CLER Site Visit

The CLER Program is designed to provide US teaching hospitals, medical centers, health systems, and other clinical settings affiliated with ACGME-accredited Sponsoring Institutions with periodic feedback that addresses the following six areas: patient safety; health care quality; teaming; supervision; well-being; and professionalism.

To accomplish this, the ACGME conducts CLER site visits to the hospitals, medical centers, and other clinical settings of accredited institutions that sponsor residency and fellowship programs. During these visits, CLER Field Representatives meet with the executive leadership of the organizations; the organization’s leaders in patient safety, health care quality, and well-being; leaders of graduate medical education (GME); and groups of residents and fellows, faculty members, and program directors. Additionally, the CLER team visits various patient floors, units, and service areas to gather input from the broader range of clinical staff members as to how the organization functions as a learning environment.

At the conclusion of each visit, the CLER team meets with the organization’s executive leadership to share its observations of resident and fellow engagement in the six CLER Focus Areas. It is through this feedback that the ACGME seeks to improve both physician education and the quality of patient care within these organizations.

The Patient Perspective Subprotocol, which assesses the clinical learning environment from the patient perspective as related to the six CLER Focus Areas, was introduced during the CLER Program's Cycle 4 visits. A webinar that describes this subprotocol's design and features information on key logistics for site visits is now available.

Click here to access the webinar

CLER Site Visit Scheduling

The CLER site visits are short-notice visits (no fewer than 10 days’ notice) and the Sponsoring Institution’s designated institutional official (DIO) is the primary contact. The CLER Field Representatives will visit one participating site per Sponsoring Institution. However, the site visitors may elect to go to more than one location at that site, especially if there are ambulatory clinical or specialty facilities within walking distance.

As part of the scheduling process, the Sponsoring Institution will be asked to confirm that both the DIO and the Chief Executive Officer of the participating site will be available to attend required opening and closing meetings. If a visit cannot be confirmed within 24 hours of contact, the Sponsoring Institution will receive a “pass.” The CLER team will make up to four attempts to schedule the visit (total of three passes allowed). Failure to accomplish a CLER site visit within the allotted number of attempts will result in a recommendation to the ACGME Board of Directors to confer upon the Sponsoring Institution the status of Administrative Probation ACGME policy 16.61.

CLER Blackout Weeks

The designated institutional official (DIO) and chief executive officer (CEO) of the clinical site being visited must be available to participate in an initial and exit meeting for the CLER visit. CLER blackout weeks are intended to optimize scheduling of CLER visits by avoiding, when possible, dates when institutional leaders and staff members are unavailable (e.g., due to retreats, holidays observed by the institution, local holidays, board meetings). When selecting blackout weeks, check with the CEO of the clinical site to be visited to identify known dates of unavailability.

Common Questions and Useful Information about Entering CLER Blackout Weeks

What are CLER blackout weeks?
The CLER Program established blackout weeks to facilitate success in scheduling CLER visits. To confirm a CLER visit, the designated institutional official (DIO) and chief executive officer of the site being visited must be available to participate in an initial and exit meeting. The blackout weeks are intended to inform CLER Program staff members so they can avoid scheduling CLER visits for dates when institutional leaders are unavailable.

Who can request blackout weeks?
During specific windows of time at key points in the year, DIOs and/or institutional coordinators are granted access in the ACGME’s Accreditation Data System (ADS) to enter requests for blackout weeks for a particular timeframe.

How does one request blackout weeks?
To request blackout weeks, DIOs and/or institutional coordinators need to log into ADS and click on the “CLER” tab on the right side of the top banner. From there, scroll down to the bottom of the CLER page to find the Blackout Dates Maintenance section; click on the “Blackout Dates” button to view the calendar to identify and select blackout weeks for the institution.

Where does one go to log into ADS?
Log into ADS from the link in the top right-hand corner of the ACGME website or via this direct link: https://apps.acgme.org/connect/. Users need to be logged in with either their DIO or institutional coordinator credentials, as these provide access to the blackout weeks calendar.

Are requested blackout weeks guaranteed?
Blackout weeks are not guaranteed. The CLER Program staff will make every effort to accommodate requests, but DIOs may still be contacted for site visits during requested blackout weeks.

Who should institutions contact with questions about blackout weeks?
Email CLER@acgme.org.

Do all Sponsoring Institutions have to enter blackout weeks?
No, only Sponsoring Institutions with a status of Continued Accreditation, Continued Accreditation with Warning, Continued Accreditation without Outcomes, and Probationary Accreditation are eligible for a CLER visit and have the opportunity to enter in blackout weeks. Sponsoring Institutions with a status of Initial Accreditation are not eligible for a CLER visit, and therefore do not need to enter blackout weeks.

If a Sponsoring Institution recently had a CLER visit or is currently scheduled for an upcoming visit, does the DIO or institutional coordinator need to enter in blackout weeks when a notification of open windows for submitting requests is sent out?
The soonest an institution’s next CLER visit could occur would be 18 months after its previous visit. Make note to resume entering blackout weeks when the windows cover a time period that is 18 months or later from the date of the last CLER visit.

Can an institution request a single date to be blacked out rather than a full work week?
No, blackout weeks must be entered in as full work weeks.

What if the “CLER” tab on the top banner isn’t visible when logged into ADS?
Users who don’t see the CLER tab might be logged in with the wrong credentials. Only DIOs and institutional coordinators have access to the CLER tab and the ability to enter in blackout weeks. Individuals in dual roles of program coordinator and institutional coordinator should ensure they are logged in with their institutional coordinator login credentials. Email ADS@acgme.org for assistance obtaining these login credentials.

For a Sponsoring Institution that is part of a larger health care system; which is the appropriate CEO to have in attendance at the CLER visit?
Email any questions about the appropriate CEO to have in attendance for a CLER visit to CLER@acgme.org.

How often do Sponsoring Institutions have the opportunity to enter blackout weeks?
Sponsoring Institutions have the opportunity to enter up to four blackout weeks during four different times per year, for a total of 16 annual blackout weeks. Below is a full year’s blackout week schedule:

• From January 1-26: Submit blackout week requests for April, May, and June
• From April 1-26: Submit blackout week requests for July, August, and September
• From July 1-26: Submit blackout week requests for October, November, and December
• From October 1-26: Submit blackout week requests for January, February, and March the following year

Are there any days that CLER visits are already not scheduled during the calendar year?
The CLER Program will avoid scheduling visits on these days each year; for single day holidays, visits may still occur during the week

• New Year’s Day (observed)
• Martin Luther King Jr. Day
• Memorial Day
• The last week of June
• The week of Independence Day (observed)
• Labor Day
• Thanksgiving day and the day after
• Christmas Day (observed)
• The week between Christmas and New Year's Day

These dates are automatically blacked out in ADS and will be listed in the blackout calendar as “ACGME Unavailable.”

Email questions to the CLER Program.