RIME

How can I assess a learner in the first few days of a rotation?

RIME is a simple intuitive assessment tool based on the typical developmental process of a medical student or resident. As students and residents broaden their medical knowledge base and develop their clinical reasoning skills they move through 4 developmental levels.

Reporter -  “What is happening?”           
Interpreter - “Why is it happening?"           
Manager - “What next?”
Educator - “Where are the knowledge gaps?”   

Here’s a more detailed overview of RIME showing when to expect learners to make transition between levels. Remember that different learners progress at different rates; it’s not unusual to see a clinical clerk working at a Manager level, or a second year resident who still needs encouragement to move from the Interpreter stage. Also remember that competence is content specific. A resident (or the preceptor!) may function at the Educator level for common issues like hypertension, but struggle at the Reporter level with an obscure neurological condition.

RIME

Reporter

• Proficient history taking and examination
• Problem identification
• Normal versus abnormal
• Expected level
  –    clinical clerk

Interpreter

• Create differential diagnosis
• Prioritize problems
• Follow-up tests
• Expected level
  –    Senior medical student
  –    First year resident

Manager

• Select appropriate diagnostic tests
• Finds common ground with patient (customizes therapy)
• Expected level
  –    Second year resident

Educator

• Identifies knowledge gaps
• Plans continuing education
• Teaches students, peers, faculty
• Expected level
  –    The ideal senior resident

By listening to a few case presentations you will be able to rapidly identify the functional level of your learner. You will also note that as the learner progresses the presentations become increasingly succinct, focusing on key points.

The video demonstrates the major features of each level.

View RIME Video

Using RIME in your teaching

Sometimes learners like to stay in their comfort zones, avoiding commitment to diagnosis or therapy. Point out their RIME stage and encourage them to move on to the next developmental level. Make the clinical clerk interpret the data and speculate on a differential diagnosis. Push the resident to develop a management plan.
RIME can also help you to pitch your teaching at an appropriate level. Reporters and interpreters are focusing on basic clinical skills; they will benefit more by help with perfecting history taking or reading ECG’s than by discussions on the merits of ARB’s rather than ACE inhibitors.

Reference
Pangaro L. A new vocabulary and other innovations for improving descriptive in-training evaluations.
Acad Med. 1999 Nov;74(11):1203-7.

Assess your learner with RIME Reporter Interpreter Manager Educator