An overdue rant on “pimping toxic quizzing”

By Eve Purdy (@purdy_eve)

In a previous post, I promised to come back to a rant on the word “pimping toxic quizzing”. So here we are, better late than never.

Simply stated, the term must go. I propose a simple, but imperfect alternative, “toxic quizzing”.

I have been disappointed to repeatedly see the phrase “pimping toxic quizzing” used by major medical journals, medical blogs, and medical educators, many of whom I admire, to describe a poor technique of teaching – asking irrelevant questions of learners so that the teacher looks more intelligent and establishes dominance. This with the purpose of embarrassing or belittling the learner and propagating hierarchy. It’s about time that both the technique, and the word used to describe it are abandoned.

It almost goes without saying that quality medical educators agree that this style of teaching is ineffective and inappropriate. The technique is different than the Socratic method of thoughtful probing questioning from a place of curiosity, which still has significant educational value. As such, in this post I am not going to explore the technique of “pimping toxic quizzing” and its drawbacks, rather I will focus on the language alone. In medical circles I am quite surprised that there is ongoing use of the term at all. In fact, there has been little debate about the suitability of using the term “pimping toxic quizzing” to describe this darker version of teaching. However, many I have spoken to in casual conversations share the same visceral a reaction to the term that I do. Some are not at all uncomfortable. Many don’t feel strongly either way. All those whom I have discussed this with outside of medicine are shocked. How can we reconcile the use of the word and does it matter?

Enter linguistic anthropology.

This field of anthropology is focused on how language reflects culture and also reflects how language has the capacity to shape culture in return. It is an essential part of socialization and much of linguistic anthropology spotlights language in the process of enculturation. There is no doubt that the term “pimping toxic quizzing” has become an essential part of the medical lexicon – and it likely dates back centuries. The term, and use of the term, serves as clear evidence of the unique language and culture of medicine. The way physicians use the term “pimping toxic quizzing” is entirely different than the rest of the population. Most cultures have a unique language that separates them from other groups, and learning that language is an essential part of coming to belong. We have adopted this term, made it our own, glorified it, then teach it to our young generation after generation. My main issue with the ongoing use of the phrase is related to sexualized power and the reality of overlapping cultures.

Sexualized Power and Overlapping Cultures

In most circles, a pimp is “a man who controls prostitutes and arranges clients for them, taking a percentage of their earnings in return.” When we enter medicine, our traditional understanding of this word does not suddenly vanish. The term “pimping” is laden with the context of sexualized power, violence, and bodily and emotional control.

That context, for me, doesn’t simply disappear when I read about “pimping toxic quizzing” in a medical journal or when I hear reference to “being pimped” or phrases like “you got pimped hard” or “we are going to have a little pimp session” used throughout the hospital. To those phrases, my visceral reaction is, and always will be:

No. No, I do not want to be pimped. Not by you and not by anybody. Ever.

Of course, I recognize that medical learners have a new context for the word, gained through the process medical enculturation. That new context takes the edge off just a bit. For many, however, the original definition will be the place that the mind goes first. I will always wonder, if for a second, whether that sense of dominance and control over every aspect of my physical, emotional, and sexual being is what those using the word have in mind as well. Within milliseconds my mind will recalibrate but I will be left feeling a tiny bit violated. Then I will feel guilty for this petty sense of violation and my good fortune to be able to reset and do a job I love – an opportunity that those unwillingly involved in prostitution and at the hands of actual pimps do not have. I will feel a bit sick that we have trivialized their plight by usurping language. Then I will worry that frivolous use of term will make us less attune to the needs of some of our most vulnerable patients………

I do recognize that this is a complete spiral. You now have a brief, and perhaps somewhat terrifying, look into my brain. Maybe now you will understand, at least in part, why I incorrectly answered that question you just asked!

The reality is that when this term came into use, the makeup of our medical community was much different than it is now. Perhaps the then clever adoption of the term “pimping toxic quizzing” landed better with an entirely male cohort –who traditionally maintain power in the pimp-prostitute relationship. I do think that our medical cohort, males and females alike have progressed. I would venture that the diversification of our workforce means that there are more people who are uncomfortable with this term’s common place in medicine and its use by medical educators. I do absolutely trust that the mind spiral illustrated above is not the point that well-intentioned folks have when they use the phrase. I trust that most of them would want that mind spiral to stop.

Pimping  >> Toxic Quizzing

 So where do we go from here? It’s simple. As individuals, or as a group, we can decide whether we want to continue using the phrase, recognizing the potential for the effects either way on our culture down the line. Language is important. It helps us know who we were, defines who we are, and allows us to decide who we wish to become. This certainly wouldn’t be the first phrase that we choose to abandon or change for very good reason (i.e Wegener’s Granulomatosis à Granulomatosis with Polyangiitis).

Simple, however, does not mean easy. Change is hard and change is slow. It means that we must come up with another term because, unfortunately, the poor educational technique still exists. Trust me, this new term is unlikely to be as catchy. Familiar language is easy. Everyone is on the same page and when we are tired we revert to it.

Now, I call it “toxic quizzing”. This phrase adequately describes the feeling it creates for the team and the dangerous dynamic the method constructs. It also holds the educator to account, something that the old term never really did. I do get loads of funny looks and I often slip up then correct myself. I explain why it’s important. Yes, I am “that” colleague and you can be too!

If you have a better phrase or term do let us know below! As always, interested in your thoughts.

Feature photo provided by author