A1.1.

Sponsoring Institution Distribution by Region and Typea

Sponsoring Institution Distribution by Region and Typea
Sponsoring Institution Distribution by Region and Typea
A1.2.

Sponsoring Institution Distribution by Number of ACGME-Accredited Residency and Fellowship Programs and Participating Sitesa

Sponsoring Institution Distribution by Number of ACGME-Accredited Residency and Fellowship Programs and Participating Sitesa
Sponsoring Institution Distribution by Number of ACGME-Accredited Residency and Fellowship Programs and Participating Sitesa

a Percentages do not total 100 because of rounding.

b Limited to 3 Sponsoring Institutions (SIs) in Puerto Rico.

Abbreviations: ACGME, Accreditation Council for Graduate Medical Education; CLER, Clinical Learning Environment Review.

A1.3.

Number and Distribution of Core Faculty Members at Sponsoring Institutions by Specialty Groupinga

Number and Distribution of Core Faculty Members at Sponsoring Institutions by Specialty Groupinga
Number and Distribution of Core Faculty Members at Sponsoring Institutions by Specialty Groupinga
A1.4.

Number and Distribution of Residents and Fellows at Sponsoring Institutions by Gender, Level of Training, and Specialty Groupinga

Number and Distribution of Residents and Fellows at Sponsoring Institutions by Gender, Level of Training, and Specialty Groupinga
Number and Distribution of Residents and Fellows at Sponsoring Institutions by Gender, Level of Training, and Specialty Groupinga

a Percentages do not total 100 because of rounding.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year; SI, Sponsoring Institution.

A2.1.

Clinical Learning Environment Distribution by Type of Ownership and Servicesa,b

Clinical Learning Environment Distribution by Type of Ownership and Servicesa,b
Clinical Learning Environment Distribution by Type of Ownership and Servicesa,b
A2.2.

Clinical Learning Environment Distribution by Beds and Staffing

Clinical Learning Environment Distribution by Beds and Staffing
Clinical Learning Environment Distribution by Beds and Staffing

a Based on the 2015 American Hospital Association Annual Survey.

b Percentages do not total 100 because of rounding.

c Member of Council of Teaching Hospital of the Association of American Medical Colleges.

d Includes psychiatric, rehabilitation, acute long-term care hospital, children's general medical and surgical, and other types of services.

e Missing data < 9%.

f Missing data < 14%.

g Missing data < 25%.

h Physicians, residents, interns, and other trainees omitted from staff count.

I Full-time and part-time personnel only; excludes full-time and part-time equivalent personnel.

Abbreviations: CLER, Clinical Learning Environment Review; IQR, interquartile range; SI, Sponsoring Institution.

a Based on the 2017 Accreditation Council for Graduate Medical Education data.

b Percentages do not total 100 because of rounding.

Abbreviation: SI, Sponsoring Institution.

A4.1.

Selected Characteristics of Residents and Fellows in the Group Interviewsa

Selected Characteristics of Residents and Fellows in the Group Interviewsa
Selected Characteristics of Residents and Fellows in the Group Interviewsa
A4.2.

Selected Characteristics of Faculty Members and Program Directors in the Group Interviewsa,c

Selected Characteristics of Faculty Members and Program Directors in the Group Interviewsa,c
Selected Characteristics of Faculty Members and Program Directors in the Group Interviewsa,c

a Based on audience response system data.

b Missing data (< 2%) have been omitted; percentages based on valid percent.

c Percentages do not total 100 because of rounding.

B1. Percentage of Residents and Fellows Who Reported Experiencing an Adverse Event, Near Miss/Close Call, or Unsafe Condition

Percent of Total Surveyeda (n = 9247)

72.7

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 286)

Distribution Across CLEsc (n = 286)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 241)***

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 241)***

Close modal

a Missing data (< 1%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B2. Percentage of Residents and Fellows Who Reported Experiencing an Adverse Event, Near Miss/Close Call, or Unsafe Condition and Submitted a Report Through the Clinical Site's Reporting System

Percent of Total Surveyeda (n = 6550)

49.8

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 286)

Distribution Across CLEsc (n = 286)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 241)**

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 241)**

Close modal

a Missing data (< 3%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B3. Percentage of Residents and Fellows Who Reported a Near Miss/Close Call Event

Percent of Total Surveyeda (n = 9243)

23.6

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 286)

Distribution Across CLEsc (n = 286)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)***

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)***

Close modal

a Missing data (< 1%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B4. Percentage of Residents and Fellows Who Reported Receiving Feedback on the Outcome of a Report Submitteda Through the Clinical Site's Reporting System

Percent of Total Surveyedb (n = 5388)

46.1

Percentage by Resident and Fellow and CLE Characteristicsb

Percentage by Resident and Fellow and CLE Characteristicsb
Percentage by Resident and Fellow and CLE Characteristicsb

Distribution Across CLEsd (n = 286)

Distribution Across CLEsd (n = 286)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2e,f (n = 240)

Change in Median Between CLER Visits: Cycle 1 and Cycle 2e,f (n = 240)

Close modal

a Report submitted by resident or fellow or through a nurse or supervisor.

b Missing data (< 7%) have been omitted; percentages based on valid percent.

c Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

d Distribution includes 95% or more of the total number of CLEs (N = 287).

e Results based on matched observations; see Methodology (p. 13–18).

f The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B5. Percentage of Residents and Fellows (PGY-3 and Above) Who Reported Participating in an Interprofessional (Physicians, Nurses, Administrators, Others) Investigation of a Patient Safety Event (eg, Root Cause Analysis)

Percent of Total Surveyeda (n = 6796)

37.6

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 280)

Distribution Across CLEsc (n = 280)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 237)*

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 237)*

Close modal

a Missing data (< 4%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B6. Percentage of Residents and Fellows Who Reported Knowing the Clinical Site's Resources to Support Them if Involved in a Major Patient Safety Event

Percent of Total Surveyeda (n = 9199)

82.3

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 284)

Distribution Across CLEsc (n = 284)

Close modal

a Missing data (< 1%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: IQR, interquartile range; PGY, postgraduate year.

B7. Percentage of Residents and Fellows (PGY-2 and Above) Who Reported Knowing the Clinical Site's Priorities in the Area of Quality Improvement

Percent of Total Surveyeda (n = 8942)

78.8

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 280)

Distribution Across CLEsc (n = 280)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 237)**

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 237)**

Close modal

a Missing data (< 2%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B8. Percentage of Residents and Fellows (PGY-2 and Above) Who Reported Participating in a Quality Improvement Project of Their Own Design or One Designed by Their Program or Department

Percent of Total Surveyeda (n = 8931)

78.3

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 280)

Distribution Across CLEsc (n = 280)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 237)*

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 237)*

Close modal

a Missing data (< 2%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B9. Percentage of Residents and Fellows (PGY-2 and Above) Who Reported Participating in a Quality Improvement Project Linked to 1 or More of the Clinical Site's Quality Improvement Goals

Percent of Total Surveyeda (n = 6820)

48.2

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 280)

Distribution Across CLEsc (n = 280)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 237)**

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 237)**

Close modal

a Missing data (< 3%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B10. Percentage of Residents and Fellows (PGY-2 and Above) Who Reported Being Engaged in Interprofessional Quality Improvement Teams (eg, Nurses, Administrators, Pharmacists, etc) While Participating in a Quality Improvement Project Directly Linked to 1 or More of the Clinical Site's Quality Improvement Goals

Percent of Total Surveyeda (n = 3214)

74.3

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 279)

Distribution Across CLEsc (n = 279)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 233)

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 233)

Close modal

a Missing data (< 3%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B11. Percentage of Residents and Fellows Who Reported Receiving Aggregated or Benchmarked Quality Performance Data About the Care of Their Own Patients

Percent of Total Surveyeda (n = 9198)

30.9

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 282)

Distribution Across CLEsc (n = 282)

Close modal

a Missing data (< 1%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; IQR, interquartile range; PGY, postgraduate year.

B12. Percentage of Residents and Fellows Who Reported Knowing the Clinical Site's Priorities With Regard to Addressing Health Care Disparities

Percent of Total Surveyeda (n = 9222)

55.1

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 286)

Distribution Across CLEsc (n = 286)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)

Close modal

a Missing data (< 1%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B13. Percentage of Residents and Fellows Who Reported Receiving Cultural Competency Training Specific to Populations at Risk for Health Care Disparities at Their Clinical Site

Percent of Total Surveyeda (n = 9171)

33.6

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 284)

Distribution Across CLEsc (n = 284)

Close modal

a Missing data (< 2%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: IQR, interquartile range; PGY, postgraduate year.

B14. Percentage of Residents and Fellows Who Reported Participating In a Quality Improvement Project Focused on Reducing Health Care Disparities

Percent of Total Surveyeda (n = 9222)

10.1

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 286)

Distribution Across CLEsc (n = 286)

Close modal

a Missing data (< 1%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: IQR, interquartile range; PGY, postgraduate year.

B15. Percentage of Residents and Fellows Who Reported Participating in Training With Nurses and Other Health Care Professionals in How to Transition Patients' Care

Percent of Total Surveyeda (n = 8940)

61.1

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 275)

Distribution Across CLEsc (n = 275)

Close modal

a Missing data (< 4%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: IQR, interquartile range; PGY, postgraduate year.

B16. Percentage of Residents and Fellows Who Reported Following Standardized Processes for Handling Transitions of Care From Inpatient to Outpatient

Percent of Total Surveyeda (n = 8886)

60.2

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 286)

Distribution Across CLEsc (n = 286)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)***

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)***

Close modal

a Missing data (< 5%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B17. Percentage of Residents and Fellows Who Reported Following a Standardized Process for Handling Transitions of Care During Handoffs Between Shifts

Percent of Total Surveyeda (n = 9193)

82.9

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 286)

Distribution Across CLEsc (n = 286)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 241)***

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 241)***

Close modal

a Missing data (< 1%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B18. Percentage of Residents and Fellows Who Reported Following a Standardized Process for Handoffs Between Shifts That Included a Standardized Written Template for Communication

Percent of Total Surveyeda (n = 7470)

75.6

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 286)

Distribution Across CLEsc (n = 286)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 241)*

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 241)*

Close modal

a Missing data (< 2%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B19. Percentage of Residents and Fellows Who Reported Having Been Placed, or Witnessing One of Their Peers Placed, in a Situation Where They Believed There Was Inadequate Supervision at the Clinical Site (eg, the Attending Was Not Available)

Percent of Total Surveyeda (n = 9212)

26.8

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 286)

Distribution Across CLEsc (n = 286)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)***

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)***

Close modal

a Missing data (< 1%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B20. Percentage of Residents and Fellows Who Reported Encountering a Physician (Attending Physicians or Consultants) Who Made Them Feel Uncomfortable When Requesting Assistance

Percent of Total Surveyeda (n = 9204)

45.9

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 282)

Distribution Across CLEsc (n = 282)

Close modal

a Missing data (< 1%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: IQR, interquartile range; PGY, postgraduate year.

B21. Percentage of Residents and Fellows Who Reported Knowing What They Were Allowed to Do Without Direct Supervision

Percent of Total Surveyeda (n = 9100)

94.0

Percentage by Resident and Fellow and CLE C haracteristicsa

Percentage by Resident and Fellow and CLE C haracteristicsa
Percentage by Resident and Fellow and CLE C haracteristicsa

Distribution Across CLEsc (n = 280)

Distribution Across CLEsc (n = 280)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 239)***

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 239)***

Close modal

a Missing data (< 2%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B22. Percentage of Residents and Fellows Who Reported Having an Objective Way to Know What Procedures Residents and Fellows From Other Services Were Allowed to Do Without Direct Supervision When They Consulted on Patients

Percent of Total Surveyeda (n = 9075)

38.2

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 286)

Distribution Across CLEsc (n = 286)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)**

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)**

Close modal

a Missing data (< 3%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B23. Percentage of Residents and Fellows Who Reported That They Would Power Through to Handoff if Placed in a Situation in Which They Were Impaired by Fatigue, Maxed Out on Caffeine, and a 15-Minute Nap Had No Effect

Percent of Total Surveyeda (n = 9184)

48.1

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 286)

Distribution Across CLEsc (n = 286)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)***

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)***

Close modal

a Missing data (< 1%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B24. Percentage of Residents and Fellows Who Reported That Their Clinical Site Provided a Supportive, Nonpunitive Environment For Coming Forward With Concerns Regarding Honesty in Reporting (eg, Patient Data, Duty Hours)

Percent of Total Surveyeda (n = 9219)

88.1

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 286)

Distribution Across CLEsc (n = 286)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)***

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)***

Close modal

a Missing data (< 1%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B25. Percentage of Residents and Fellows Who Reported They Had Documented a History or Physical Finding in a Patient Medical Record That They Did Not Personally Elicit at the Clinical Site (eg, Copying and Pasting From Another Note)

Percent of Total Surveyeda (n = 9186)

36.4

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 286)

Distribution Across CLEsc (n = 286)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)**

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)**

Close modal

a Missing data (< 1%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

B26. Percentage of Residents and Fellows Who Reported Having Felt Pressured to Compromise Their Honesty or Integrity to Satisfy an Authority Figure During Their Training at the Clinical Site

Percent of Total Surveyeda (n = 9214)

14.6

Percentage by Resident and Fellow and CLE Characteristicsa

Percentage by Resident and Fellow and CLE Characteristicsa
Percentage by Resident and Fellow and CLE Characteristicsa

Distribution Across CLEsc (n = 286)

Distribution Across CLEsc (n = 286)

Close modal

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)

Change in Median Between CLER Visits: Cycle 1 and Cycle 2d,e (n = 242)

Close modal

a Missing data (< 1%) have been omitted; percentages based on valid percent.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) omitted to ensure anonymity.

c Distribution includes 95% or more of the total number of CLEs (N = 287).

d Results based on matched observations; see Methodology (p. 13–18).

e The horizontal line in the middle of the box indicates the median, and the top and bottom of the box indicate the 75th and 25th percentiles, respectively, also known as the interquartile range (IQR). The whiskers above and below the box mark the maximum and minimum values, respectively. The points beyond the whiskers are outliers.

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviations: CLER, Clinical Learning Environment Review; PGY, postgraduate year.

C1. Percentage of CLEs That Tracked the Number of Patient Safety Event Reports Submitted by Residents and Fellowsa

Percentage of CLEs That Tracked Reporting, by CLE Characteristics

Percentage of CLEs That Tracked Reporting, by CLE Characteristics
Percentage of CLEs That Tracked Reporting, by CLE Characteristics

Change Between CLER Visits: Cycle 1 and Cycle 2c (n = 201)***

Change Between CLER Visits: Cycle 1 and Cycle 2c (n = 201)***

Close modal

a Missing data (< 5%) have been omitted; percentages based on valid percent. Of note, data are missing largely due to the development and refinement of a formal written site visit report template in the early stages of program implementation.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) have been omitted to ensure anonymity.

c Results based on matched observations; see Methodology (p. 13–18).

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviation: CLER, Clinical Learning Environment Review.

C2. Percentage of CLEs by Proportion of Nurses' Understanding of Reportable Patient Safety Events

Percentage of CLEs Where Most Nurses Had an Understanding of Reportable Patient Safety Events, by CLE Characteristics

Percentage of CLEs Where Most Nurses Had an Understanding of Reportable Patient Safety Events, by CLE Characteristics
Percentage of CLEs Where Most Nurses Had an Understanding of Reportable Patient Safety Events, by CLE Characteristics

a Results from clinical learning environments (CLEs) in Puerto Rico (1%) have been omitted to ensure anonymity.

C3. Percentage of CLEs Where Residents and Fellows Frequently Submitted Patient Safety Event Reportsa

Percentage of CLEs Where Residents and Fellows Frequently Submitted Reports, by CLE Characteristics

Percentage of CLEs Where Residents and Fellows Frequently Submitted Reports, by CLE Characteristics
Percentage of CLEs Where Residents and Fellows Frequently Submitted Reports, by CLE Characteristics

a Missing data (< 1%) have been omitted; percentages based on valid percent. Of note, data are missing largely due to the development and refinement a formal written site visit report template in the early stages of program implementation.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) have been omitted to ensure anonymity.

C4. Percentage of CLEs by Proportion of Resident and Fellow Knowledge of Basic Patient Safety Terminology and Principles

Percentage of CLEs Where Most Residents and Fellows Had a Working Knowledge of Patient Safety Principles, by CLE Characteristics

Percentage of CLEs Where Most Residents and Fellows Had a Working Knowledge of Patient Safety Principles, by CLE Characteristics
Percentage of CLEs Where Most Residents and Fellows Had a Working Knowledge of Patient Safety Principles, by CLE Characteristics

Change Between CLER Visits: Cycle 1 and Cycle 2b (n = 194)***

Change Between CLER Visits: Cycle 1 and Cycle 2b (n = 194)***

Close modal

a Results from clinical learning environments (CLEs) in Puerto Rico (1%) have been omitted to ensure anonymity.

b Results based on matched observations; see Methodology (p. 13–18).

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviation: CLER, Clinical Learning Environment Review.

C5. Percentage of CLEs by Proportion of Resident and Fellow Knowledge of Basic Quality Improvement Concepts

Percentage of CLEs Where Most Residents and Fellows Had a Working Knowledge of Quality Improvement Concepts, by CLE Characteristics

Percentage of CLEs Where Most Residents and Fellows Had a Working Knowledge of Quality Improvement Concepts, by CLE Characteristics
Percentage of CLEs Where Most Residents and Fellows Had a Working Knowledge of Quality Improvement Concepts, by CLE Characteristics

Change Between CLER Visits: Cycle 1 and Cycle 2b (n = 220)

Change Between CLER Visits: Cycle 1 and Cycle 2b (n = 220)

Close modal

a Results from clinical learning environments (CLEs) in Puerto Rico (1%) have been omitted to ensure anonymity.

b Results based on matched observations; see Methodology (p. 13–18).

Abbreviation: CLER, Clinical Learning Environment Review.

C6. Percentage of CLEs by Proportion of Resident and Fellow Quality Improvement Projects With Components of a Complete Quality Improvement Cycle

Percentage of CLEs Where Most Resident and Fellow Quality Improvement Projects Had Components of a Complete Quality Improvement Cycle, by CLE Characteristics

Percentage of CLEs Where Most Resident and Fellow Quality Improvement Projects Had Components of a Complete Quality Improvement Cycle, by CLE Characteristics
Percentage of CLEs Where Most Resident and Fellow Quality Improvement Projects Had Components of a Complete Quality Improvement Cycle, by CLE Characteristics

a Results from clinical learning environments (CLEs) in Puerto Rico (1%) have been omitted to ensure anonymity.

C7. Percentage of CLEs With Handoff Processes That Were Standardized Across Programs, Based on Direct Observationsa

Percentage of CLEs With Handoff Processes That Were All Standardized, by CLE Characteristics

Percentage of CLEs With Handoff Processes That Were All Standardized, by CLE Characteristics
Percentage of CLEs With Handoff Processes That Were All Standardized, by CLE Characteristics

Change Between CLER Visits: Cycle 1 and Cycle 2c (n = 233)***

Change Between CLER Visits: Cycle 1 and Cycle 2c (n = 233)***

Close modal

a Missing data (< 1%) have been omitted; percentages based on valid percent. Of note, data are missing largely due to the development and refinement of a formal written site visit report template in the early stages of program implementation.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) have been omitted to ensure anonymity.

c Results based on matched observations; see Methodology (p. 13–18).

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviation: CLER, Clinical Learning Environment Review.

C8. Percentage of CLEs by Mechanism Used for Identification of Resident and Fellow Competency to Perform Clinical Procedures, as Reported by Nurses

Percentage of CLEs Where Trust is Primarily Used to Identify Competency, by CLE Characteristics

Percentage of CLEs Where Trust is Primarily Used to Identify Competency, by CLE Characteristics
Percentage of CLEs Where Trust is Primarily Used to Identify Competency, by CLE Characteristics

Change Between CLER Visits: Cycle 1 and Cycle 2b (n = 237)

Change Between CLER Visits: Cycle 1 and Cycle 2b (n = 237)

Close modal

a Results from clinical learning environments (CLEs) in Puerto Rico (1%) have been omitted to ensure anonymity.

b Results based on matched observations; see Methodology (p. 13–18).

Abbreviation: CLER, Clinical Learning Environment Review.

C9. Percentage of CLEs Where Patient Safety and Quality Leaders Recalled Patient Safety Events Related to Resident and Fellow Fatiguea

Percentage of CLEs Where Patient Safety and Quality Leaders Recalled Events, by CLE Characteristics

Percentage of CLEs Where Patient Safety and Quality Leaders Recalled Events, by CLE Characteristics
Percentage of CLEs Where Patient Safety and Quality Leaders Recalled Events, by CLE Characteristics

Change Between CLER Visits: Cycle 1 and Cycle 2c (n = 200)

Change Between CLER Visits: Cycle 1 and Cycle 2c (n = 200)

Close modal

a Missing data (< 1%) have been omitted; percentages based on valid percent. Of note, data are missing largely due to the development and refinement of a formal written site visit report template in the early stages of program implementation.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) have been omitted to ensure anonymity.

c Results based on matched observations; see Methodology (p. 13–18).

Abbreviation: CLER, Clinical Learning Environment Review

C10. Percentage of CLEs Where Residents and Fellows Reported Observing Some Signs of Burnout Among Faculty Members and Program Directorsa

Percentage of CLEs Where Residents and Fellows Reported Observing Signs of Burnout, by CLE Characteristics

Percentage of CLEs Where Residents and Fellows Reported Observing Signs of Burnout, by CLE Characteristics
Percentage of CLEs Where Residents and Fellows Reported Observing Signs of Burnout, by CLE Characteristics

a Missing data (< 7%) have been omitted; percentages based on valid percent. Of note, data are missing largely due to the development and refinement of a formal written site visit report template in the early stages of program implementation.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) have been omitted to ensure anonymity.

C11. Percentage of CLEs Where Executive Leadership Recalled Incidents Concerning Professionalism

Percentage of CLEs Where Executive Leadership Recalled Events, by CLE Characteristics

Percentage of CLEs Where Executive Leadership Recalled Events, by CLE Characteristics
Percentage of CLEs Where Executive Leadership Recalled Events, by CLE Characteristics

Change Between CLER Visits: Cycle 1 and Cycle 2b (n = 229)***

Change Between CLER Visits: Cycle 1 and Cycle 2b (n = 229)***

Close modal

a Results from clinical learning environments (CLEs) in Puerto Rico (1%) have been omitted to ensure anonymity.

b Results based on matched observations; see Methodology (p. 13–18).

* Statistically significant at P < .05.

** Statistically significant at P < .01.

*** Statistically significant at P < .001.

Abbreviation: CLER, Clinical Learning Environment Review.

C12. Percentage of CLEs With Reports of Chronic Disrespectful or Disruptive Behavior Across More Than 1 Clinical Unita

Percentage of CLEs With Reports of Chronic Disrespectful or Disruptive Behavior, by CLE Characteristics

Percentage of CLEs With Reports of Chronic Disrespectful or Disruptive Behavior, by CLE Characteristics
Percentage of CLEs With Reports of Chronic Disrespectful or Disruptive Behavior, by CLE Characteristics

a Missing data (< 2%) have been omitted; percentages based on valid percent. Of note, data are missing largely due to the development and refinement of a formal written site visit report template in the early stages of program implementation.

b Results from clinical learning environments (CLEs) in Puerto Rico (1%) have been omitted to ensure anonymity.