Pressure to Perform: Canadian Student Perspectives of Pimping Through a Self-Determination Theory Lens

Traditional clinical teaching involves physician teachers asking questions to gauge students' knowledge-controversially referred to as "pimping." Previous studies have explored students' perceptions of pimping; however, research from a motivational science perspective is limited. This study used Self-Determination Theory (SDT) as a lens to explore medical students' perspectives of pimping. In this qualitative study, we purposively sampled and interviewed undergraduate medical students from the class cohorts of 2019-2022 from the University of Saskatchewan, Canada, who shared their experiences and perspectives of pimping and how it affected motivation and well-being. We used thematic analysis guided by SDT to code the data and develop themes. We conducted interviews until no new themes were identified. Thirteen medical students participated-nine from Year 1 (five female, four male), one from Year 2 (female), one from Year 3 (male), and two from Year 4 (both male). Learners expressed mixed perspectives about pimping, some noting increased motivation for studying and engagement, while others experienced the opposite. We identified themes related to thwarting of autonomy, competence, and relatedness; more controlled forms of motivational behaviors (feeling forced, guilt, embarrassment, desire to prove); and negative well-being consequences. Learners described autonomy-supportive approaches to questioning. This study supports SDT's continuum of motivation emphasizing quality of motivation beyond just presence or absence of motivation, which helps understand how pimping can motivate students but through less optimal controlled forms of motivation, accompanied by negative well-being. Effects of pimping may also differ between junior and senior learners. We present practical implications for questioning approaches that support learner autonomy and shift away from exerting control and pressure.