During my first year of medical school, I noticed these odd terms reappearing in my lectures and assignments. These were along the lines of “critical thinking” or “analytical evaluation,” and at first I overlooked them as I busied myself with learning anatomy, physiology and the likes. But by second year and their continual mentioning here and there, I thought to myself, “these terms must have some sort of importance and if they do, how am I to learn how to change the way I think?” It was finally during a tutorial at hospital where these wishy-washy terms started to develop meaning. The teaching doctor began his lesson by saying “You medical students are too used to being spoon-fed, I’m going to teach you this lesson through the Socratic method,” and off he started. His first question to our slightly confused faces was “Who was Socrates?”.
Ancient Greek was never my forte, so I soon found myself learning that Socrates was in fact a famous classical Greek philosopher credited one of the great founders of Western philosophy. His “method” was to engage his students in a line of questioning in order to solve a problem. As simple as that sounds, he noted that specific questions directed in a specific order would reveal the extent of his students’ knowledge and their underlying beliefs. This teaching style is often practised in law school, however can also be used in a medical setting.
Once young, fresh, slightly scared but excited medical students find themselves thrown into hospital and begin roaming carelessly around the wards or into an operating theatre, they will develop their own taste of the “Socratic method”.
Translated into a medical education setting, a modern version entails: A senior doctor proposes a series of questions to lead the medical student to arrive at the same answer to their question via their own critical thinking. This often generates a rational discussion where a student can memorably extend their knowledge due to the slightly traumatic experience of being questioned/targeted by a doctor but also shows the student that they are able to work out the question using their own foundations and some well-directed guidance. An overall positive and educational experience!
However, sometimes something peculiar will happen. This situation is referred to in medical terminology as “pimping,” and often masquerades itself as the Socratic method. It is as follows: similar to our previous scenario, a senior doctor will direct their line of questioning towards their junior colleagues starting at the bottom of the food chain, beginning however, with a rather inconspicuous topic, with which they are guaranteed to hear “sorry I don’t know…”. They will then move their way upwards from intern to resident and so forth until someone answers correctly or everyone is shown to be “incompetent”.
This type of questioning does not line up with the intentions of the Socratic method. In fact, the purpose behind “pimping” is not based in education at all, but as a way to re-establish the medial hierarchy. By using an incredibly difficult question, or one that requires a list e.g describe the descending pathway of the vestibulospinal tract, the attending doctor can make themselves look and feel very knowledgeable with an after effect of both attempting to teach the medical student something useful mixed with a tinge of humiliation. Obviously this is not the best way of teaching, however it is an age-old tradition that has been practised for over three centuries with earliest references found in 1628 by a London doctor named Harvey.
Following in the footsteps of every medical student, we must remain vigilant and prepare ourselves to be posed difficult questions in rapid succession anywhere in hospital may it be ward rounds, operating rooms or even after getting your whole team coffee.