How Do I Progress from Pass to Honors?

Students often ask us what distinguishes an "honors" student from a "pass" student. The development of skills by students throughout their medical education is probably best conceptualized by understanding the R.I.M.E. schema.

This scheme defines a "framework and terminology for describing the professional growth of medical trainees, especially students"(1).

It uses the following terminology:

R = Reporter
I = Interpreter
M = Manager
E = Educator

This scheme was initially proposed by Louis Pangaro, M.D., an internist at Uniformed Services University of the Health Sciences, and is now used in many clerkships and residencies across the country (2). Its purpose is to "articulate a clear, cogent and concise vocabulary of expectations" (1). The descriptions and requirements for each stage of development are outlined. It is expected that the average student will function as a Reporter and beginning Interpreter by the completion of the third year of medical school.

Reporter

Accurately gathers and communicates the clinical facts on his/her patients

Requires:

Skills: basic history and physical exam, communication, distinguish normal from abnormal, identify problems
Knowledge: enough to know what to look for
Attitude: rapport, reliability, responsibility, organization

Interpretor

Prioritizes patient problems, offers differential diagnosis, interprets laboratory tests

Requires:

Skills: select most important features of a patient's presentation, apply test results to specific patient, better communication than at reporter stage
Knowledge: more than at reporter stage
Attitude: more active participation in patient care

Manager

Proposes and selects from diagnostic and therapeutic options for patients, taking into account patient circumstances and preferences

Requires:

Skills: more problem solving skills (analyze risks/benefits, incorporate patient values), better "clinical judgment"
Knowledge: more knowledge (anticipate consequences of diagnostic/therapeutic decisions)
Attitude: more "professional" relationship with patient, confidence

Educator

Goes beyond the basic requirements, defines questions to research in more depth, looks for evidence to answer these questions, shares in responsibility for teaching the team

Requires:

even better ability to identify important aspects of a case, development of new skills (self directed learning, critical appraisal, teaching)

More information on "How does that translate to my grade?"

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