Purpose The most well-studied feedback system used in internal medicine clerkships is the RIME system. RIME is a descriptive framework in which students and their teachers can gauge progress throughout a clerkship from R (reporter) to I (interpreter) to M (manager) to E (educator). The purpose of this project was (1) to see if a student's RIME rating is associated with end-of-clerkship examination performance and (2) to determine whose independent RIME rating is most predictive of a student's examination performance: attendings, residents, or interns.
Methods Students have two 4-week rotations on our general medicine services, working with two to four attendings (usually hospitalists), two residents, and four interns. For academic year 2004-05 and the first third of 2005-06, each attending, resident, and intern independently evaluated the student on a written form at the end of the 4-week block. On the form, each evaluator was asked to circle the RIME stage and its accompanying descriptor that most matched their assessment of the student. For the purpose of analysis, R stage = 1, I = 2, M = 3, and E = 4. The attending, resident, and intern RIME score was the mean score of all of their attendings, residents, and interns, respectively. End-of-clerkship examinations included the NBME Medicine Subject examination and a Clinical Performance Examination (CPE), a 12-station examination using standardized patients. Pearson's correlations assessed the bivariate relationships between the various measures. Regression analyses were performed with the examination scores as dependent variables, with independent variables of mean attending RIME score, mean resident score, and mean intern score.
Results Data were received regarding 122 students. Mean attending RIME rating was 2.86 (SD 0.8), resident rating was 2.87 (0.9), and intern rating was 3.11 (0.8). In regression analyses, significant predictors of NBME subject examination score were resident RIME rating (p = .008) and intern RIME rating (p = .02). Significant predictor of CPE performance was resident RIME rating (F = 6.50, p = .01); intern and attending ratings approached statistical significance (p = .09 and .07, respectively).
Conclusion Housestaff ratings of students using the RIME taxonomy are associated with better student examination performance. These findings suggest that housestaff (including interns) are accurate in their evaluation of student ability, perhaps better than attendings.
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