Download Socrates Is Still Not a Pimp

UNC D IVISION
OF
H OSPTIAL M EDICINE
I SSUE 19
M ARCH 29, 2017
Socrates Is Still Not a Pimp
A few years ago, I shared a piece by Rick Garlikov where he illustrated the joy of the Socrartic
Method in a short article called Teaching by Asking Instead of by Telling. In this piece, he
illustrated the excitement and contagion of learning through questions. Instead of asking for
esoteric bits of forgotten knowledge or “guess what I’m thinking questions,” Mr. Garlikov
modeled the power of inquisitive thinking and taught the concept of binary arithmetic to a 3rd
grade class using only questions. Today, I revisit this idea with a more pragmatic spirit.
By the time these 3rd graders have made it to medical school, the thrill of learning has often
been replaced by the fear of humiliation and the communal pack of excitement has been stifled
by far too much self awareness and academic competition. Additionally, as teachers, The
Socratic Method is difficult. Preparation, flexibility, energy, and time are essential in using the
Socratic Method and the hierarchy of medical education is a real and palpable force. Not to
mention the past praise of pimping as framed in two JAMA articles both named, “The Art Of
Pimping.” Robert C. Oh explores the differences between pimping and The Socratic Method
in a short article in the American Medical Association Journal of Ethics “The Socratic Method
and Pimping: Optimizing the Use of Stress and Fear in Instruction.”
Paul Ossman, MD, MPH
Associate Director of
Education
Table 1. The Socratic method versus Pimping
Technique
Socratic method
Goals
• Connect new knowledge to
existing knowledge
• Teach
Probing and leading: making
connections
Types of questions
Optimal setting
Ex: Why do patients get hypotensive when pyelonephritis is
treated with antibiotics?
One-on-one
Pimping

Evaluate student.

Establish hierarchal order

Teach
Factual, pertaining to history,
eponyms, lists
Ex: What is the JarischHerxheimer reaction?
Small group
Pointers for Teachers from Robert Oh
1. Diagnose the learners (and teach to that level). Ask questions to assess their baseline
knowledge level. But don’t embarrass; ensure that your goal is to help and motivate them
to learn.
2. Avoid asking questions for questions’ sake. Do students really need to know what year the
stethoscope was invented? Avoid trivia, historical facts, non-meaningful eponyms, and
impossible, guess-what-I’m-thinking questions.
Cont’d.
In this Issue

Socrates Is Still Not A Pimp

Hillsborough Update

Procedure Service
Update
P AGE 2
H OSPITALIST H APPENINGS
3. Tell students your goal in asking questions. Tell students up front that you will ask
questions not to harm, humiliate, or embarrass, but to teach.
4. Emphasize important learning points. Link topics discussed to a clinical context for patient care,
perhaps one in which clinical pearls are given to help to solve complex clinical problems.
5.
Do not attempt to intentionally embarrass or humiliate the students. We all make mistakes, and
reflection on the teaching encounter helps you to determine if you’ve asked irrelevant
questions or if your learning outcome was unintended embarrassment or humiliation. Use
this to improve your approach and questioning for future teaching opportunities.
See supplemental attachments.
Hillsborough Update
Volume: March continues to a busy month for Hillsborough, although not quite as busy
as February. We’ll have numbers soon.
Consults: Pulm/critical care is still on track for this July. We are working with IM and
hospital leadership to initiate a pilot for telemedicine consults at Hillsborough. This will
be starting soon with ID. I am hoping that it will open the door to other medicine
subspecialties providing consultative services at Hillsborough (endocrine, rheum, etc.).
I also anticipate that we will have Dermatology consults available by May, as well as
anesthesia pain. In addition, Interventional Radiology at Hillsborough is starting this
Thursday. It will begin as a once a week service (Thursdays) for fluoro and U/S guided
procedures but will hopefully grow.
Office space: With the addition of scribes and students, our office space has gotten
quite crowded over the last few months. Fortunately, we are acquiring a second office
later this week, which will give our team some much needed breathing room.
Departures/Recruiting: We recently learned that Erin Schmid, our amazing NP,
will be leaving at the end of April to be closer to family in Florida. In addition, Roberto
Sanchez has accepted a position in Hawaii and will be leaving this summer. The APP
position is now posted, and we are continuing to interview for hospitalists.
Upcoming meetings: We will be doing Team STEPPS training on April 5. On April
19, our very own Paul Ossman will be stopping by to discuss patient communication.
Thanks Paul!
Eric Edwards, MD
Medical Director,
Hillsborough Hospital
P AGE 3
H OSPITALIST H APPENINGS
How did the Medicine Procedure Service do in 2016?



We received 1041 request for procedures
Inpatient requests came from all internal medicine inpatient services, neurology,
emergency medicine, family medicine, transplant surgery, neurosurgery, ENT, psychiatry, GI surgery, trauma surgery, surg-onc, rehab, and gynecology.
We also received requests from transplant, radiation-oncology, hepatology, and
oncology clinics.
Breakdown of types of procedures done in 2016
Ria Dancel, MD
Director, Medicine
Procedure Service
Complications
Diagnostic
Para
LVP
Central lines
Thoracentesis
LP
# Performed
123
351
112
85
166
Complication
Rate
Bleeding 0%
Infection 0%
Bowel perf 0%
Bleeding 0.85%
Infection 0.85%
Bowel perf 0%
Bleeding 2.7%
PTX 0.9%
Arterial puncture 0%
CLABSI 0.9%
PTX needing chest
tube 0%
Hemothorax 0%
Bleeding
0%
HA 0.6%
Kelly, Dana, and Amy at the APP conference in
Ashville earlier this week.