Evaluation, grading, and use of the RIME vocabulary on internal medicine clerkships: Results of a national survey and comparison to other clinical clerkships

Background: Evaluation methods within and across clerkships are rapidly evolving, including greater emphasis or frameworks for descriptive evaluation and direct observation of competence. Purpose: The purpose of this study is to describe current evaluation methods, use of the Reporter-Interpreter-Manager/Educator (RIME) framework, and grade assignment by internal medicine clerkship directors. Methods: In 2005, the Clerkship Directors in Internal Medicine surveyed its 109 institutional members. Topics included evaluation methods and grade contribution, use of evaluation sessions and/or RIME, and grade assignment (criterion referenced or normative). Results: Response rate was 81% (88/109). The evaluation methods were as follows: teachers' evaluations, 93% (64% of grade); National Board of Medical Examiners subject examination, 81% (25% of grade); faculty written exam, 34% (14% of grade); objective structured clinical examinations, 32% (12% of grade); direct observation, 22% (7% of grade). RIME is used by 42% of respondents. Many clerkship directors (43%) meet with teachers to discuss student performance. Criterion-referenced grading is used by 59%, and normative grading is used by 27%. Unsatisfactory grades are given for examination failures (72%), unprofessional behavior (49%), poor clinical performance (42%), and failure to meet requirements (18%). Conclusions: Internal medicine clerkship directors emphasize description and observation of students. RIME and discussions with teachers are becoming commonplace.