-directed learning and humility.

‘Demoralizing’: Why ‘pimping’ aka toxic quizzing in medical education is harmful

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