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CLER Identifies Consistency with Top Priorities

The Accreditation Council for Graduate Medical Education (ACGME) has established, as a component of its next accreditation system, the Clinical Learning Environment Review (CLER) program to provide frequent on-site sampling of the graduate medical education learning environment. The CLER site visit is used primarily to provide feedback, learning and baseline assessments, and to provide the opportunity for the institutions to demonstrate leadership in patient safety and quality improvement.

On March 18-19, the UT Graduate School of Medicine and The University of Tennessee Medical Center participated in their first CLER site visit. During the visit, two ACGME representatives met with administration of the medical center, the deans of the Graduate School of Medicine, faculty members, program directors, resident and fellow representatives, and staff members in the hospital and clinics. The reviewers also observed four live resident handoffs that demonstrated transitions of patient care.

Preliminary feedback from the site visit identified areas of both consistency and variability across the institution in six focus areas pertinent to residents and fellows: Patient Safety, Health Care Quality, Transitions of Care, Supervision, Duty Hours and Fatigue Management, and Professionalism. Points of consistency included the medical center’s top patient safety priorities for injury-related falls prevention, central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and standardization through the clinical care pathways. Variability assessment identified among other issues, the need for better reporting of near misses and the standardization of handoffs using EMR.

From this experience, leaders of the Graduate School of Medicine and medical center have identified opportunities for improvement and have begun the process of strategically addressing how the institution can both educate high quality physicians and deliver the best patient care.

William Metheny, PhD, Assistant Dean of Graduate Medical and Dental Education, said, “This CLER visit provides a baseline for our progress in addressing these opportunities for improvement. Our thanks to all the participants, especially the residents and fellows.”

A final written report of CLER findings from the ACGME will be available in six to eight weeks.

Posted April 7, 2014