Using BDA/RIME

Karen Spear Ellinwood, PhD, JD, EdS

Key Concepts

• Clinical Teaching Strategies (BDA, RIME)
• Reflective Feedback Conversations

What is BDA?

• BEFORE, DURING & AFTER patient encounters or other clinical experiences
• Promotes student and instructor reflection on learning/teaching
• Structures your approach to teaching in clinical settings

What is RIME?

• Practice of medicine is the integral performance of (at least) four roles
• Reporter-Interpreter-Manager-Educator
• Describes behaviors, skills & attitudes defining each role
• Guides learner expectations and anchors formative feedback

RIME

BEFORE
Establish or clarify expectations for the learner's role in this clinical encounter

Ask yourself: What do I want the learner to learn or be able to do by participating in this encounter?

Ask yourself: How could the learner participate in the encounter to accomplish this objective?

Ask yourself: How could I support the learner's achievement of the objective?

a Reporter?

An Interpreter?

A Manager?

An Educator?

DURING - Observe performance of role, when possible, and guide as needed

Guidance During Clinical Encounters

• Interrupt, as needed
• Demonstrate HOW
• Explain WHY or Verbalize your thinking process
• Enable PRACTICE
• Confirm COMPREHENSION

AFTER - Invite self-assessment, questions, analysis of how and why, examine team interaction and...

Offer Formative Feedback

ANCHOR feedback to expectations established BEFORE/DURING encounter

Example: If the learner acted as a REPORTER, describe the specific behaviors that demonstrated how the learner performed this role.

EXAMPLE: You did a great job with the patient interview. The patient reported diarrhea, and your exam showed a rash and joint inflammation. You asked about her diet and history of taking iron and calcium supplements. You decided to add lab requests for calcium and iron levels. Your investigation broadened our differential to include Celiac, a plausible cause for all patient's symptoms. (Image, Nephron@wikimedia, copyleft)

Frame feedback as a conversation

Encourage student reflection on expectations, performance & WHAT and HOW to improve

1. INVITE Self-assessment

2. RESPOND with Constructive Compliments & Correction

3. DESCRIBE Specific, relevant observable behaviors and...

4. PROVIDE strategic (actionable) guidance for improvement

Remember: It's a conversation. Invite a reply :)

Untitled Slide

What's helpful?

ACTIONABLE Feedback is helpful.

ACTIONABLE feedback means the student can take action to continue or improve behaviors, skills or knowledge based upon what you have told them.

Ask yourself?

So they can continue effective or improve ineffective behaviors.

Feedback should be HELPFUL - FORMATIVE

References

• Cantillon P, Sargeant J, Teaching Rounds, Giving Feedback in clinical settings. BMJ; November 337 (7681); 2008.
• Ende J. Feedback in Clinical Medical Education. JAMA 250(6); 1983.

References

• Schön D. The reflective practitioner: How professionals think in action. NY:Basic Books; 1983.
• Schute VJ. Focus on Formative Feedback. Review of Educational Research March 78:153-189; 2008.

References

• Hewson M, Little M, Giving Feedback in Medical Education; J Gen Intern Med. 1998 February; 13(2); 1998.
• Pangaro LN. A New Vocabulary and Other Innovations for Improving Descriptive In-Training Evaluations. Academic Medicine 74:11 (November); 1999.

References

• Vacca RT and Vacca JL. Content Area Reading: Literacy and Learning Across the Curriculum. Boston: Pearson Publishers; 2005.

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