Editor's Note: The ACGME News and Views section of JGME includes data reports, updates, and perspectives from the ACGME and its review committees. The decision to publish the article is made by the ACGME.
The Accreditation Council for Graduate Medical Education (ACGME) recognizes the public's need for a physician workforce capable of meeting the challenges of a rapidly evolving health care environment. The ACGME has responded to this need by implementing the Clinical Learning Environment Review (CLER) program as a part of its Next Accreditation System. The CLER program is designed to provide US teaching hospitals, medical centers, health systems, and other clinical settings affiliated with ACGME-accredited institutions with periodic feedback that addresses the following 6 areas: patient safety, health care quality, transitions in care, supervision, duty hours and fatigue management and mitigation, and professionalism. The feedback provided by the CLER program is designed to improve how these clinical sites engage physician trainees in learning to provide safe, high-quality patient care.
To further the aim of the CLER program, the ACGME has developed the CLER Pathways to Excellence as a tool to promote discussions and actions that will optimize the clinical learning environment. The CLER pathways are designed as expectations rather than requirements. It is anticipated that by setting these expectations, clinical sites that provide training will strive to meet or exceed them in their efforts to provide the best care to patients and train the highest-quality physician workforce.
Patient Safety
PS Pathway 1: Reporting of adverse events, close calls (near misses)
PS Pathway 2: Education on patient safety
PS Pathway 3: Culture of safety
PS Pathway 4: Resident/fellow experience in patient safety investigations and follow-up
PS Pathway 5: Clinical site monitoring of resident/fellow engagement in patient safety
PS Pathway 6: Clinical site monitoring of faculty member engagement in patient safety
PS Pathway 7: Resident/fellow education and experience in disclosure of events
Health Care Quality
HQ Pathway 1: Education on quality improvement
HQ Pathway 2: Resident/fellow engagement in quality improvement activities
HQ Pathway 3: Residents/fellows receive data on quality metrics
HQ Pathway 4: Resident/fellow engagement in planning for quality improvement
HQ Pathway 5: Resident/fellow and faculty member education on reducing health care disparities
HQ Pathway 6: Resident/fellow engagement in clinical site initiatives to address health care disparities
Care Transitions
CT Pathway 1: Education on care transitions
CT Pathway 2: Resident/fellow engagement in change of duty handoffs
CT Pathway 3: Resident/fellow and faculty member engagement in patient transfers between services and locations
CT Pathway 4: Faculty member engagement in assessing resident-related patient transitions of care
CT Pathway 5: Resident/fellow and faculty member engagement in communication between primary and consulting teams
CT Pathway 6: Clinical site monitoring of care transitions
Supervision
S Pathway 1: Education on supervision
S Pathway 2: Resident/fellow perception of the adequacy of supervision
S Pathway 3: Faculty member perception of the adequacy of resident/fellow supervision
S Pathway 4: Roles of clinical staff other than physicians in resident/fellow
S Pathway 5: Patients and families and graduate medical education supervision
S Pathway 6: Clinical site monitoring of resident/fellow supervision and workload
Duty Hours/Fatigue Management and Mitigation
DF Pathway 1: Culture of honesty in reporting of duty hours
DF Pathway 2: Resident/fellow and faculty member education on fatigue and burnout
DF Pathway 3: Resident/fellow engagement in fatigue management and mitigation
DF Pathway 4: Faculty member engagement in fatigue management and mitigation
DF Pathway 5: Clinical site monitoring of fatigue and burnout
Professionalism (Selected Topics)
PR Pathway 1: Resident/fellow and faculty member education on professionalism
PR Pathway 2: Resident/fellow attitudes, beliefs, and skills related to professionalism
PR Pathway 3: Faculty engagement in training on professionalism
PR Pathway 4: Clinical site monitoring of professionalism
Footnotes
Kevin B. Weiss, MD, MPH, is Senior Vice President, Institutional Accreditation, and Co-Chair, Clinical Learning Environment Review (CLER) Evaluation Committee, Accreditation Council for Graduate Medical Education (ACGME); James P. Bagian, MD, is Professor of Anesthesiology and Industrial and Operations Engineering, University of Michigan, and Co-Chair, CLER Evaluation Committee, ACGME; and Robin Wagner, RN, MHSA, is Vice President, CLER, ACGME.
The Clinical Learning Environment Review Pathways to Excellence is reprinted with permission from the Accreditation Council for Graduate Medical Education.
Selected Readings
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