HackMDWhat goes into your eval
I only learned about the RIME framework when a fellow MS4 shared revealed how they used it as an "inside secret" to improve the evals they received and I never liked how underhanded that felt.
Just like SOAP and formal HPI presentations are a pre-set format/order for sharing clinical information. Examples of trainee skills are often mapped by grading committees onto a domain like the RIME framework.
RIME Framework
The RIME framework is a way of conceptualizing a trainees maturation from medical student to independent physician. As students grow in knowledge, skills and attitudes, they generally progress through four stages: Reporter, Interpreter, Manager and Educator. Each stage requires an integration of knowledge, skills and attitudes. The more advanced stages require a higher degree of sophistication and confidence.
This continuum is also context dependent, as a PGY1, where I'm expected on average to be at manager level, I'm practicing educator skills (literally right now) in some areas, but closer to interpreter level in others (like treating HRS). When I have a sense of what stage you're at in a given area, I'll try to help you reach the next level.
The examples below are taken from an EM perspective but highlight the progression.
Observations
Here's roughly where I see these stages mapping onto years of training years to RIME stage from MS3 to PGY-2 and beyond
R->I - Usually happens early in clerkships if not before. Often both R/I skills are being developed simultaneously because we now push students into wards so early. Most clerkship students are working on interpreter skills a few months in while still refining reporter skills. On average most beginning LIC/MS2's already have a good foundation of reporter skills
I->M - Conceptualized as the time between mid MS4 to mid PGY-1. I usually see the average LIC student showing interpreter-level facets. As they begin and progress through AI's I see efforts to model what they see the interns on their team doing. Taking on more patients, being first call on their patients, fielding questions from families/nurses independently.
M->E - Usually late-PGY1 through mid-PGY2 also picking up a few educator skills like bringing trials to rounds or trying to teach junior students
References
https://www.med.unc.edu/medclerk/education/grading/rime-framework/
