Pimping in Bedside Clinical Education: Questioning Style of Attending Physicians and Associations with Learners’ Evaluations

Abstract

Purpose. Given the interest and momentum in medical education on psychological safety and the learning environment, we sought to evaluate whether there was an association between questioning style of attending physicians and their corresponding evaluations from learners.

Methods. Building on our prior study that developed a pimping scale to categorize the questioning styles of attending physicians on inpatient teaching services at two university-affiliated hospital internal medicine residency programs, this cross-sectional study examined the association between a physician’s score on our scale and that physician’s learner evaluations. For our primary outcome, we used the overall summative rating from teaching evaluations at both residencies, and for secondary outcomes we picked two questions from each residency’s evaluation felt to be most characteristic of pimping behaviors.

Results. Including both residency programs, the range of evaluation values for the “overall attending rating” was 2-4 (potential range 1-4), and the mean for all faculty was 3.7. There was no correlation between attendings’ pimping scores and their overall student rating (p = 0.65). At the Osler Residency, there was no correlation between attendings’ pimping scores and student ratings for respectfulness (p = 0.87) or supportiveness (p = 0.67). At the Bayview Residency, there was no association between pimping scores and students rating of the attendings propensity to either ask questions in non-threatening way (p = 0.62) or explore complications and errors without intimidation (p = 0.78)

Conclusion. Pimping questioning behaviors do not appear to be correlated with teaching evaluations of attending physicians by house staff. This may be due to the limited scope and fidelity of current teacher evaluations. It is also possible that some residents have come to accept pimping-type questioning as a cultural norm in medical education.