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Construct Validity of the Reporter-Interpreter-Manager-Educator Structure for Assessing Students Patient Encounter Skills

Tolsgaard, Martin G. MD; Arendrup, Henrick MD; Lindhardt, Bjarne O. MD, DMSc; Hillingsø, Jens G. MD, PhD; Stoltenberg, Michael MD, PhD; Ringsted, Charlotte MD, MHPE, PhD

Academic Medicine:
doi: 10.1097/ACM.0b013e318253c8be
Patient Management Skills

Purpose: The aim of this study, done in Denmark, was to explore the construct validity of a Reporter-Interpreter-Manager-Educator (RIME)-structured scoring format for assessing patient encounter skills.

Method: The authors developed a RIME-structured scoring form and explored its construct validity in a two-step procedure. The first step (implemented in 2009) was a randomized, controlled, experimental study in which the performance of three groups (16 fourth-year medical students, 16 sixth-year medical students, and 16 interns) was assessed in two simulated patient encounters. The second step (carried out during 2009–2010) was an observational study of patient encounter skills where clinician examiners used the scoring form in end-of-clerkship oral examinations of three consecutive cohorts of a total of 547 fourth-year medical students.

Results: In the experimental study, RIME scores showed significant difference between the three groups—fourth-year students, mean 41.7 (standard deviation [SD] 11.0); sixth-year students, mean 48.2 (SD 10.9); and interns, mean 61.9 (SD 8.5), one-way ANOVA, P < .0001—and showed a progression over the four RIME elements with participants’ increasing competence.

In the observational study, the mean RIME score was higher (83.8 [SD 15.5]), and advanced RIME levels were frequently missing or scored “not relevant” by the clinician examiners.

Conclusion: In an experimental setup, the RIME structure demonstrated construct validity in terms of reflecting progress in competence in managing patient encounters when assessed according to an advanced criterion. However, clinician examiners may tacitly score the elements according to what can be expected at a certain level of student experience.

Author Information

Dr. Tolsgaard is research fellow, Centre for Clinical Education, Rigshospitalet, Copenhagen, Denmark.

Dr. Arendrup is associate professor and consultant surgeon, Department of Thoracic Surgery, Rigshospitalet, Copenhagen, Denmark.

Dr. Lindhardt is associate professor and chief physician, Department of Pulmonary Medicine and Infectious Disease, Hillerød Hospital, Hillerød, Denmark.

Dr. Hillingsø is associate professor and head, Department of Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark.

Dr. Stoltenberg is associate professor and consultant physician, Department of Rheumatology, Køge Hospital, Køge, Denmark.

Dr. Ringsted is professor and director, Centre for Clinical Education, Rigshospitalet, Copenhagen, Denmark.

Correspondence should be addressed to Dr. Tolsgaard, Centre for Clinical Education, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; telephone: (+45) 61303072; e-mail:

© 2012 Association of American Medical Colleges