Lets talk about an effective evaluation process called RIME developed in 1999 by Pangaro. Not only is the name catchy, but it also makes intuitive sense.

RIME stands for
  • R – reporter
  • I – interpreter
  • M – manager
  • E – educator / expert
It’s perfect for those who want to evaluate in a meaningful and nonjudgemental way that is quick and useful. It can provide structure that is more valuable than saying, “you were awesome today”. Because the tool uses observed behaviors, it allows for the evaluator (you!) the ability to grade based upon what you see. 
 

What is RIME?

Reporter: Learner who saw a patient and then regurgitated a bunch of facts right back at you. Word vomit, if you will. Sometimes they are fantastic reporters and their presentations are sheer poetry. Sometimes the learner get the wrong facts; sometimes they get too little facts; sometimes they get too many facts about something that is trivial.
 
Interpreter: Learner who saw the patient, gave you a history and physical exam presentation, and is now able to say to you, “I think XYZ is going on in the patient”. Essentially, the interpreter can synthesize the information that was gathered and reported, and subsequently gives you their thoughts. Developing a differential diagnosis is a good example of interpretation.
 
Manager: One who can discuss the management and treatment plan for the patient. Sometimes the learner is really off such as saying, “I want to get a stat trans-esophageal echo.” Not happening in the ED.
 
Educator / Expert: Someone who can report information gathered accurately and succinctly, can infer and interpret meaningfully, can develop a management plan, and finally can discuss evidence and debate important clinical concepts.

Pitfalls

When using RIME, one has to be aware that different levels of learners will be in different categories. For example, you would not expect a first year medical student observing in the ED to be at the level of educator / expert, let alone reporter. At the same time, a good stand out candidate as a future intern could be that fourth year rotator who is knowledgable about the contraindications of beta-blockers in acute MI.
 

Beyond RIME

The next step in using RIME is to use what you observe about the learner from your encounter and nudge them into a higher competency level. RIME will let you know prodding questions to ask  For example, a learner who is a reporter may be asked to interpret the information given. This is a way to challenge and allows you an easy way to teach something that is appropriate for the level that they are currently sitting.
 
References
  • Bloomfield L, Magney A, Segelov E. Reasons to try ‘RIME’. Med Educ. 2007. Nov;41(11):1104. PubMed PMID: 17883381
  • DeWitt D, Carline J, Paauw D, Pangaro L. Pilot study of a “RIME”-based tool for giving feedback in a multi-specialty longitudinal clerkship. Med Educ. 2008. Dec;42(12):1205-9. Pubmed PMID: 19120951
  • Pangaro L. A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med. 1999. Nov;74(11):1203-7. PubMed PMID: 10587681
  • Sepdham D, Julka M, Hofmann L, Dobbie A. Using the RIME model for learner assessment and feedback. Fam Med. 2007. Mar;39(3):161-3. PubMed PMID: 17323203
Nikita Joshi, MD

Nikita Joshi, MD

ALiEM Chief People Officer and Associate Editor
Clinical Instructor
Department of Emergency Medicine
Stanford University
Nikita Joshi, MD

@njoshi8

Emergency Medicine Doctor Associate Editor of ALiEM Gun Sense Advocate #FOAMed #Docs4GunSense #MomsDemandAction Tweets represent my own views and opinions