Competency Based Medical Education
The RIME Framework: A Tool For Describing and Monitoring Student Progress
The RIME framework provides terminology for describing the professional growth of PA students. It is used in many medical training programs across the country. Students can use it to monitor their own progress and clinical instructors can use it to monitor student progress and to provide appropriate feedback.
The progression of student development during the clinical year is probably best conceptualized by the RIME framework. The 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, and we have adapted it for use in PA education. 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 didactic year.
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). All students are expected to begin their clinical year primarily at this stage, and to demonstrate significant progress to a manager towards the latter part of the clinical year.
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 earlier in the clinical year, not all will make this transition until the latter part of the clinical year. The transition from Interpreter to Manager is essential during the course of the clinical year.
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 at the very end of the clinical year, though not all students will demonstrate the characteristics of an Educator in all domains.
The RIME model provides a framework and terminology for describing the professional growth of PA students. Students should use it to monitor their own progress and clinical instructional faculty should use it to monitor student progress and to provide appropriate feedback in guiding students’ professional growth in becoming a practicing PA.