#KeyLIMEpodcast 128: Pimping and Socrates:  Optimizing Clinical Teaching

This week the Key Literature In Medical Education podcast covers the most common(?), most feared (?) approach to teaching at the “bedside.” Pimping -the process where an attending physician asks junior trainees unstructured questions of increasing difficulty and decreasing educational utility is a phenomenon many of us have endured in clinical training.  But if trust is a foundational condition for effective learning, should a Clinician Educator including pimping in their educational toolbox?  Socrates, psychological safety and more are covered this week.

The summary is below.

The podcast is here.

– Jonathan

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KeyLIME Session 128 – Article under review:

Listen to the podcast

View/download the abstract here.

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Stoddard HA, O’Dell DV. Would Socrates Have Actually Used the “Socratic Method” for Clinical Teaching? J Gen Intern Med. 2016 Sep;31(9):1092-6.

Reviewer: Linda Snell (@LindaSMedEd)

Background

Socrates thought that the act of teaching did not consist in transmitting information from “teacher” to “student (what we would call didactic) but was an exercise in helping stimulating students to introspectively discover true knowledge through logic and reasoning. (what we might call constructivist?)

The authors review 4 contemporary categories of teaching methods (from teacher- to learner-centered): Didactic, Socratic, Inquiry, Discovery.

They then define ‘pimping’ –“posing exceptionally difficult questions to trainees, politically motivated and encouraging learners to admire the teacher while keeping students in their appropriate place in the pecking order, reinforcing power differentials and maintaining hierarchies without expanding knowledge. Pimping questions are intended to expose ignorance rather than to stimulate new knowledge”, and differentiate it from Socratic teaching – which lies in the intent of the questioner:  “questions intended to offer learners an opportunity to express their existing knowledge, promote the synthesis of new knowledge is Socratic method; the same questions from a teacher whose intent is to belittle the learner without fostering intellectual curiosity would be pimping”.

Socratic teaching means posing pointed questions, and Socrates’ deployment of questions as a pedagogical tool remains relevant to medical educators. However there is a fine line between pimping, good clinical teaching, and the philosophy of Socrates. If not presented properly, posing a series of increasingly difficult questions until the teacher finds the limits of the learners’ knowledge can easily be perceived by learners as pimping

Purpose

To characterize the theoretical foundations of the Socratic method in teaching, and contrast it with pimping by introducing the construct of “psychological safety.

Type of Paper

Commentary and literature synthesis

Key Points on Methods

The authors briefly review the Socratic method in a contemporary context then discuss psychological safety in learning, linking both to pimping and clinical teaching.

Key Outcomes

  • A person’s emotional state affects the physiological processes of learning – deep, more permanent learning happens when all areas of the brain are used, including the emotional center. (Artino) Students are more likely to learn when the positive centers of the brain are activated.
  • Psychological safety leads to increased learning, especially in groups with hierarchical membership. Factors affecting this are interpersonal trust, mutual respect, feeling valued, personal comfort, and threats of humiliation and hostility are minimized.
  • A psychologically safe environment does not mean accepting substandard learner performance – it is not ignored but corrections or reprimands are applied in a compassionate manner that clearly identifies the failings without causing humiliation or resentment.
  • Clinical teachers using probing questions in an environment of psychological safety leads learners to identify their own knowledge deficits and motivates them to expand their own knowledge, both characteristics of independent learning and being a professional.
  • The authors show practical examples of such questions and their classification for a clinical setting. (Table 1), and discuss appropriate use of silence, reflection, and finding limits of knowledge ‘a la Vygotsky’.

Key Conclusions

The authors conclude that teaching trainees about complicated clinical problems can be carried out effectively using genuine Socratic questioning to reveal learners’ existing knowledge and move them towards critical analytical thinking. However what gets called the Socratic method in contemporary education bears little resemblance to what Socrates actually did. In order to reap the benefits of this approach, it must be used within an environment of psychological safety.

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