1. PRIME+ Vicki Hayes, MD and Peggy Cyr, MD February 6, 2015

2. Objectives Identify key components of PRIME+ tool Apply tool to a student scenarios Discuss helpful evaluative assessment vs standard evaluative phrases Discuss how to adapt tool to be utilized with current rating tool Exposure to other teaching situations in which tool applicable

3. How do we do at giving useful feedback to our learners?

4. Feedback Exercise #1 Think about a learner with whom you’ve had a recent meaningful clinical teaching interaction. This can be someone who did a great job, or someone who wasn’t doing as well as you’d expect. Take a few minutes to write down some narrative feedback on that student’s performance.

5. Before PRIME+ “Needs to expand fund of knowledge” “Performed as expected for level of training” “A pleasure to work with” “Improved over the course of the rotation” “Seemed to enjoy their FM rotation” “Very bright” “Will improve with experience”

6. Applying PRIME+

7. Reporter Gathers info Distinguishes normal from abnormal Reports finding (oral presentations and written) Proper terminology Understands what is wrong

8. Video 2

9. Interpreter Prioritizes problems and data Formulate differential diagnosis Supports or argues for recommendations Understands why something is wrong

10. Video 3

11. Manager Formulates plan Manages/executes all aspects of care Modifies the plan based on additional info Performs simple procedures Manages one’s own time Pro-active rather than reactive Understand how to address the problem

12. Video 4

13. Educator Informs/communicates with others Self-educates Teaches others and patients Accepts and responds appropriately to feedback Access and interpret medical literature Defines important questions

14. Background RIME developed 1999 by Dr. Lou Pangaro, IM R: Reporter I: Interpreter M: Manager E: Educator

15. RIME Standardized vocabulary Simplicity leads to consistency Improved inter-rater reliability Emphasizes developmental approach Usable feedback

16. PRIME RIME assumed professionalism implicit in each category Professionalism – Responsible – Honest – Reliable – Team player – Work ethic Holmes, Pediatrics, 2014 – Timeliness – Respectful – Pursuit of excellence – Commitment – Integrity/accountability

17. PRIME+ + (Plus) – Next steps for each category – Move learner further on the path to graduation

18. PRIME+ Allows teachers to describe what they see, not just give a grade Removes emotional/more honest Less over-inflating/more fairness Context for feedback Helps others to understand big picture of student’s performance

19. Pros PRIME+ Accepted/validated Non-judgmental Criterion based Common terminology Detect at-risk students

20. Cons PRIME+ Not for individual skills Doesn’t evaluate in-depth fund of knowledge

21. Mirrors SOAP H&PS, OReporter AssessmentAInterpreter PlanPManager/Educator Pangaro, 2007

22. Mirrors Developmental Process MS1, MS2Observer MS3Reporter MS4Reporter/Interpreter PGY1Interpreter/Manager PGY2,3Manager/Educator Pangaro, 2007

23. Mirrors Performance Level (3 rd year) ObserverLow PassD ReporterPassC InterpreterHigh PassB Manager/EducatorHonorsA Pangaro, 2007

24. Evidence for RIME Correlation with clinical performance evaluation: – Better detects and describes changes over time – Improves student understanding of performance feedback – Predictive of performance on shelf exam – Reliability/validation – Ander S, J of Emerg Med, 2012

25. Adapt Existing Tool Narrative for each competency area Provide list of descriptors Know learner’s expected level & evaluate based on that Link to developmental process/milestones Add: Reporter/Interpreter/Manager/Educator at end and circle one

26. Other Uses Precepting Feedback Letters of recommendation

27. Exercise #2 Think about the learner and teaching interaction you selected for exercise #1 Rewrite your narrative feedback using PRIME+

28. Summary Select the level based on current level of function. Give all learners meaningful narrative feedback. Give all learners something to work on.

29. Questions?

30. Bibliography Ander S. Reporter-Interpreter-Manager-Educator (RIME) descriptive ratings as an evaluation tool in an emergency medicine clerkship. J or Emerg Med 2012;(43):720-727. DeWitt D. Pilot study of a ‘RIME’-based tool for giving feedback in a multi-specialty longitudinal clerkship. Med Educ 2008;(42):1205-1209. Holmes AV. Pediatrics 2014;(133):766-768. Klocko D. Reporter, Interpreter, Manager, Educator (RIME): A novel enhancement to clinical evaluation methods. J of Phys Asst Educ 2008;(19):29-33. Pangaro L. A new vocabulary and other innovations for improving descriptive in-training evaluations. Academic Medicine 1999; Nov;74(11):1203-7.

31. Disclosures None

32. Please evaluate this session at: stfm.org/sessionevaluation