The art of pimping.

in 1989. As he defined it, pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. Among surgeons, pimping may occur when students and residents are a captive audience observing a patient undergoing an operation. Brancati described the origins of the term, which date back to 17th-century London. Koch’s series of “Pümpfrage” (pimp questions) were used on his rounds in the 19th century. The practice migrated to North America in the 20th century and was documented by Flexner while observing Osler making rounds at Johns Hopkins. Brancati outlined suggestions for attending physicians to further hone their pimping skills and methods for students to defend themselves from it. He posited that the art of pimping would disappear in the future with increased specialization and educational reorganization. This Commentary revisits the art of pimping 20 years later and provides an update for faculty members and students alike on modern methods in this important skill. Pimping is indeed alive and well within academic medicine for several reasons. First, the basic structure of medical teaching has not changed. Ross and Detsky have described the teaching services at 2 academic hospitals on both sides of the Canada/US border. Students and residents still work up patients and report to attending physicians as much in 2009 as they did in the last half of the 20th century. Faculty still meet with smallto medium-sized groups of medical students and residents and use interactive methods that somewhat resemble Socratic techniques. Second, the power relationship between teacher and student still exists and likely always will, because the teacher has more content knowledge and is responsible for evaluating the students. Pimping reinforces that power relationship because the teacher usually controls the questions. The teacher likely knows the answers while the students may or may not. A historical example of the effect of this phenomenon was described by Ausiello in a brief biography of Their. When Their was chair of medicine at Yale, a resident once fainted from anxiety prior to a case presentation. This experience resulted in giving Thier the nickname “Syncope Sam.” The third reason pimping has flourished is the explosive expansion of the knowledge base in clinical medicine.