Meaningful Evaluation: Framework, Process, Impact Inis Jane Bardella, M.D., FAAFP Associate Dean for Faculty Development and Global Health Initiatives Department of Family and Preventive Medicine Lecia M. Apantaku, M.D., FACS Assistant Dean for Clinical Sciences Education Associate Professor, Department of Surgery Chicago Medical School Rosalind Franklin University of Medicine and Science

Objectives Discuss the relationship between evaluation and learning. Discuss a framework [RIME, Reporter Interpreter Manager Educator] for evaluation. Discuss the process of evaluation. Apply the RIME framework to achieve meaningful [accurate, useful, efficient] evaluation of students and residents.

Vision Effectively prepare medical students and residents to meet the health needs of the people of the United States [especially the poor] with compassion, integrity, high ethical standards and a high level of competence.

Responsibility Patients, always first Students and Residents Faculty Clinical teachers – you Clerkship director Program director Education system Centegra CMS

Definition Process of making judgments based on factual information and observations in order to rate, rank or assess an individual’s status at a given point in time.

Background – Adult Learning and Teaching What is different about adults? Self-directed Goal-directed Application-oriented Competency concerns Shared responsibility Moral responsibility Teacher is: Resource, Facilitator, Mentor

Background – Adult Learning and Teaching How does this influence evaluation? How should this influence evaluation?

Bottom Line of Evaluation Evaluation drives learning. Objectives determine evaluation. Evaluation is the second greatest fear of preceptors/clinical faculty. Evaluation is absolutely necessary to determine progression toward independent practice.

So, why formal evaluation? Summarize performance Determine competencies (behaviors) Guide future learning Communicate summary information Determine a grade

Framework – RIME Reporter Interpreter Manager Educator

Framework – RIME Reporter Consistently professional, good interpersonal skills Reliably obtains and communicates clinical findings Ownership of clinical findings Interpreter Consistently able to analyze and prioritize patient problems Ownership of explaining things

Framework – RIME Manager Consistently proposes reasonable options incorporating patient preferences Ownership of developing action plan with patient Educator Consistent level of knowledge of current medical evidence Can critically apply knowledge to specific patients Ownership of evidence for action and sharing

RIME Caveat Students must be reasonable, residents must be right.

Application – RIME What is the RIME? How did you determine the RIME?

Framework – RIME Synthetic model – synthesis What we do all day long in patient care! Focus is patient – performance in relationship to patient care Professionalism required High level of interpersonal skills required Descriptive Progressive, building model Competencies (KSA, behaviors) integral Not relative – Expectations clear

A Few More RIME Caveats Program must determine common problems and uncommon problems. Program must determine core or essential areas and non-essential areas

BREAK TIME

Application What is the RIME? What if: Beginning 3 rd year? Middle 3 rd year? End 3 rd year? Mid 4 th year? Beginning intern? Mid intern? 2 nd year resident?

Process – PIE Cycle Planning Instruction Evaluation

Process - PIE Planning Clerkship goals and objectives Requirements/projects Student self-evaluate Review the form Planning

Process - PIE Instruction Observation Feedback Action plans Gather and record data Patient and staff perceptions Chart documentation Observation Student progress notes Instruction

Process - PIE Evaluation Form Student You Unrushed Emphasize objectives, improvement Specific comments Meeting Evaluation

Comments about Comments Examples? Demonstration Consistency Progression Improvement Recommendations RIME it

Application - Forms RIME the elements RIME the learner Complete the form using RIME as the framework to assess behavior, i.g. competency. Comments

Summary Evaluation is a continuous process. Evaluation drives learning. Goals & objectives determine evaluation. RIME it. Determine the student’s starting point. Develop a plan for progression. Determine the final evaluation. Include comments To teach is to learn again!

References Bardella IJ, ed. Essentials of precepting , revised Ende, J. Feedback in clinical medical education. JAMA. 1983;250: Massachusetts statewide area health education center program. Faculty development workbook Pangaro LN. A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med. 1999;74: Pangaro LN. Evaluating trainees in the clinical setting: what does competency in patient care look like? Presented 25 Jan 2012 at RFUMS, North Chicago, IL. Society of teachers of family medicine pep2 committee. Preceptor education project, second edition: facilitators guide. Society of teachers of family medicine. Kansas City

Thank you