It is the first month of medical school, and you hear the word pimping in an unfamiliar context: medical education. You learn that pimping, also known as “toxic quizzing”, happens when a junior trainee is asked a series of obscure or intentionally unanswerable questions, usually publicly, by a more senior physician. You may adopt pimping into your vocabulary, which is already rapidly expanding with medical terminology. Or you may not be able to shake the colloquial connotations of pimping – a form of sex-trafficking – and you may silently disengage when classmates and professors casually use the term. Or you may begin to question the culture of your profession, which has retained qualities of exclusion for women, non-binary individuals, and people of color throughout its evolution.
We are adding our voices alongside medical educators and learners who are calling into question the use of the word, and the practice of pimping in medical education.
(…) seeing the very good has helped us to recognize the very bad.
To be clear, we do not fear hard work. We are not afraid to meet the limits of our own knowledge, or the exciting challenges of learning the science and art of medicine. We wouldn’t be here if we did. Instead, we have each had the privilege of experiencing effective clinical teaching. When a senior physician maps out how to localize a neurologic lesion, or stays an hour after clinic to teach us how to read EKGs and chest x-rays, or shows us how to properly hold an otoscope. We have each reaped the benefits of these learning moments. These are the opportunities in which physicians, our teachers, seek to understand how much we know so they can show us what is beyond. We have experienced the good, and seeing the very good has helped us to recognize the very bad.
The word pimping, as described in our commentary, was popularized in a satirical 1989 JAMA article. At that time, women comprised less than 20% of medical faculty positions and around 30% of medical student graduates. The word to describe the practice of toxic quizzing was born from a system that not only excluded people of color and non-male identified persons, but trampled on the practices of traditional woman-identified healers. The result is a training system the perpetuates the abuse of power hierarchies. A symptom of this system is the normalized culture of using words that some (and certainly not all) would describe as “locker room talk”, including pimping.
It is time to rethink the practice of pimping, and the elimination of the use of the word will naturally follow.
We have arrived, after centuries long-struggle, to a moment of reckoning in the face of the #MeToo movement. We are questioning not only what language we use as leaders, but also what toxic behaviors exist within society, and in places of learning. We must work to stop harms that persist, particularly in spaces where hierarchies are the foundation of systems. It is time to rethink the practice of pimping, and the elimination of the use of the word will naturally follow.
Can medicine, and particularly medical education, make this change? It can, it should, and it must to meet the evolving demands and needs of a contemporary physician workforce. We see this work, this evolution, related to the ongoing discourse on licensing exams, rethinking resident work hour limits, questioning the harms of medical honor societies, and calling out the lack of patient consent in medical training. When practice changes, the labels used to describe the practice will follow. When toxic quizzing is eliminated, the term pimping in medicine will become irrelevant, because these behaviors will cease to exist.
The use of the word, and practice of pimping within medicine is not devoid of cultural and contextual meaning. Pimping occurs in a training system in which up to 50% of women medical students experience gender harassment from faculty and staff, and a society in which 1 in 4 undergraduate women are sexually assaulted by the time they graduate. For now, the use of the term pimping serves as a label for a behavior that is culturally ingrained within the medical education system. In addition to asking the medical community to stop using this degrading word, we are also calling for the end of this practice.
In the United States, Title IX of the Education Amendments of 1972 (“Title IX”) and the Clery Act are federal laws that require educational programs to address and remedy any known sex and gender discrimination, including sexual assault and harassment on campus. All institutions that accept federal financial support are required to stop discrimination, prevent the recurrence of the behavior and mitigate its effects. Contact the Title IX Coordinator at your institution for more information about your rights and resources.
Some institutions have non-reporting, private resources on campus, such as privileged or confidential advocate programs (resources will vary by institution and state). If you need help navigating issues related to sexual assault or harassment, the National Sexual Assault Telephone Hotline is a free, 24/7 resource: 1-800-656-HOPE (4673).