When providing narrative comments, please try to utilize the RIME framework.
Reporter: understands what is wrong
Interpreter: understands why it is wrong
Manager: understands how to address the problem
Educator: committed to self-learning and education of team
Click here to learn more about RIME
| Below Expected | Expected | Above Expected | |
|---|---|---|---|
| Focused history and physical exam skills | Extraneous or insufficient information. May miss key physical findings or examine incorrectly. | Generally adequate information. Exam mostly adequate and correct. May not differentiate important from extraneous detail. | Appropriate information for clinical context. Exam complete and appropriately tailored. May include excess detail, but thorough and accurate. |
| Ability to generate a prioritized differential diagnosis | Limited ability to filter, prioritize, and connect information to generate a basic differential based on clinical data and medical knowledge. | Generally able to filter and connect information to generate a basic differential based on clinical data and medical knowledge. Beginning to incorporate data and prioritize. | Reliably synthesizes data into a complete differential. Incorporates data. Prioritizes differential by likelihood. |
| Ability to formulate plan (diagnostic, therapeutic, disposition) | Difficulty applying knowledge to formulate plans or does not offer plan. | Usually able to apply knowledge to formulate plans, though plans may be incomplete/incorrect in some details. | Reliably able to apply knowledge to formulate plans that are complete, appropriate, and tailored to patient needs/desires. |
| Observation, monitoring and follow-up | May not re-evaluate patients or follow up results in a timely fashion. | Usually re-evaluates patients and follows up results, though may need prompting. Beginning to integrate new data into ongoing plan. | Reliably re-evaluates patients and follows up results in a timely manner without prompting. Integrates basic data into ongoing plan, though may need help. Completes tasks despite distraction. |
| Emergency recognition and management | Does not recognize or respond to abnormal vital signs or patient deterioration. Delays or fails to seek help. Unable to recommend stabilization interventions. | Recognizes and responds to most abnormal vital signs but may miss subtle changes. Promptly seeks help. Recommends and/or initiates some basic stabilization interventions. | Reliably recognizes and responds to all vital sign abnormalities and trends. Promptly seeks help. Recommends and/or initiates all basic and some advanced stabilization interventions. |
| Patient- and team-centered communication | Communication with patients and/or team is unidirectional or not tailored to circumstances. May not read or respond to others’ emotions well. May not always attend to patient comfort or preferences. May not always integrate well into team. | Communication with patients and/or team is bidirectional and usually tailored to circumstances. Generally, reads and responds to others’ emotions well. Usually attentive to patient comfort and preferences. Usually integrates well into team | Communication with patients and/or team is bidirectional and reliably tailored to circumstances. Skillful in reading and responding to others’ emotions. Reliably sensitive to patient perspective and preferences. Integrates well into team. |
| Practice-Based Learning and Improvement | May not accept or incorporate feedback. Is not able to identify appropriate electronic resources (e.g. UpToDate). Does not understand evidence-based medicine principles and their application to patient care. | Accepts and incorporates feedback. Limited understanding of evidence-based medicine principles and their application to patient care. Limited application of electronic resources. | Describes basic principles of evidence-based medicine. May perform patient follow-up. Actively seeks and incorporates feedback on shift. Effectively utilizes electronic resources. Effectively utilizes clinical decision rules. |
| Professionalism | May appear to be uncaring or intolerant. Does not respect patient privacy or confidentiality. | Demonstrates behavior that conveys caring, honesty, genuine interest and tolerance when interacting with most patients. Respects patient confidentiality and privacy. | Demonstrates behavior that conveys caring, honesty, genuine interest and tolerance when interacting with a diverse population of patients and families. Maintains patient confidentiality. |
| Systems-Based Practice | Does not recognize medical errors or adverse events. May not understand the need for standards and procedures for a safe working environment. Does not recognize opportunities for health system improvement. Unable to identify the members of the ED team. Does not utilize the EHR to find relevant medical information. | Recognizes when a medical error or adverse event has occurred. Understands the existence of standards and procedures for a safe working environment. Identifies the members of the ED team. Able to utilize the EHR to find relevant medical information. | Reviews EHR and patient medications. Adheres to standards for maintenance of a safe working environment. Describes medical errors and adverse events. Describes members of ED team and their role. |