CLINICAL LEARNING ENVIRONMENT REVIEW (CLER) Duke Graduate Medical Education Prepared by: Catherine M. Kuhn MD & Alisa Nagler JD, EdD KEY POINTS CLER is a component of the ACGME Next Accreditation System (NAS) CLER is intended to provide feedback to the institution and encourage resident/fellow engagement in providing safe, high quality patient care The CLER Pathways to Excellence document* notes the 6 pathways & 89 properties of an ideal institution that can be achieved through joint efforts of trainees, GME leaders, health system executives, and hospital leaders CLER emphasizes the importance of inter-professional teams in addressing the six focus areas “CLER visit is built on model of continuous quality improvement. Its purpose is to evaluate, encourage, and promote improvements to the clinical learning environment.” * Six CLER Focus Areas: Resident Meeting Core Faculty Meeting Program Director Meeting Initial Meeting Exit Meeting w/DIO, CEO, CMO, CSO, GMEC Chair w/DIO, CEO, CMO, CSO, GMEC Chair Foundational Learning Walk Around Walk Around Exploration & Inquiry Walk Around 1. 2. 3. 4. 5. Patient Safety Quality Improvement Transitions of Care Resident Supervision Duty hour oversight & Fatigue Management 6. Professionalism Review, Clarify & Feedback CLER SITE VISIT FLOW What is your program doing to teach and evaluate each of these 6 areas? PRACTICAL TIPS Review the CLER Pathways to Excellence (Executive Summary) document Recognize how your program teaches and assesses resident performance in the six CLER focus areas. ASK your GME Program Director if you don’t know! Be ready and available to participate in a CLER visit IN GENERAL - WHAT TO EXPECT FROM A CLER VISIT The institution receives approximately two weeks notice before a CLER visit ACGME CLER field representatives (2-3 individuals) will visit the institution for approximately 2 days CLER team meets with executive leaders including Chief Executive Officer, Chief Medical Officer, Chief Nursing Officer, leaders in patient safety, informatics, GME leaders, program directors, core faculty and residents/fellows CLER teams visit patient floors and service areas gathering input from staff and patients on the learning and patient care environment, with resident/fellow ambassadors accompanying them The CLER team interviews groups of Program Directors, Core Faculty and Residents/fellows separately and uses an Audience Response System to gather responses from participants At the end of the visit, CLER team meets with the institution’s executive leaders to share its observations. A written report follows in 6-8 weeks. WHAT YOU SHOULD DO BEFORE AND DURING A CLER VISIT Hospital Leaders IN PREPARATION Review CLER Pathways document Assist in distributing information and details related to CLER visit Identify health system priorities regarding disparities in care Support chairs/PTDs with clinical schedule adjustments as needed DURING Be available for CLER team meetings Share information about how the health system provides safe, high-quality care with trainee involvement Core Faculty Residents & Fellows IN PREPARATION Review CLER Pathways document Identify how your program is teaching/assessing 6 focus areas above Consider what the institution provides regarding the 6 areas Understand what being a core faculty member means IN PREPARATION Review CLER Pathways document Consider how your program is teaching & assessing the 6 focus areas above Know whether you have been peerselected to meet with the site visitors Program Directors IN PREPARATION Educate core faculty and residents/faculty on purpose and process for CLER Consider how your program is teaching/assessing 6 focus areas and share with residents and faculty Review CLER Pathways document DURING Advertise QI initiatives (e.g. display posters) Support core faculty and residents to meet with the CLER team Be available for PTD meetings DURING Be available for CLER team meetings Be prepared to share stories about supervision and training of residents Share examples of teamwork and patient safety DURING Be available for CLER team meetings Be prepared to share stories of how you work in teams Be prepared to share stories of patient safety and quality activities RESOURCES ACGME - CLER Pathways to Excellence http://www.acgme.org/acgmeweb/Portals/0/PDFs/CLER/CLER_Brochure.pdf ACGME – CLER Website http://www.acgme.org/acgmeweb/tabid/83/'/acgmeweb/tabid/436/ProgramandInstitutionalAccreditation/NextAccreditationSystem/ClinicalLearningEnvironmentReviewProgram.aspx Weiss, KB, et al. "Advances in the ACGME Clinical Learning Environment Review (CLER) Program." Journal of graduate medical education 5.4 (2013): 718-721. Weiss, KB, Wagner, R and Nasca T. "Development, testing, and implementation of the ACGME Clinical Learning Environment Review (CLER) program." Journal of graduate medical education 4.3 (2012): 396-398.
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