Byron Joyner, MD, MPA
There are many things that are changing besides the weather.
With the imminent departure of Dr. Lindee Strizich, the current GME Director of Quality & Patient Safety at UWMC-ML, we are thinking about ways to improve our efforts and efficiency around the Clinical Learning Environment Review (CLER) site visit. We haven’t had one since January of 2019. Since then – and considering the COVID-19 pandemic, the ACGME has developed better procedures and practices to provide hospitals with feedback in the six CLER domains: patient safety, healthcare quality, teaming, supervision, well-being, and professionalism.
In addition, the ACGME recently introduced the new CLER domain of Diversity, Equity, and Inclusion (EDI), recognizing that these qualities are essential to improving patient and learner experiences –and achieving equity in healthcare. EDI replaces supervision as a stand-alone domain.
The ACGME CLER program is built upon the concept of continuous quality improvement. The purpose of the CLER site visit is to ensure that GME programs, in partnership with their hospital leadership, are meeting the demands of a rapidly evolving healthcare environment and are collectively aligned with the six cross-cutting domains listed above, including the new EDI domain.
Under Dr. Strizich’ leadership of the CLER committee, we have continued to develop ways to engage residents and fellows in quality and patient safety activities. These activities are critical to our learning environment and are mutually beneficial: housestaff learn from adverse events during intensive reviews and the hospital leadership, including risk management, learns about resources that are central to create safer learning environments for residents, fellows, and patients.
Three years ago, as the chair of the Graduate Medical Education Committee (GMEC), I charged an EDI subcommittee to help improve all aspects of EDI in our learning environment. But EDI is not just a clinical issue; it is a systems issue. As a result, we have been thinking of better ways to align our goals with those of the hospital leadership so that we are not duplicating efforts but working together to boost those efforts.
Nationally, most hospitals have been making improvements in the six CLER domains, as demonstrated by the ACGME’s annual report on CLER. With these positive changes, and given that EDI is now folded under the CLER framework, we have decided to consolidate the work of our EDI subcommittee within the GMEC CLER Subcommittee. This group will consist of trainees and faculty with expertise to address EDI needs for our community. In addition, we will establish an ad hoc EDI workgroup. This new group will collaborate with other individuals and entities in our organization, improving the work we are already doing to deliver care that demonstrates cultural humility for all patients and their families.
Some of our current EDI efforts include support of the Network of Underrepresented Residents and Fellows (NURF), which is involved with the recruitment of new residents and fellows. We also work collaboratively with the Office of Healthcare Equity (OHCE) to expand awareness of education in, and policies that will create an antiracist environment in the SOM. The GME EDI Workgroup will be engaged in deciding which of the many projects we need to pursue aligned with these and other groups.
There is a lot to do – and GME wants to be involved by partnering with other UW Medicine entities to engage residents, fellow, nurses, staff, and faculty in developing a just culture where everyone is treated better.
Byron Joyner, MD, MPA
Vice Dean for GME and DIO