# What 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](https://canadiem.org/teaching-that-counts-diagnose-your-learner/) 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/