The practice of “procuring” in medical schools can be “harmful and painful”


Dr Sarita Verma says the teaching method has real value when done right, but can be destructive when used to humiliate rather than enlighten

The dean of the Northern Ontario School of Medicine says that a common teaching method in medical school known by the odd term of “pimping” can be instructive if done right, but be quite the opposite when it is poorly executed.

As a method of teaching, pimping puts medical students in the spotlight with difficult and straightforward questions. Its use and misuse were reviewed in the Journal of the Canadian Medical Association (CMAJ) this week.

The unusual form of education – which has nothing to do with prostitution – has raised concerns about bullying and burnout among some medical students, the journal article says.

Dr. Sarita Verma, dean and executive director of the Northern Ontario School of Medicine, said the type of teaching described in the CMAJ article can be harmful and painful, and can even be destructive for some. students, if it is not used correctly.

“The way the article describes the high-voltage, rapid-fire interrogation is considered, you know, ‘pimping.’ I hate that term. If it’s done wrong,… then [students] will feel that they are humiliated, that it is harmful, it is painful. And I totally understand that, ”she said.

Verma also said, however, that the high pressure interrogation style can be done well and can produce good results. She said the Socratic Method, the method of teaching through a kind of cooperative argumentative process of asking and answering questions, is valuable in testing knowledge and encouraging critical thinking.

But, she continued, it must be done correctly, adding that in many cases teachers and doctors do not learn the right way to practice the Socratic method.

“It’s a very valuable way to learn, but the right way to teach people how to learn, using this method, is to connect their knowledge,” Verma said. “And then to help them understand by probing what they know and what they don’t know, to help them actually figure out how to learn.

“And while it’s potentially encouraging and sometimes feels insecure, it’s a safe and respectful process, but it makes people uncomfortable.”

But that discomfort is part of the teaching, she said, because students “have to learn critical thinking, because if they don’t know what’s going on and if they don’t think about it, they will. errors. And patient safety is at the root of it all, isn’t it? “

Verma said the Socratic process is meant to engage the learner with appropriate questions, to question their knowledge and memories, but should not be used to humiliate anyone.

The article, written by CMAJ editor Diane Duong, examines both sides of the issue. The article quoted Drs. James Healy and Peter Yoo in the Journal of Surgical Education, who described the discomfort of procuring as a kind of inoculation.

“While unpleasant at times, this type of education is really long-term kindness to the student, just as a vaccination creates temporary discomfort for lasting gain,” they said in the article.

But, Duong wrote that when the teaching style is done poorly, it can “easily cross the line of teaching through humiliation, especially when experienced doctors question students in a way that makes them ashamed of their behavior. lack of knowledge”.

In the article, Duong refers to a study conducted in Australia which found that nearly 75 percent of a cohort of students at two medical schools were so intimidated by the practice that many did not participate in the visits. in the hospital with teaching doctors.

And while pimping may be common in medical schools, at NOSM Verma said the method of teaching during hospital visits is not common.

“We tend not to have that kind of training because a lot of our learners are spread across community settings,” Verma said.

She said another version of patrolling is to bring medical students together to study patient charts at the hospital. And while this is invaluable, teaching at the bedside is still important so that medical students can see and experience what the patient demonstrates, she said.

To that end, Verma said many hospitals are now using paid actors to achieve a similar effect. She said it works well for NOSM, whose learners work in hospitals and clinics in the North.

“Because we’re so distributed, we have what a lot of medical schools have adopted, which is standardized patients… actors, who have real medical diagnoses. But you know, they consented and they take action,” he said. Verma.

“Actually, a lot of schools are doing it. Now. It’s called ‘standardized patients.’ And it’s a form of simulation, it’s what we call ‘low fidelity simulation’,” Verma said.

This form of “low-fidelity simulation” is valuable, she added, but NOSM and other medical schools also use high-fidelity simulations.

“So you can do a lot of what’s going on in terms of teaching people from blood work to cardiac arrest. Even surgery is done with robotics or with digital medicine. And it’s actually a really good way to teach people, you can reduce the amount of patient error because of it, right? So people will have the opportunity to practice, especially in specialties where they require technical skills, so you can practice before you end up performing the procedure on a real patient, ”Verma said.

She added that medical learners should be prepared for unfamiliar and unexpected situations that may arise.

“I think at some point people, especially learners, need to realize that they have to develop some resilience to the very stressful environment that is involved in medical education and medical practice.”

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