So now that you've looked at some videos, and tried to judge where a learner might be in the RIME schema, let's think about how you might incorporate this RIME model into your own setting. So, first it's going to be really important to orient both the learners and of course your educators on the RIME method. It's again, it's really important to go over with the student, so, they understand what you're going to be doing with them. And you actually want to use that vocabulary. Again it's very simple. Everybody understands it. And so students will really understand if they know that their attendings are going to be saying, hey, you're at the reporter level, or the interpreter level. It just puts everybody on a level playing field. And really what you want to talk about with your attending physicians, is that the whole purpose of RIME is also to help the learners get to the next level. So if a student or a resident is at the reporter level. You want to give them that feedback, and then talk to them a little bit about how they're going to make that leap to the next level. To do this we have some slides where you can get, actually see using the language. Well, you might think it's a little uncomfortable at first. I want to remind you about the topic of feedback. And what's one of the things that we always say with feedback? You've gotta use that word. This is your feedback. Well it's the same thing with RIME. You actually want to use the language. You want to say, you are functioning at a reporter level. So we're using here a clinical problem that's pretty common should be familiar to anybody no matter what discipline you're in. So let's say you have a learner who reports dysuria, urinary frequency times 3 days. The urine dip is positive for nitrates. Your coaching response would be, that's an excellent report. Now let's interpret those symptoms for me. Let's come up with a differential diagnosis. So again, you're honing in on what they did, that's your evaluation, and how they can get to the next level. An interpreter, remember the interpreter can prioritize begin to use some clinical reasoning, so for this you'd expect their presentation, after they give you the symptoms, they will give you what they think is a possible differential diagnosis and so your couching responses again going to murray that, and say, excellent differential diagnosis,you're functioning at the interpreter stage. Now let's talk a little bit about how you're going to manage this workup. Then your manager, so remember the manager is going to come to you with what they think the assessment is, the plan. And they're going to couch that in what's going to work out for the patient. So their presentation might go along the lines of, I'll send her urine for a microscopic exam and culture. We'll also send specimens to test for sexually transmitted infections. I'm going to treat the patient with drug X for three days. Your coaching response could be along the lines of, that's an excellent plan, good management plan. But why did you choose drug X instead of Y? And why are you going to treat for three days, instead of seven? And finally the educator. And so for this remember that the learner is taking control of the situation, using self-directed learning. Trying to figure things out for themselves, and sharing with the team. So their presentation might entail exactly why they chose the drug that they did, and why they choose to like, that that patient needed to use the drug and your response may be you're on top of the literature, you're able to educate the team on this. Let's get you a more complicated case. There's really some other tips and reasoning behind RIME that's very helpful to know as well. If possible in your setting it's actually really best, for all of those who will be evaluating a student to get together in a group. And talk about the student and where that everybody felt they would be in that RIME sequence. Well, this might take some extra time up front. Remember that it's going to allow you to get better evaluations on your students, and on your learners. When people are together in a group, they tend to sometimes, give a little bit more honest an evaluation. It's also going to allow you to generate a very rich narrative for that student. So how many times have you gotten feedback on a student, and it just says nice job or pleasure to work with. When you have a group discussion about learners, you're able to really get some great examples to give really good feedback to your learners. So in summary, RIME is a very good model for evaluation. It's a little, it's simplistic. The language is understandable to everybody. Learners and attendings understand that vocabulary, and what it means to be a reporter, or an interpreter. Remember again it's best if it, you can do your evaluations as a group, as this has a lot of effect in getting really good narrative summaries for your learners. I hope that you've had a good time doing these past two modules. And hope that you have a great time doing the rest of the course.
