The Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review (CLER) Program is pleased to announce the publication of Version 3.0 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 (GME) accreditation requirements. As elements of the CLER Pathways to Excellence migrate to the ACGME 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.
The CLER Evaluation Committee and, ultimately, the ACGME Board of Directors, continually monitor the progress of the CLER Program. Success associated with the CLER Pathways to Excellence is assessed by tracking aggregated data over time and mapping progress along the pathways toward the goal of achieving optimal engagement.
The CLER Pathways to Excellence is intended to accelerate national conversations among educators, health care leadership, policy makers, and patients as to the importance of continually assessing and improving the environments in which the US physician workforce trains, as well as the role of GME in promoting safe, high-quality patient care. Version 3.0 will also serve as the foundation for the fifth CLER protocol that is planned for implementation in 2025.
Version 3.0 Introduces a New Focus Area
This version introduces a new Diversity, Equity, and Inclusion (DEI) Focus Area, which replaces the previous CLER Focus Area of Supervision. This new focus area recognizes that diverse, equitable, and inclusive clinical learning environments are essential to improve patient and learner experiences and achieve equity in health care. The DEI focus area includes 5 pathways for the clinical learning environment (see Table). The Supervision properties were either retired or redistributed as properties of other Focus Areas.
The optimal clinical learning environment commits to strategies, policies, procedures, and practices that are equitable and inclusive of all individuals, regardless of their race, culture, ethnicity, religion, ability, sexual orientation, gender identity, or other dimensions of diversity. To ensure an optimal patient experience and achieve better health outcomes, the clinical site develops, assesses, and monitors its strategies and efforts to promote DEI and improve interprofessional learning.
In all 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 on the ACGME website.1
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Editor’s Note
The ACGME News and Views section of JGME includes data reports, updates, and perspectives from the ACGME and its review committees. The decision to publish the article is made by the ACGME. Portions of this article have been preprinted from CLER Pathways to Excellence: Expectations for an Optimal Clinical Learning Environment to Achieve Safe and High-Quality Patient Care, Version 3.0, with permission.
