The Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review (CLER) Program is pleased to announce the publication of version 2.0 of CLER Pathways to Excellence: Expectations for an Optimal Clinical Learning Environment to Achieve Safe and High-Quality Patient Care.1 The CLER Pathways, organized according to the 6 CLER Focus Areas (table), serve as a tool to promote discussions and actions to optimize the clinical learning environment. The ACGME presents the CLER pathways as expectations rather than requirements, anticipating that clinical learning environments will strive to meet or exceed these expectations in their efforts to provide the best care to patients and to produce the highest quality physician workforce.
The CLER Pathways to Excellence is designed to continuously evolve, keeping up with the needs of dynamic clinical learning environments. The ACGME's CLER Evaluation Committee, a group that provides oversight and guidance on all aspects of the CLER Program, periodically reviews cumulative data from the CLER site visits, along with emerging research in the 6 Focus Areas, and uses the information to reassess the pathways, revise them as needed, and make recommendations, as appropriate, regarding potential changes to graduate medical education accreditation requirements. As elements of the CLER Pathways to Excellence migrate to the requirements, these elements are removed from future versions of the document and replaced with new areas for exploration. In this manner, the CLER Program serves as a catalyst to continually inform accreditation, while striving for excellence in patient safety and health care quality.
In keeping with this evolution, version 2.0 of the CLER Pathways to Excellence differs from previous versions in that it frames each of the pathways and their associated properties from the health system's perspective. This change recognizes that health care organizations create, and therefore are primarily responsible for, the clinical learning environment. It also emphasizes the importance of the interface between graduate medical education and the hospitals, medical centers, and ambulatory sites that serve as clinical learning environments.
This version also introduces the new CLER Focus Area called “Teaming.” The concept of teaming recognizes the dynamic and fluid nature of the many individuals who come together in the course of providing patient care to achieve a common vision and goals. Teaming recognizes the benefits of purposeful interactions in which team members quickly identify and capitalize on their various professional strengths—coordinating care that is both safe and efficient. In high-performance teaming, team members collaborate and share accountability to achieve outstanding results. “Teaming” replaces the previous CLER Focus Area of “Care Transitions.” The properties from Care Transitions were either retired or redistributed as properties of the other 5 Focus Areas.
In all of its activities, the CLER Program remains committed to continuous improvement toward the goal of optimizing the delivery of safe, high-quality patient care. The CLER Pathways to Excellence is part of the ACGME's efforts to help shape a physician workforce capable of meeting the challenges of a rapidly evolving health care environment. The full document is available at https://www.acgme.org/What-We-Do/Initiatives/Clinical-Learning-Environment-Review-CLER.
