During medical school, the RIME framework is used to assess the progression in the educational process as the student moves from the most basic role of gathering and reciting information as the Reporter, to an Interpreter of the information utilizing skills to prioritize problems. Towards the end of medical school and during the intern year, the same student hopefully achieves the status of Manager by synthesizing the problems into a coherent plan for the patient. By the end of residency, the student should have mastered these clinical skills and become an Educator, passing these skills along to others on the team.
This model has been widely accepted yet the clinical reasoning process and the methods by which these skills might be imparted to other students has not been as well defined. Dr. Judith Bowen offers an excellent take on the delivery of this information, methods to assess clinical reasoning, and ways for the educator to facilitate the clinical experience so as to provide excellent patient care and produce an articulate problem-focused presentation. She highlights elements of the Clinical Diagnostic Reasoning Process, use of Illness Scripts, and examples of Diagnostic Hypotheses for various disease processes. Furthermore, she identifies ways to diagnose the learner’s skills and areas of weakness in clinical reasoning while offering strategies to “treat” the deficient skill. The article was published in NEJM in 2006 and is titled, Educational Strategies to Promote Clinical Diagnostic Reasoning. The review is pertinent for all levels of training but especially useful for residents and faculty to use with their team of interns and medical students to facilitate growth during rotations.