The Accreditation Council for Graduate Medical Education (ACGME) established the Clinical Learning Environment Review (CLER) program to assess and improve the learning environment of the country’s teaching hospitals. CLER emphasizes hospitals’ responsibility for the quality and safety of its environment for learning and patient care. These site visits occur approximately every 18 to 24 months at each institution.

Last month, BWH hosted its second CLER site visit. Over two and a half days, CLER site visitors conducted walking rounds, observed resident end-of-shift handoffs and met with senior leaders, program directors, faculty, patient safety and quality officers, and residents and fellows.

“The site visitors remarked on the wonderful conversations they had with nurses, interns, residents, fellows, faculty and program directors during their visit,” said Deborah Mulloy, PhD, RN, CNOR, associate chief nurse of Quality and the Center for Nursing Excellence.

CLER site visits began in 2012 with several goals, including gaining a better understanding of how well graduate medical education is incorporated into a teaching hospital’s quality and safety activities. During a typical ACGME institutional site visit, site visitors spend a significant portion their time delving into hospitals’ written policies and procedures. In contrast, during CLER site visits, site visitors have the opportunity to walk around patient care units and engage in conversations with residents, fellows, faculty, nurses and other frontline staff in their actual work environment. Group meetings provider further opportunities for site visitors to better understand how residents, fellows, program directors and faculty view the learning environment.

“Residents are so intricately involved in frontline care; it’s essential that their voices are heard, which is part of the value of these visits to help us assess how well we are accomplishing this,” said John Co, MD, MPH, Partners director of Graduate Medical Education.

With CLER site visits, site visitors are looking at how hospitals are creating a strong learning environment in the areas of patient safety, quality improvement, care transitions, supervision, duty hours and professionalism. The CLER site visit does not affect hospitals’ accreditation status; instead, site visitors provide feedback in a report several weeks after the visit, allowing institutions to identify strengths and areas for improvement.

“The visitors told us they were impressed by the enthusiasm and dedication of faculty, trainees and nurses around creating a safe learning environment,” said Co. “There was a lot of discussion about Partners eCare, too, and recognition that we’re doing some things to improve in the areas of safety reporting and teaching quality improvement principles.”

Co says the visitors also praised the Center for Professionalism & Peer Support for being a valuable resource for faculty and residents, as well as BWH’s Housestaff Safety and Quality Council, which is comprised of a group of residents and fellows who work closely with Chief Medical Officer Stan Ashley, MD, Chief Quality Officer Allen Kachalia, MD, JD, and Co to engage housestaff on improving quality and safety at the Brigham.