February 11, 2019

The CLER Program: Here's What's Happening in 2019

The ACGME’s Clinical Learning Environment Review (CLER) Program provides US teaching hospitals, medical centers, health systems, and other clinical settings affiliated with ACGME-accredited institutions with periodic feedback on six Focus Areas: Patient Safety; Health Care Quality; Care Transitions; Supervision; Well-Being; and Professionalism.

The feedback provided by the CLER Program is designed to improve how clinical sites engage resident and fellow physicians in learning to provide safe, high quality patient care.

As 2019 revs up, the CLER team (pictured above) thought it was a good time to look ahead at what the CLER Program has lined up for the coming year.

The foundation of the CLER Program is visits to participating sites that occur on an ongoing basis every 24 months (+ 6). At present, the CLER Program is implementing the third version (Protocol 3) of the site visit protocol (a “protocol” in the CLER Program describes the plan that governs the site visit process, including the agenda, composition of group and individual interviews, and questions or areas of inquiry), and for the first time all Sponsoring Institutions, both large and small, are included concurrently. Visits under Protocol 3 will continue through 2019.

Both individual and national reports of findings generated from these visits provide a wealth of information and highlight opportunities to improve both learning and patient care. And GME and clinical learning environment leaders across the country have respondedforming new relationships and testing new ways to integrate residents, fellows, and faculty members into the strategic operations of the hospitals and ambulatory sites that comprise their clinical learning environments. The GME community is beginning to share these new approaches to improving the clinical learning environment through initiatives such as Pursuing Excellence in Clinical Learning Environments and sessions at the Annual Educational Conference—including the CLER Ideas Exchange, Special Topics Discussions, and various sessions presented by the GME community.

New this year, site visit teams are exploring the CLER Focus Area of Well-Being. Specifically, they are examining the role of the clinical learning environment in designing and implementing systems that monitor and support the well-being of residents, fellows, faculty members, and others on the clinical care team. We look forward to analyzing and sharing the results of the findings in this new area!

Also new this year is the roll-out of a sub-protocol (a “sub-protocol” includes all of the elements of the protocol, targeted to a specific area or topic and applied to a sample of the Sponsoring Institutions being visited) for operative and procedural areas—the first of several planned sub-protocols. As with all elements of the CLER Program as a whole, the sub-protocol is anchored in the CLER Pathways to Excellence and addresses all six CLER Focus Areas, with assessment and observations tailored to the settings of these operative and procedural areas.

Not every CLER site visit will include the sub-protocol for operative and procedural areas; it will be included in approximately 10-12 visits per year, and for this initial cycle, the CLER teams will focus on larger Sponsoring Institutions (those with more than 30 ACGME-accredited residency or fellowship programs). The observations and assessments of those observing these areas will be added to those of the principal CLER site visit team so they can share themes that emerge across programs and service areas without identifying any particular departments or service lines. This new information will also be aggregated, and used to inform a national report of de-identified data specific to the operative and procedural areas after the visits are completed.


In 2019, the CLER Program will also field test another new sub-protocol exploring the patient perspective of how clinical learning environments engage residents and fellows in the six CLER Focus Areas. This is a truly exciting development for our work, and we hope you’ll stay tuned for updatesmore to come on this new area!

Beyond the site visits, there is also ongoing work in the areas of analysis, national reports, and development of future directions, including drafting of the CLER National Report of Findings of initial visits to the smaller Sponsoring Institutions (those with one or two core programs) and development of a new Focus Area called Teaming that will debut in the CLER Pathways to Excellence Version 2.0 planned for release in the third quarter of 2019.

We will continue to provide details and updates in future posts throughout the year.