2. Annual Data Collected and Reviewed 1. Annual ADS Update - Streamlined ◦ Program Attrition ◦ Program Characteristics – Structure and Resources ◦ Scholarly Activity 2. Board Pass Rate – Rolling Rates 3. Clinical Experience (Case Logs) 4. Resident Survey 5. Faculty Survey – Core Faculty 6. Semi-Annual Resident Evaluation and Feedback ◦ Milestones ◦ Clinical Competency Committees 7. CLER site visits

3.  Emphasizes the responsibility of the SI for the quality and safety of the environment for learning and patient care  Also emphasizes addressing health care disparities  Intent to improve quality and safety goals after graduation

4.  Key institutional policies affecting residents: ◦ Transitions of care (patient handoffs) ◦ Supervision ◦ Duty hours, fatigue management & mitigation ◦ Professionalism  Integration of residents into projects: ◦ Patient Safety ◦ Quality Improvement (Including health care disparities)

5.  Support national efforts addressing patient safety, quality improvement, and reduction in health care disparities.  Increase resident knowledge of and participation in safety activities and quality improvement.  Monitor Sponsoring Institution maintenance of a clinical learning environment that promotes the six goals.

6.  Initially, not for accreditation decisions ◦ Set expectations for the 6 focus areas and provide institutions with formative feedback  CLER Evaluation Committee charged to set expectations for the 6 focus areas  First cycle (18 months): information shared with ACGME/RCs will be de-identified and/or reported in aggregate.  Second cycle: CLER Evaluation Committee will share relevant information from the CLER site visits with the IRC and RCs

7.  Senior leadership initial and exit meetings: CEOs, DIO/GMEC Chair, Resident Member of GMEC  Quality & Safety Leadership: Chief Safety Officer and Chief Quality Officer  Residents/Fellows  Core Faculty  Program Director  Walk-arounds

8.  Organizational charts  Supervision policy  Duty hour policy  Care transitions policy  Patient safety protocol/strategy (approved by Board)  Quality strategy (approved by Board)  Quality & Safety Committee membership rosters (identifying resident members)  DIO’s most recent annual report to SI governance

9.  Patient Safety: relatively little resident reporting in PSN and viewed as a “black hole”; many didn’t know Patients are First goals  Quality Improvement: Data from hospitals not readily available for QI projects; need to brand Housestaff Quality and Safety Council (HQSC); no strategy on health care disparities  Transitions in Care: CORES is a best practice but could be more effectively used; observed a handoff without supervision  Supervision: Policy template is a best practice; need to make policies and approved procedures available to nurses/care team  Duty Hours/Fatigue: No significant duty hour concerns; insufficient fatigue training for faculty; need to improve fatigue monitoring  Professionalism: Very strong education; residents know how to report concerns (too many avenues to report?)

10.  Include residents in real, meaningful experiences ◦ Root cause analysis ◦ Protocol development ◦ LEAN/RPIW teams ◦ Patient safety reporting  Obtain clinical effectiveness data  Work with SI leadership, including safety and quality officers ◦ One should be on GMEC

11.  Implement meaningful policies for supervision and duty hours  Develop transitions of care protocols  Provide fatigue management/mitigation training  Develop monitored standards for professionalism  Include residents in SI initiatives in patient safety, quality improvement, and addressing health care disparities