Resident Expectations

Grading Guidelines and Expectations with the RIME Method

These guidelines are a construct; one way to conceptualize how we are evaluating trainees over the course of time. They compliment but do NOT replace the grading competencies found in the Residency Handbook and Curriculum book.

If you don’t understand something, ask questions. We would rather teach something 3 times to be sure you “get it” than to only do it once and make dangerous assumptions that you understand what’s going on with your patients.

R-I-M-E

(in progressively successful fashion) with expectations for the trainee at each level. You cannot move on to the next level until you have mastered the previous one.

Reporter

1. accurately gather information about your patients, through an independent history and physical examination, chart review, and from other sources such as family or referring physicians
2. use appropriate terminology to clearly communicate your findings, both orally and in writing
3. interact professionally with patients and staff
4. consistently and reliably carry out your responsibilities

This stage requires that trainees have an adequate knowledge base, the basic skills to perform fundamental tasks, and core attributes of honesty, reliability, and commitment.

Trainees who are Reporters can answer the “What” questions about their patients.

MS III’s should be at this level and moving on.

Interpreter

1. demonstrate ability to identify and prioritize problems independently
2. offer three reasonable explanations for new problems
3. generate and defend a differential diagnosis

This step requires a greater knowledge base, increased confidence and skill in selecting and applying clinical facts to a specific patient, and the ability to begin to pose clinical questions.

Interpreters organize, prioritize, synthesize, and interpret problems.

Trainees who are Interpreters can answer the “Why” questions about their patients.

This is the level of an excellent MS III, a decent MS IV and an average intern.

Manager

1. be more “proactive”, suggest diagnostic and therapeutic plans that include reasonable diagnostic options and possible therapies.

This step takes even greater knowledge (you need to read more), more confidence, and the skill to select interventions for an individual patient (know when to ask for help and consult other specialists).

Managers understand their patients' needs and desires and can enter into “relationship-centered care”.

This is where interns are expected to be by the end of the rotation, and the level at which residents need to be performing at a minimum to pass the rotation.

Educator

1. “master” the ability to be a Manager
2. Identify questions related to patients that cannot be answered from textbooks
3. Cite evidence that new or alternative therapies or tests are worthwhile, and share their acquired knowledge with other members of the health care team
4. Possess the desire and ability to educate oneself and others not only to teach colleagues but also, and most importantly, to help your patient.

A Manager/Educator answers the “How” questions, for themselves, and their patients.

It is not simply a matter of “bringing in articles to the team.”

This is where we would ideally see all senior residents in the ICU; although we realize not everyone is capable of this level of functioning in such a complex environment.