June 2013| ISSUE 6
Using the ORIME Framework for Formative Assessment


By Associate Professor Tham Kum Ying

With Imperial College London as one of our parent universities, it was logical to adopt the United Kingdom General Medical Council Tomorrow’s Doctors  as a basis for LKCMedicine new graduate outcomes. Because Tomorrow’s Doctors describes outcomes in terms of a graduate (i.e. end product of medical school), interim outcomes are needed to guide assessment of student progress, especially during the clinical years. In our search for interim outcomes framework, we were attracted by the Reporter-Interpreter-Manager-Educator (RIME) framework that has been used by the National Healthcare Group (NHG) Residency for formative assessment of residents since 2010. With NHG as LKCMedicine’s primary clinical partner, adoption and expansion of RIME framework for undergraduate interim outcomes followed naturally. The descriptors vis-à-vis Reporter, Interpreter, Manager and Educator are intuitive and self-explanatory, and lend themselves to easy comprehension and use by students and clinical teachers.

While the ability to observe is implicit in the RIME framework, we decided to explicate the “observer-emulator” component because local students are young undergraduates unlike mature graduate medical students in US, from where RIME first originated. Furthermore it is appropriate to remind clinical teachers that students are constantly observing and emulating them. Junior students, for example those in Year 1 and early Year 2 will not have learnt how to take a history or perform physical examination or report such findings, and hence cannot be assessed as Reporter. Instead, junior students often learn by observing and emulating their teachers in key clinical skills for example how to greet a patient, seek permission to start a conversation or be active listeners. Hence making explicit the need for medical students to be keen observers-emulators is important for assessment of Year 1 and 2 students. It also communicates the expectation for medical students to cultivate the ability to observe-emulate as a foundational tenet for life-long learning. Underpinning the ORIME framework are the skills of reflection and critical thinking-evaluation: life-long learning skills that we will nurture in our students from Day 1.