Advances in the ACGME Clinical Learning Environment Review (CLER) Program.

The Clinical Learning Environment Review (CLER) program was launched in late 2012 as a key component of the Accreditation Council for Graduate Medical Education's (ACGME's) Next Accreditation System. The goal of CLER is to provide formative feedback to sponsoring institutions (SIs) on the effectiveness of resident and fellow engagement in 6 focused areas (box), with the intent of continually improving institutional performance in these areas.1,2 The CLER program is intended to serve as a foundation for the Next Accreditation System (figure 1). The only accreditation requirement associated with this new program is that each SI must undergo a CLER visit every 18 to 24 months to maintain accreditation. Upon this foundation of formative feedback and continuous improvement of the clinical learning environment rests the continuous accreditation activities for each SI, residency, and fellowship program. These include annual reviews of program data, a required 10-year self-study process, and a 10-year self-study accreditation site visit. FIGURE 1 The Building Blocks or Components of the Next Accreditation System Box Clinical Learning Environment Review Program—Areas of Focus Patient Safety—Opportunities for residents to report errors, unsafe conditions, and near misses and to participate in interprofessional teams to promote and enhance safe care Quality Improvement—How the sponsoring institution (SI) engages residents in reducing health care disparities, and improving patient outcomes Transitions in Care—How the SI demonstrates effective transitions of care Supervision—How the SI maintains supervision Duty Hours Oversight, Fatigue Management, and Mitigation—How the SI demonstrates effective and meaningful oversight of duty hours across all programs; designs systems and provides settings that facilitate fatigue management and mitigation; and provides effective education of faculty and residents in sleep and in recognition and fatigue of fatigue Professionalism—How the SI educates and monitors specific areas of professionalism of its residents and faculty The CLER was established with 2 learning objectives for both ACGME and the graduate medical education (GME) teaching institutions. The first is to learn how to best optimize patient safety and clinical quality in clinical environments where residents and fellows are providing care. The second entails learning how to best prepare physicians-in-training to meet the needs of health care systems in the 6 focus areas. This is relevant to safety and quality of care, both in teaching settings and in the settings where physicians practice after completing their training. Through the CLER program, ACGME proposes to learn from the GME community and to share that learning back with the community. During the past year, the program has undergone initial development (alpha testing) and early deployment (beta testing). A detailed view of the CLER program and site visit protocol has been the subject of an earlier publication.3 The purpose of this article is to provide an update on the CLER program, including some initial observations and insights into upcoming developments for 2014.