WIHI: From Here to CLER: Graduate Medical Education and the Clinical Learning Environment Review (CLER)

Date: September 24, 2014


  • Kevin B. Weiss, MD, MPH, Senior Vice President, Institutional Accreditation, Accreditation Council for Graduate Medical Education (ACGME)
  • Robin Wagner, RN, MHSA, Vice President, Clinical Learning Environment Review, ACGME
  • Maren Batalden, MD, Medical Director of Hospital Quality, Associate Director of Graduate Medical Education for Quality and Safety, Cambridge Health Alliance (CHA)
  • James Moses, MD, MPH, Medical Director of Quality Improvement, Boston Medical Center; Academic Advisor, IHI Open School for Health Professions

Whether or not you are directly involved in graduate medical education (GME), its priorities have implications for all of health care.

A new Institute of Medicine (IOM) report released over the summer has reignited debate and discussion about the financing and goals of GME in the US. Given that Medicare is the primary funder, to the tune of $15 billion per year, the report’s authors call for greater accountability for all the government support, along with a change in priorities. For example, the IOM committee points to a disconnect between what the health care system desperately needs right now — more cost-conscious doctors capable of improving patient care, managing population health, and committed to primary care — and residency programs that remain overwhelmingly hospital-based and focused on medical specialties.
This is not the first time we’ve heard calls to reform GME, or the first time we’ve seen efforts to respond by the accrediting body itself, the Accreditation Council for Graduate Medical Education (ACGME). They’re in the midst of rolling out a new set of residency training expectations that are more aligned with delivering value and helping patients achieve optimal health. The program is called the Clinical Learning Environment Review.
Learn from our panel of experts as we explored the goals of CLER and the specific ways residents are being asked to contribute to patient safety, quality improvement, care transitions, supervision, duty management, and professionalism.
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