1. PAFP Fall 2015 milestones workshop Pam Vnenchak
CLER Visit Prep
PAFP Fall 2015 milestones workshop
Pam Vnenchak

2. CLER = Clinical Learning Environment Reviews
Team Survey of Sponsoring Institutions every 18 months
Multiple Meetings and “walk rounds”
6 Focus Areas
Once established, comparison to national bench marks

3. Clinical Learning Environment Reviews (CLER)
“…graduate medical education must include training and active participation in quality and safety initiatives by every resident physician”.
Dr. Nasca; JAMA 2013

4. Six CLER Focus Areas
Patient Safety – including opportunities by residents to report errors, unsafe conditions, and near misses, and to participate in inter-professional teams to promote and enhance safe care
Quality Improvement – including how sponsoring institutions engage residents in the use of data to improve systems of care, reduce health care disparities and improve patient outcomes.
Transitions in Care – including how sponsoring institutions demonstrate effective standardization and oversight of transitions of care
Supervision – including how sponsoring institutions maintain and oversee policies of supervision concordant with ACGME requirements in an environment at both the institutional and program level that assures the absence of retribution
Duty Hours Oversight, Fatigue Management and Mitigation – including how sponsoring institutions demonstrate: (i) effective and meaningful oversight of duty hours across all residency programs institution-wide; (ii) design systems and provide settings that facilitate fatigue management and mitigation; (iii) and provide effective education of faculty members and residents in sleep, fatigue recognition, and fatigue mitigation
Professionalism – with regard to how sponsoring institutions educate for professionalism, monitor behavior on the part of residents and faculty and respond to issues concerning: (i) accurate reporting of program information; (ii) integrity in fulfilling educational and professional responsibilities; and (iii) veracity in scholarly pursuits.

5. The CLER Team will include at least one professional site visitor employed by the ACGME and may include volunteer site visitors from other ACGME-accredited institutions. The size and composition of the CLER Team will be determined by the size and complexity of the sponsoring institution.
The CLER does not require a sponsoring institution to submit information to the ACGME prior to the visit. The sponsoring institution must maintain current information related to the above six focus areas along with evidence of periodic reporting of this information to the chief executive officer of the sponsoring institution. The sponsoring institution must provide this information to the CLER Team.
Site visits will be based on performance, and will occur, at a minimum, every 18 months.
ACGME will notify the sponsoring institution’s DIO of the CLER Site Visit Team’s arrival date and expected length of visit no less than 10 days prior to the visit.

6. First Round of CLER evaluations will seek answers to 5 key questions:
Who and what form the infrastructure of a Sponsoring Institution’s clinical learning environment? What organizational structures and administrative and clinical processes do the SI and its major participating sites have in place to support GME learning in each of the six focus areas?
How integrated is the GME leadership and faculty within the SI’s current clinical learning environment infrastructure? What is the role of GME leadership and faculty to support resident and fellow learning in each of the six areas?

7. Key questions continued
How engaged are the residents and fellows in using the SI’s current clinical learning environment infrastructure? How comprehensive is the involvement of residents and fellows in using these structures and processes to support their learning in each of the six areas?

8. How does the SI determine the success of its efforts to integrate GME into the quality infrastructure? From the perspective of the SI and its major participating sites, what are the measures of success in using this infrastructure and what was the level of success?
What areas have the Sponsoring Institution identified as opportunities for improvement? From the perspective of the SI and its major participating sites (if different), what are seen as the opportunities for improving the quality and value of the current clinical learning environment infrastructure to support the six focus areas?

10. Prepping the “C-Suite”
Mandatory participation of the CEO/President of SI and DIO
Engagement of CMO, COO, CSO, CNO, CFO, Chair GMEC, resident GMEC strongly recommended but not required
Develop FAQs about the CLER process
Quick fact sheets regarding the 6 focus areas

11. Site Visit Instructions and notes
Quality & Patient Safety Leadership Meetings: CQO, CPSO, CMIO, Director Risk Management,
Resident And Fellow Group Meetings: Peer selected Residents (PGY2 or higher) to provide broad representation
Faculty Member Group Meetings – core faculty members
Program Directors from each residency, fellowship
Walking Rounds – One chief or senior resident to guide walking rounds on floors

12. The information derived from these visits is a component of the continuous data acquisition of ACGME-accredited sponsoring institutions and programs. CLER findings alone will not result in adverse accreditation actions unless the CLER Team identifies potential egregious violations of accreditation standards.