ACGME Releases New Clinical Learning Guidance to Transform How Medical Residency Programs Prepare Future Physicians for a Changing Health Care System

Jan 27, 2014, 09:00 ET from Accreditation Council for Graduate Medical Education

WASHINGTON, Jan. 27, 2014 /PRNewswire-USNewswire/ -- The Accreditation Council for Graduate Medical Education (ACGME) today released new guidance for graduate medical education in US teaching hospitals and medical centers. This effort creates the framework to reshape the clinical environments in which tomorrow's doctors learn to deliver quality patient care and respond to rapid developments in health care delivery.

Summarized in a paper published in the January 27, 2014 online edition of the New England Journal of Medicine and announced to health care leaders at a policy forum in Washington, DC, the ACGME's new guidance – called the Clinical Learning Environment Review (CLER) Pathways to Excellence – represents a roadmap for the  approximately 700 accredited institutions and their 9,000 medical residency and fellowship programs across the country to improve resident and fellow physicians' skills in addressing issues of patient safety and health care quality as an essential component of modern medical practice. The ACGME will also use the Pathways to Excellence framework as the foundation for issuing periodic reports on the performance of graduate medical education (GME) programs in preparing the physician workforce in patient safety and quality improvement.

"The release of the CLER Pathways to Excellence document marks an important step in the delivery of patient care by providing teaching hospitals, medical centers, and clinics with a framework to create better learning environments, or 'pathways,' that advance the learning outcomes of resident and fellow physicians and seek to improve the safety and quality of care that patients receive," said Thomas J. Nasca, MD, MACP, chief executive officer of the ACGME. "Building a cadre of young physicians who have the clinical skills to practice medicine in an increasingly complex health care system is the ACGME's top priority."

Launched in conjunction with the transition to the Next Accreditation System, the Clinical Learning Environment Review (CLER) program is an ongoing initiative to assess the learning environment at each accredited teaching institution. As a critical component of this initiative, the CLER Pathways to Excellence document is intended as a guide of ways to improve physician education in the patient care environments in which residents and fellows learn, and as such:

  • incorporates findings from over 100 site visits conducted in 2013, and input from national focus groups involving designated institutional officials (DIOs) and chief medical officers (CMOs) from GME teaching hospitals, medical centers, and clinics from across the country
  • defines the expectations for an optimal clinical learning environment to deliver high quality and safe patient care while seeking to educate our nation's new physicians
  • lays out the "pathways" for teaching hospitals, medical centers, and clinics to improve resident and fellow physician engagement in six core areas: patient safety; health care quality; care transitions; supervision; duty hours, fatigue management and mitigation; and professionalism
  • provides tools for institutions to monitor their progress over time and prioritize areas for future improvement

"Support for education in systems-based practice requires stewardship at the highest level of leadership within each teaching hospital, medical center, and clinic," said Kevin B. Weiss, M.D., ACGME senior vice president, Institutional Accreditation, who oversees the CLER program. "CLER is defining expectations for an optimal clinical learning environment for graduate medical education and providing the tools so our teaching institutions will usher in a system of physician education that can rapidly adapt to new knowledge and technology and is responsive to the public's needs."

New Framework is Complement to the Ongoing Evaluation of GME Institutions

The Pathways to Excellence framework is the latest development in the national rollout of the CLER program, initiated in 2012 to improve the learning environment for educating over 117,000 medical resident and fellow physicians at teaching hospitals and academic medical centers.

Intended to generate national data on the program and institutional factors that advance both graduate medical education and quality patient care in teaching institutions, the CLER program consists of three related activities:

  • The CLER Site Visit – scheduled to occur on an ongoing basis every 18-24 months to assess the clinical learning environments where graduate medical education occurs

  • The CLER Evaluation Committee – involving a range of regional and national experts in patient safety, health care quality, fatigue management, and GME, who review the data from the CLER visits, set expectations for the six focus areas of physician education, and give formative feedback

  • Support for faculty and leadership development at teaching hospitals, medical centers, and clinics – where the ACGME, in collaboration with other key organizations, provides resources to educate and support faculty and executive leadership across the six focus areas

"The CLER Pathways to Excellence will serve as both a tool to support discussions and activities at the clinical site and as a framework for structured feedback from the CLER visits," said Weiss.

The new Pathways framework was developed by the members of the CLER Evaluation Committee based on their observations from the first 100 site visits, focus group research, and a review of the published literature. A complete list of the membership of the CLER Evaluation Committee is available at

The complete CLER Pathways to Excellence framework is available at

About the ACGME
The ACGME is a private, non-profit organization that accredits approximately 9,200 residency programs in 133 specialties and subspecialties that educate over 117,000 residents. Its mission is to improve the quality of health care in the United States by assessing and advancing the quality of resident physicians' education.

SOURCE Accreditation Council for Graduate Medical Education