laughingThanks to Dr. Rob Roger’s podcast on EM-RAP Educator’s Edition series, I learned of one of the funniest publications EVER in a medical journal. It was published on April 1, 2009 in JAMA. The article focuses on teaching medical students the essential skill set– how to survive “pimping”.

Pimping traditionally occurs when an attending physician poses a difficult question to a learner in a public forum, such as board rounds or in the operating room. As a student or resident, you know that this will happen during your training, and you should be prepared. If you think of pimping as a form of battle, you will need a good defense, and you should mix it up to be successful.

Which of these techniques have you used in the past?


Don’t make eye contact with the teacher. Stay very still. Lower your head as if you are deep in thought. But don’t look like you are sleeping and not paying attention. Bottom line is to not draw attention to yourself while appearing to listen. It’s a fine line to walk.

The Muffin

Hold a large muffin in front of your mouth, as if you are going to take a bite. If you don’t know the answer, take a big bite. If you still get called on, pretend to choke. I would go one step further and say – If desperate, syncopize.

Hostile Response

The best defense is a good offense. Take a tone and body posture of hostility. Say “I — DON’T — KNOW.” Personally, as a teacher, I’d be afraid of asking this student questions — ever –again.

The List

If asked to contribute to a list of answers, you can repeat a response from earlier pretending that you didn’t hear it, because you were busy with patient care responsibilities (answering pages, working on your medical charting).

Honorable Surrender

Tell the teacher that you are uncomfortable with the open forum of questioning.

Pimp Back

Another version of – the best defense is a good offense. Ask questions in a subspecialization which the teacher may not be as familiar with. Careful – this technique may totally backfire, since pimpers often know and don’t appreciate when they are being pimped back.

Politician’s Approach

Don’t answer the question asked but rather answer a question you would have preferred to answer.

Use Personal Digital Assistant

Use your handheld device to find answers in real-time.

Don’t Sulk or Cry

Pimpers rarely remember who gave incorrect answers – this happens all the time. But sulkers and weepers definitely are memorable. Whatever you do, don’t be labeled as one who loses composure. I feel like Emergency Medicine trainees do well in this area. We are constantly barraged by stressors, and it takes a lot for us to lose our composure.

Detsky AS. The art of pimping. JAMA. April 1, 2009; 301(13): 1379-81.


Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at Bio:
Michelle Lin, MD