1. RIME Method of Student Evaluation Dan Sepdham, MD Family & Community Medicine UT Southwestern

2. Objectives ► Introduce the RIME model ► Define RIME terminology ► Illustrate RIME model in practice ► Discuss advantages & disadvantages

3. Goals ► Describe RIME terminology ► Apply RIME in practice

4. Why? ► Have you ever struggled when evaluating students? Why? ► Have you ever had difficulty giving meaningful feedback to students?

5. Introduction ► Developed by Lou Pangaro in 1999 ► Originally fielded on Internal Medicine clerkships ► Has been applied to other specialties at other locations

6. Vocabulary ► Observer ► Reporter ► Interpreter ► Manager ► Educator o-R-I-M-E

7. Observer ► Innocent bystander ► Unable to meaningfully contribute to patient care

8. Reporter ► Reliably, respectfully, honestly gathers info ► Writes basic notes ► Can distinguish normal from abnormal ► Understands “what” is wrong

9. Interpreter ► Can present the case ► Prioritize problems and data ► Offers differential diagnoses ► Can support or argue against various possibilities ► Understands “why” something is wrong

10. Manager ► Formulates diagnostic and therapeutic plans ► Executes plans ► Modifies plans based on follow up info ► Understands “how” to address the problem

11. Educator ► Defines important questions ► Reads deeply and informs others ► Supervises others ► Committed to self- learning

12. Example RIME LevelCase Presentation by RIME LevelPreceptor Coaching Response Observer“Ms. XX is a 23 y.o. female. The nurse reports she is complaining of burning on urination.” “Good. Now, go in and ask the patient herself to describe to you what she is feeling wrong.” Reporter“… and the patient reports dysuria, hematuria, and pyuria for 3 days. She denies nausea/vomiting, fevers/chills, or flank pain. Her vital signs are stable and her physical exam is normal. She has no abdominal tenderness or flank tenderness. Her urine dip is notable for positive nitrites, blood, and leukocyte esterase.” “Excellent report. Now, “Interpret” these symptoms and signs for me. What do your think could be going on? Let’s come up with a differential diagnosis.” Interpreter“…Based on her symptoms and abnormal urine dip, I believe she has a urinary tract infection. Other possibilities might include bacterial vaginosis, vaginal candidiasis, or an STD.” “Excellent differential diagnosis. Now, how will we proceed to “Manage” the work up?” Manager“…I’ll complete the work up by sending her urine for microscopic examination and culture. I’ll also perform a vaginal exam and obtain specimens for KOH/wet prep, and GC/Chlamydia. I plan to treat with drug XX for 3 days.” “That sounds like a first class work up and an excellent plan. Why would you choose this particular antibiotic instead of,drug YY and why treat for three days rather than five or seven?” Educator“This case meets the criteria for a simple UTI, and the latest research indicates that for cases of simple UTI, drug XX is more cost effective and efficacious than drug YY.” “Good job, you are right on top of the latest literature. Now let’s get you a more complicated case“ See Handout

13. MS1 MS2 MS3 MS4 PGY1 PGY2 PGY3 TIME Educator Manager Interpreter Reporter Observer Above Average Learner Average Learner Below Average Learner The RIME Developmental Process Sepdham 2006. Adapted from “The Learning Vector” by Stritter and colleagues

14. Pros & Cons ► Advantages  Highly accepted  Non-judgmental  Common terminology  Criterion based  Sensitive for detecting at risk students ► Disadvantages  Not to be used as sole basis for grade  Does not evaluate indiviual skills (e.g. suturing)  Not very good at evaluating in-depth fund of knowledge

15. Questions?