The association of student examination performance with faculty and resident ratings using a modified RIME process

BACKGROUND: 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). RIME, as described in the literature, is complemented by residents and attending physicians meeting with a clerkship director to discuss individual student progress, with group discussion resulting in assignment of a RIME stage. OBJECTIVE: 1) to determine whether 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. DESIGN: Prospective cohort study. PARTICIPANTS: Third year medical students from academic years 2004-2005 and early 2005-2006 at 1 medical school. MEASUREMENTS AND MAIN RESULTS: Each attending, resident, and intern independently assessed the student's final RIME stage attained. For the purpose of analysis, R stage=1, I=2, M=3, and E=4. Regression analyses were performed with examination scores as dependent variables (National Board of Medical Examiners [NBME] medicine subject examination and a clinical performance examination [CPE]), with independent variables of mean attending RIME score, mean resident score, and mean intern score. For the 122 students, significant predictors of NBME subject exam score were resident RIME rating (p=.008) and intern RIME rating (p=.02). Significant predictor of CPE performance was resident RIME rating (p=.01). CONCLUSION: House staff RIME ratings of students are associated with student performance on written and clinical skills examinations.