GradeHow do evaluate medical students and residents, who are rotating through your Emergency Department? Do you have a structured framework for assessing their competencies?

Have you heard of the RIME method of evaluating learners on their clinical rotation? Dr. Lou Pangaro (Vice Chair for Educational Programs in the Dept of Medicine at the Uniformed Services University) published a landmark article in 1999 on his simple yet effective approach in evaluating medical students and residents. I had the pleasure of briefly meeting Dr. Pangaro when he gave CDEM’s keynote speech in 2008.

KISS

As faculty evaluating students, we are constantly inundated with various evaluation forms and complex assessment tools. To optimize inter-rater reliability amongst evaluators, the key is to keep the evaluation simple, short, and concrete. In short – KISS – Keep It Simple Stupid.

RIME

RIME sets itself apart from other evaluation tools by standardizing the vocabulary so that we are talking about the same thing. It proposes a developmental model for novice through advanced learners. It represents a system which assesses the learner’s skills, knowledge, and attitudes, based on observed behavior.

In a nutshell, a medical student’s performance is classified into one of 4 categories:

1. Reporter

  • Reliability gathers accurate history and performs physical examination
  • Has basic medical knowledge
  • Adequately communicates findings
  • Average interpersonal skills with patients

2. Interpreter

  • Able to prioritize problem list based on patient complaint
  • Generates differential diagnosis list
  • Interprets data (labs, EKG, imaging) to adjust differential diagnosis list
  • Engages more as active provider for patient

3. Manager

  • Tailors plan to patient’s circumstance and presentation
  • Demonstrates high-level interpersonal skills
  • Starts to educate patients about disease process and clinical course
  • Demonstrates more medical knowledge and advanced judgment in patient management plan
  • Proposes reasonable treatment plans while incorporating patient preferences
  • More adept at procedural skills

4. Educator

  • Performs at high-level in managing multiple patients
  • Practices self-directed learning
  • Able to share knowledge with others (junior residents and medical students)
  • Supervises junior trainees
  • Knowledgeable of current medical evidence

Personally, I believe that the RIME structure should correlate with particular training levels as follows:

  • Reporter – goal for medical student in first clinical year
  • Interpreter – goal for medical student in final clinical year and for PGY-1 resident
  • Manager – goal for PGY-2 resident
  • Educator – goal for PGY-3+ resident

The RIME method of evaluation demonstrated high reliability and validity when implemented in an internal medical clerkship.

Reference
Pangaro, L. (1999). A new vocabulary and other innovations for improving descriptive in-training evaluations Academic Medicine, 74 (11), 1203-7 DOI: 10.1097/00001888-199911000-00012
Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD

@M_Lin

Professor of Emerg Med at UCSF-Zuckerberg San Francisco General. Founder of ALiEM @aliemteam #PostitPearls https://t.co/7v7cgJqNEn
Michelle Lin, MD