Appendix 15 - Pimping

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]


From "On the Culture of Student Abuse in Medical School": "The power driven authority in these [medical] settings, added to the use of aversive reinforcement to make students learn and behave, gives rise to a style of education and supervision that often is insensitive and punitive."[209] As one resident put it in criticizing a student, "she did not appear chagrined enough when the answers she volunteered were wrong."[210]

Semi-farcical JAMA commentary entitled "The Art of Pimping":

On the surface, the aim of pimping appears to be Socratic instruction. The deeper motivation, however, is political. Proper pimping inculcates the intern with a profound and abiding respect for his attending physician while ridding the intern of needless self-esteem. Furthermore, after being pimped, he is drained of the desire to ask new questions....[211]

A doctor responds in a subsequent issue:

I must say that pimping accomplished only four things for me: (1) establishment of a pecking order among the medical staff; (2) suppression of any honest and spontaneous intellectual question or pursuit; (3) creation of an atmosphere of hostility and anger; and (4) perpetuation of the dehumanization for which medical education has been criticized.[212]

"Of course attendings bawl you out, humiliate you - that's part of training."[213]

Disempowerment, disillusionment and demotivation are common in medical schools.[214] An article called "Passing through Third Year: A Guide for Wary Travelers" lists "I can't do it" and "I'm too tired" as two things third years should never say. "No. No. No. These phrases do not exist for the medical student...."[215]

Attending physician: "Forget the resident who says, 'I don't know what happened - it was my night off.' He'll never make it. I say that in the army there were only three answers you could give: 'Yes, sir'; 'No, sir'; and 'No excuse, sir.' That's true for surgery too."[216]

A famous psychologist reviews the relevant corrupting components of basic training:

The military training area is spatially segregated from the larger community to assure the absence of competing authorities. Rewards and punishments are meted out according to how well one obeys. A period of several weeks is spent in basic training. Although its ostensible purpose is to provide the recruit with military skills, its fundamental aim is to break down any residues of individuality and selfhood.[217]

 
 

[209] Kassebaum, DG and ER Cutler. "On the Culture of Student Abuse in Medical School." Academic Medicine 73(1998):1149-1158.

[210] Branch, WT. "Professional and Moral Development in Medical Students." Transactions of the American Clinical and Climatological Association 109(1998):218-230.

[211] Brancati, FL. "The Art of Pimping." Journal of the American Medical Association 262(1989):89090.

[212] Stanton, C. Letter. Journal of the American Medical Association 262(1989):2541.

[213] Bosk, CL. Forgive & Remember: Managing Medical Failure Chicago: University of Chicago Press, 1981:72.

[214] Kent, A. An Overview of Medical Education Today. Thesis. www.uct.ac.za/depts/doogie/2text.htm.

[215] Ricks, AE. "Passing Through Third Year." New Physician 31(1982):16-19.

[216] Bosk, CL. Forgive & Remember: Managing Medical Failure Chicago: University of Chicago Press, 1981:72.

[217] Milgram, S. Obedience to Authority New York: HarperCollins Publishers, Incorporated, 1983:181.

 
 
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