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Commentary: The RIME/EMR scheme: an educational approach to clinical documentation in electronic medical records


This commentary utilizes an existing framework and modifies it to include EMR specific competencies based on the authors’ knowledge and research in the field. The Reporter-Integrator-Manager-Educator (RIME) scheme provides terminology to describe the professional growth of medical students and residents, and was adapted in this work to describe how to teach trainees to document & communicate in a clinical setting using EMRs (the RIME/EMR scheme).


The first stage involved accurate entry of directly observed findings into the EMR, without relying on preformed checklists or copy-paste functions. Integrator. At this stage, students assimilate clinical data within the EMR to create accurate summary problems lists, used to develop clinical assessments. Manager. Successful managers use EMRs to articulate a safe, logical, and accurate therapeutic plan, request necessary consultations, tests, etc. using EMR-specific functions. Educator. Learners are able to appropriately use available clinical decision support tools. EMR-specific skills continue to complement clinical skills to promote safe and effective care.


With the growth of EMR use, it is necessary to gauge the ability of students and residents to use EMRs as they leave the educational environment to pursue independent practice. The RIME/EMR scheme is a way to systematically structure expectations for use of EMRs by medical trainees in the context of the Accreditation Council for Graduate Medical Education core educational competencies.


For institutions already employing the RIME scheme to assess student and resident progress through medical education, this can be a very useful and non-intrusive way to structure EMR introduction into the curriculum. However, reference to existing research on why particular EMR competencies and skills are important and evidence to back up the inclusion of each EMR skill (creation of summary problem lists, use of decision support etc.) is sparse. In part, this is due to a scarcity of available literature. Nonetheless, the authors seemingly rely more on common sense to produce these recommendations than on evidence-based research. 4/5 checks on CHEC. See PDF for more information on criteria for evaluation.