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P.R.I.M.E. and its many Uses - A new vocabulary for evaluation in the 21st century

Joseph O. Lopreiato, MD, MPH Professor of Pediatrics

joe.lopreiato@simcen.usuhs.edu

adapted from L. Pangaro MD, USUHS

Background:

Competencies are ACGME defined behaviors expected of finishing residents in the USA.

Competencies are not scary, just a common way of communicating skill acquisition. Each competency is measured along a continuum called milestones.

However, these terms are complex and confusing as descriptors of performance in the hands of all teachers.

Consider:

A new vocabulary aimed at better documenting the competencies that all faculty can recognize, observe and write about.

A new system should have:

Simple phrases that all faculty and learners can remember. Be easy for faculty to observe and write about performance. Be easy for learners to know what the endpoints are during training. Use a common vocabulary to measure progress across rotations and for

learners to gauge progress. Have high reliability and validity.

P.R.I.M.E. and its many uses ? J. Lopreiato MD, MPH Uniformed Services University

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Examples:

What's wrong with our current descriptive system of performance documentation? See for yourself................

Here are some typical examples abstracted from our residency program evaluation forms:

"Needs to work on follow-through of plans, communicating with staff. Will refer to Program Director."

"Very pleasant. Fun to work with. Seemed to enjoy Ped ED setting. Overall, performed as expected."

"Solid FOK, gets the job done."

"Great job. No problems w/ students, staff, patients. Supervised well. Knew his patients. Organized."

"Exceeded all expectations. Very bright and organized."

"Although a likable person, at times he appeared to be confused during the rotation."

"Work on FOK. Did o.k. overall."

"Pleasant. Interested in learning. Performed as expected"

These nonspecific written evaluations lack reliability (based on lack of structure) and are mostly focused on personality rather than performance domains. They reflect the type of comments referenced in the article by Patricia Lye in Ambulatory Pediatrics 2001 1:128-131.

P.R.I.M.E. and its many uses ? J. Lopreiato MD, MPH Uniformed Services University

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A Solution:

Devise a structure of performance domains common to all learners and consistent with the ACGME competencies. One such system had been devised and field tested by Dr. Louis Pangaro, Professor of Medicine at the Uniformed Services University School of Medicine.

The mnemonic "R.I.M.E." was developed by him, to which we have added the additional domain of Professionalism. Therefore the mnemonic become

"P.R.I.M.E.".

Here are the domains of the mnemonic P.R.I.M.E.

PROFESSIONALISM

Did the learner demonstrate Professionalism?

Reliability, Responsibility, Teamwork Respect for patient's values Punctuality Respect for staff and peers Appropriate attire for clinical care Demeanor and Comportment

REPORTER

Is the learner a reliable and honest reporter?

Interviewing skills Physical Examination skills Written Documentation Oral case presentations

INTERPRETER

When given data, can the learner interpret them?

Problem Prioritization Differential Diagnosis formation Interpreting clinical data (Hx,PE,Labs)

P.R.I.M.E. and its many uses ? J. Lopreiato MD, MPH Uniformed Services University

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MANAGER

Can the learner manage patients (or manage a team)?

Management of individual patients Management of a medical team Formulate Diagnostic Plans Formulate Therapeutic Plans Demonstrate Risk/Benefit Decision making Be proficient at Basic Procedures (IVs, etc.) Be proficient at Advanced Procedures Incorporates Patient Values into Medical Plan

EDUCATOR

Does the learner demonstrate educator qualities?

Self-directed Learning Skills Good response to Feedback Critical Reading Skills Teaching Skills with peers and subordinates

PLUS...........

What is needed to reach the next step in their professional development as a physician?

P.R.I.M.E. and its many uses ? J. Lopreiato MD, MPH Uniformed Services University

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Prime is Developmental and Progressive........ it can be

used to measure progress in a learner.......

Aspect of professional growth

MS - III MS - IV Intern

REPORTER

M

Interviewing

M

Physical Examination

M

Written Documentation

P

M

Oral case presentations P

M

INTERPRETER

P

M

Problem Prioritization

M

Differential Diagnosis

P

M

Interpreting Data (Hx,PE,Labs)

I

P

M

MANAGER

I

P

Management of individual

I

P

patients

Management of a medical

I

team

Diagnostic Plans

I

P

M

Therapeutic Plans

I

P

P

Benefit/Risk Decision

I

P

P

making

Basic Procedures (IVs,

I

P

M

etc.)

Advanced Procedures

I

P

Incorporates Patient

I

P

M

Values in Plan

PGY 2+ & beyond

M M P&M M M M

P.R.I.M.E. and its many uses ? J. Lopreiato MD, MPH Uniformed Services University

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