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.