The RIME Framework:
A Tool For Describing and Monitoring Student Progress
The RIME framework provides terminology for describing the professional growth of medical students. It is used in many clerkships across the country. Students can use it to monitor their own progress and residents and faculty can use it to monitor student progress and to provide appropriate feedback.
The progression of student development during the clinical years is probably best conceptualized by the RIME framework. The RIME framework for describing student progress was developed by Dr. Louis Pangaro, an internist and medical education expert at the Uniformed Services University of the Health Sciences. 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. Attributes of each level include:
Reporters can accurately and reliably gather clinical information on each of their patients. Reporters can communicate clearly (both verbally and in writing) the clinical information they have obtained. Reporters are able to distinguish important information from unimportant information and are able to focus data collection and presentation on central issues. It is expected that all students will function as master Reporters (and be transitioning into beginning Interpreters) by the end of the clerkship.
Interpreters are able to identify problems independently and to prioritize problems, including new problems, as they arise. Interpreters are able to develop a differential diagnosis independently and to make a case for and against each of the important diagnoses under consideration for a patient's central problem(s). Helping students make the transition from Reporter to Interpreter is one of the focal efforts of the clerkship. All students are expected to show significant progress in this area; students should continue making progress in this stage during the rest of their 3rd year clerkships.
Managers are able to develop and defend a diagnostic and a therapeutic plan for each of their patients' central problem(s). Managers are able to utilize their growing clinical judgment to decide when action needs to be taken. Managers can analyze the risk/benefit balance of specific diagnostic and therapeutic measures based on an individual patient's circumstances. While some students will acquire sufficient knowledge, skills, and confidence to function as Managers for some of their patients in the latter part of the clerkship, not all will make this transition. The transition from Interpreter to Manager is one of the goals of the fourth year Acting Internship.
Educators have mastered the fundamental skills described above. Educators have the insight to define important questions to research in more depth, the drive to seek out the evidence behind clinical practice, and the skills to scrutinize the quality of this evidence. Educators take a share in educating the rest of the team. The transition from Manager to Educator is usually completed during Internship and Residency.
The RIME model provides a framework and terminology for describing the professional growth of medical students. Students should use it to monitor their own progress and residents and faculty should use it to monitor student progress and to provide appropriate feedback.