Socrates, “pimping” and teaching in medical education

Recently, one of the words in the title of an article in Academic Medicine really caught my eye: “Socrates Was Not a Pimp:  Changing the Paradigm of Questioning” by Dr. Amanda Kost and Dr. Frederick M. Chen. (Kost & Chen, 2015)

Of course, the word that caught my eye was “Socrates,” he of sitting with students under an olive tree fame

20120223-Socrates Greuter

and, of course,  from Bill and Ted’s Excellent Adventure. socrates with bill and ted

Much of the scant information we have about Socrates is from his students, Plato and Xenophan.  Plato portrayed Socrates as an excellent teacher and questioner, in the Dialogues, where a series of questions is asked not only to draw out individual answers, but also to encourage fundamental insight into the issue at hand.

Can it be, Ischomachus, that asking questions is teaching? I am just beginning to see what is behind all your questions. You lead me on by means of things I know, point to things that resemble them, and persuade me that I know things that I thought I had no knowledge of.

–       Socrates (Quoted in Xenophon’s “Economics”) Portrait Herm of

Of course, I can’t deny that another word caught my eye in the title:  It’s not always that you see the word “pimp” in a medical education journal.

However, it’s a common term in medical education, since 1989 at least, where Brancati used it to refer to a questioning method that is supposedly Socratic but is defined as “whenever an attending poses a series of very difficult questions to an intern or a student.” (Brancanti, 1989) He suggests questions “should come in rapid succession and be essentially unanswerable.”  There are other definitions, and the “not a pimp” authors Drs. Kost and Chen, write that in these definitions the purpose of the practice is to reinforce the power hierarchy of the team and, more specifically, the attending physician’s place at the top. (Kost and Chen, p. 21)

In a 2005 study, by Wear et al. fourth year medical students were questioned about the practice of this form of questioning:

Students divided pimping into “good” and “malignant” categories. “Good pimping” actions included questioning that advanced or enhanced the learning process and also encouraged students to be proactive about their learning…“Malignant pimping” frequently employed techniques designed to humiliate the learner. All students in this study identified humiliation as an outcome of any type of pimping—even good pimping had a component of shame because of the public embarrassment of not knowing the answer.  (Wear, et al, 2005 cited in Kost & Chen)

I’d like to discuss “pimping” both from a syntactical and a pedagogical perspective.

I was trained as a language educator to acknowledge that language has a very pronounced impact on constructs in our thinking.  I have to admit that I don’t get the use of the term.  The other definition of pimp:  a person, especially a man, who solicits customers for a prostitute or a brothel, usually in return for a share of the earnings; pander; procurer (Online Dictionary and Merriam-Webster Dictionary) seems to have very little to do with questioning, whether benign, or malignant.

“Pimping” then… you know, that’s the last time I’m going to use the word! I dislike the relationship it implies that could so easily settle into the hindbrains of all us who have been using it.   With your permission, I’m going to try “hounding” instead.  Drs. Kost and Chen agree with me: “This word may evoke a negative affective response, and we would also argue that the use of such a derogatory term to describe an experience in medical education is unprofessional.”

Because, you see, questioning is one thing, and is an excellent and powerful educational tool.  However, when does questioning move into “hounding”? It happens when the questioner is pursuing a different goal than a pedagogical one:  perhaps humiliation(“She needs to know this stuff”), or going way beyond the knowledge of the level of the learner (“Shouldn’t clerks know this, or is it residents? Fellows?”) or venting frustration and anger (“You guys think you’re so smart? Well, let’s see…).  They include the well-known “Read my mind” type of question, and the question that is so obscure that very few know the answer (except perhaps the questioner?).

In the Wear study, students felt questioning  “was useful to “promote learning, logical thinking, defending one’s decisions, quick recall, self-assessment, and communicating well with one’s peers.”  They didn’t like the hounding part of it, and wanted to use volunteering answers as an alternate to centering someone out and hounding them. (I know, I know…this can be an important part of questioning…I hear you and I’ll come back to this.)

So, let’s get back to Socrates.  The Socratic questioning method is used often today, tho’ it appears it can be misunderstood.  In a recent vehement and lively DR-ED listserve discussion, the Socratic method was linked heavily with “hounding” by one participant.

Socrates used the dialectic method of teaching, whereby he assumed the role of someone who knew nothing about a topic, and drew the students’ ideas out, through a series of questions, each one probing more in depth or looking at different options. (Fun fact:  Did you know that the word “education” comes from the Latin ex ducere (to lead or draw out?)

The scientific method, which begins with a hypothesis and then proves or disproves the hypothesis is widely credited with having its roots in the Socratic method. just saying

Since Socrates was mainly concerned with students uncovering their own beliefs, and the validity of those beliefs, the correction of misconceptions and reliable knowledge construction all around large concepts such as truth and justice, modern teachers have created a sort of system for modern Socratic questioning of all types of learning.  Here are some of the characteristics:

1.    Students are questioned in a group, and in modern times, others in the group can collaborate with each other to find answers.  But not always…Socrates challenged his listeners and students.  And he picked them out, as well as had them volunteer.  But learners could help each other.  You’ll see in this sculpture, Socrates teaching in the Agora, by Henry Bates,  below how avidly everyone listens to each other.listening

2.    Socrates believed questioning would motivate learners and help them to the joy of learning. Thus, questioners should create a safe and comfortable context for questioning, where wrong answers are simply a signpost to heading down another path of learning.  In other words, they wouldn’t mind being centred out because they were enjoying learning.

3.  Use of by “why”, “what if” “how”, “then, if…” or open-ended questions vs. closed ended questions such as “What is this object?” “What is 1+1?” (Perhaps we can start with close-ended questions especially for novice learners, but they shouldn’t be the end goal of the questions.)

socrates and exams

3.  Socratic questions must be: 1) Interesting, 2) Incremental, 3) Logical (moving from the student’s prior knowledge towards a goal), and 4) Designed to illuminate particular points.

4.  Questions should be well-planned with a goal of benefiting the student at his/her learning level in mind.  Sometimes you have to start factually, but there should be progression toward critical thinking.

Let’s summarize, and then I’m going to prepare for you to write in to tell me what you think about “hounding” and questioning:

1.    Let’s not use that word again…it’s really ugly semantically.

2.    Hounding is not questioning.  Hounding is hounding and it’s not supported pedagogically. Questioning is an excellent way to teach.  It doesn’t have to be sweet, nor does it have to be easy.  It has to be respectful and with the appropriate underlying purposes.

3.    If we’re going to claim that “hounding” is Socratic, or even our questioning strategies are Socratic, let’s start using Socrates’ methods more.  Let’s aim for critical thinking questions, one of Socrates’ key purposes in questioning.i cannot make

4.    Let’s focus on our learners and tailor questions to their learning level.

5.    Let’s create a climate where questioning is accepted and even welcomed.  Let’s give our learners appropriate language to acknowledge they haven’t prepared, or are at the limits of their abilities thus far and need assistance.

In my next column (look for it in January 2016), I’ll provide more suggestions—based on Socratic principles—for keeping Questioning productive.

So, what do you think?  Are you a Socratic questioner?  Do you think hounding has a purpose?  Are there aspects of your teaching and questioning that can be enhanced through Socrates?

Looking forward to hearing from you about this.

And it’s not a smooth segue, but while I’m here with you, I’d like to take this opportunity to wish you all the best of the season!

seasons greetings

And here’s to great teaching in 2016!

 

 

References:

Brancati FL. (1989). The art of pimping. JAMA. 262:89–90.

Dictionary.com http://dictionary.reference.com/browse/pimp and Merriam-Webster Dictionary http://www.merriam-webster.com/dictionary/pimp

Kost, A.& Chen, F.E. (2015). Socrates was not a pimp:  Changing the paradigm of questioning in medical education. Academic Medicine, 90: 1.

Wear D, Kokinova M, Keck-McNulty C, Aultman J. (2005). Pimping: perspectives of 4th year medical students. Teach Learn Med. 17:184–191.

 

 

 

2 Responses to Socrates, “pimping” and teaching in medical education

  1. A Meds 2017 says:

    On the linguistic perspective: to pimp is also to P.I.M.P, that is, to be Put In My Place.

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