Brancati Article Revisited in JAMA 20 Years Later

An article published in JAMA by GIM Division Chief Fred Brancati, MD, MHS, in 1989 is the subject of a commentary in JAMA’s April 1, 2009, issue.  The current commentary by Allan S. Detsky, MD, PhD, bears the same title as Dr. Brancati’s earlier essay, “The Art of Pimping.” The title refers to the practice of attending physicians peppering trainees with questions during daily rounds. The articles regard the purposes of this teaching practice from perspectives as varied as the structure and widening content of medical education, the Socratic method, and power relationships.  Is it an effective  teaching technique, or merely a means to humiliate students?

Since its original publication in 1989, Dr. Brancati’s article has been cited in at least 14 further articles. Keywords attached to these articles reflect the multiple facets of the subject, ranging from the purely cerebral (perceptions, interpretation,  phronesis) to the educational (medical education, clinical reasoning, role models, feedback) to the professional  and social (medical career, medical slang, social systems) to the outright psychopathological (stress, mistreatment,  student abuse).

As JAMA has not completed digitizing its contents for 1989, neither the full text of Dr. Brancati’s article nor the contemporaneous responses to it are available electronically. The article’s citation is Brancati FL. The art of pimping. JAMA. 1989 Jul 7;262(1):89-90.

The current commentary by Dr. Detsky  can be found online. Its citation is Detsky SA. The art of pimping. JAMA. 2009;301(13):1379-1381.     

Articles in scientific journals that have cited Dr. Brancati’s essay include the following:

1.  Stanton C. Pimper pimped [Letter]. JAMA. 1989 Nov 10;262(18):2541.

2.  Rustin TA. Pimper pimped [Letter]. JAMA. 1989 Nov 10;262(18):2542. [and other letters on pages 2451-2]

Also: [Letter and Editorial Note]. JAMA. 1990 Mar 23-30;263(12):1632-3.

3.  Woolf SH, Kamerow DB. Testing for uncommon conditions: The heroic search for positive test results.. Arch Intern Med.1990 Dec;150(12):2451-8.  

4.  Coombs RH, Chopra S, Schenk DR, Yutan E. Medical slang and its functions. Soc Sci Med. 1993 Apr; 36(8):987-98.

5.  Bennett HJ. Humor in the medical literature. J Fam Pract. 1995 Apr; 40(4):334-6.

6.  Dans PE. Self-reported cheating by students at one medical school.  Acad Med. 1996 Jan;71(1 Suppl): S70-2

7.  Brodell RT, Wile MZ, Chren MM, Bickers DR. Learning and teaching in dermatology - A practitioner's guide. Arch Dermatol. 1996 Aug;132(8):946-52.

8.  Hunter K. ''Don't think zebras'': Uncertainty, interpretation, and the place of paradox in clinical education. Theor Med.1996 Sep;17(3):225-41.

9. Dans PE. The use of pejorative terms to describe patients: “Dirtball” revisited. Proc (Bayl Univ Med Cent). 2002 Jan;15(1):26-30.

10.  Penciner R. Clinical teaching in a busy emergency department: Strategies for success. CJEM. 2002 Jul;4(4):286-8.  

11.  Green DP. On the shoulders of mortals. J Hand Surg [Am]. 2005 Jan;30(1):177-81.

12.  Wear D, Kokinova M, Keck-McNulty C, Aultman J. Pimping: Perspectives of 4th year medical students. Teach Learn Med. 2005 Spr;17(2):184-91.

13.  Cook KD, Gutowsky, R.B. Teaching During Rounds. Clin Podiatr Med Surg. 2007 Jan; 24(1):27-36.

14.  Reilly, BM. Inconvenient truths about effective clinical teaching. Lancet. 2007 Aug 25;370(9588):705-11.