The CLER National Report of Findings 2019: Initial Visits to Sponsoring Institutions With 2 or Fewer Core Residency Programs was released today. This special report, produced by the ACGME’s Clinical Learning Environment Review (CLER) Program, includes initial findings on 270 clinical learning environments of the nation’s smaller Sponsoring Institutions, or those with two or fewer core residency programs. The clinical learning environments featured in this report represent an important segment of the graduate medical education (GME) community, as they often serve the nation’s most vulnerable rural and intercity patient populations.
“With the publication of this initial report of CLER findings focusing on smaller institutions, the ACGME and its Board of Directors, the GME community, and the public have a way of better understanding and improving our nation’s clinical learning environments,” said ACGME President and CEO Thomas J. Nasca, MD, MACP, in his introduction to the report.
One of the biggest lessons learned through these visits to the smaller Sponsoring Institutions is that, overall, clinical learning environments are largely facing the same issues, regardless of size, setting, and other features. As in the 2016 and 2018 CLER National Reports on larger Sponsoring Institutions with more than two core programs, this special report reveals variability across the six CLER Focus Areas of patient safety; health care quality (including health care disparities); care transitions; supervision; fatigue management, mitigation, and duty hours; and professionalism. For example, resident and fellow recognition and reporting of patient safety events into the clinical site’s patient safety event reporting system varied. In addition, clinical learning environments, regardless of size, appear to have similar challenges with regard to GME engagement in transitions of care and professionalism.
“To date, the CLER site visit findings shine an important light on how residents and fellows learn in the context of delivering patient care in dynamic health care systems,” said Kevin B. Weiss, MD, ACGME Chief Sponsoring Institutions and Clinical Learning Environment Officer. “The CLER Program will continue to explore new opportunities to provide the nation’s clinical learning environments with information they can use to simultaneously optimize learning and patient care.”
A Look Ahead
The CLER Program will continue to remain formative and entirely separate from the accreditation function of the ACGME.
Going forward, the CLER Program will present findings from both larger and smaller Sponsoring Institutions in a single biennial report. This will allow the CLER Program to streamline its site visit operations, as well as explore the findings as they apply to all institutions, regardless of size and setting. The next report will explore teaming and include insights from subprotocols on operative and procedural areas and the patient perspective.