Byron Joyner, MD, MPA
The ACGME Clinical Learning Environment Review (CLER) team has invited us to participate in a 3-day CLER Site Visit between July 30th and August 1st. This is a wonderful opportunity for UW Medicine, and UWMC-ML, specifically, to learn more about developing and sustaining an optimal clinical learning environment.
In this rapidly evolving health care environment, it is critical that hospitals support training of residents and fellows in communication, systems-based practices and interprofessional teamwork. Residents and fellows are the front line of patient care in our hospitals, and they should have opportunities to learn about diversity, disparities, social determinants of health and participate in quality care and patient safety.
The ACGME CLER program, created in 2012, was established to encourage hospitals to focus on continuous quality improvement. To this end, CLER site visits provide GME leaders, hospital executives and the local medical community feedback in 6 critical and cross-cutting areas:
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In addition to the general CLER Site Visit, we have volunteered for the new Patient Perspective Subprotocol. Through this subprotocol, the ACGME hopes to learn more about the patient voice. To do so, a separate set of site visitors will visit simultaneously the in-patient wards at UWMC-ML to ask 14 standard questions regarding their satisfaction with our health system. Examples of questions will be:
- Please tell me who is the doctor in charge of your care.
- Do doctors and nurses go over your plan of care so that you understand it?
- Do you feel that doctors encourage you to ask questions?
- Did you feel when there was lack of coordination in planning your care?
- Did you receive conflicting information from doctors and nurses?
- Do doctors and nurses seem to treat each other with respect?
- Do nurses and residents treat each other with respect?
All of the questions can be found on the ACGME site. These questions are substantive and remind us of how teamwork can affect patient expectations.
Although CLER site visits are not graded, there is a requirement that each institution sponsoring graduate medical education has a periodic CLER site visit. These site visits allow a sponsoring institution to qualify for an accreditation status. There are two expectations. First, each sponsoring institution should develop action plans based on the feedback received from the CLER site visitors and implement improvements to address any identified deficiencies. Second, faculty, housestaff, nurses and pharmacists should be invovled in working to improve hospital quality and patient safety. You can learn more about what we are doing in GME by reviewing our CLER website.
During our last 3-day CLER site visit in 2019, CLER field representatives collected information through observations of and interviews from executive leadership, program directors, residents, fellows, nurses, and faculty about the six CLER domains. In the weeks ahead, I will be sharing with you changes and improvements that UW Medicine has made based on the feedback from the last CLER site visit, priorities set by feedback from you and securing resources to make improvements.
Before our CLER site visit, Hadar Duman, Director of GME Accreditation will send requests to many of you to participate in interviews with members of the CLER Site Visit team. Thank you for responding promptly to her requests. And, thank you for cooperating in this exciting opportunity to be better!
Byron Joyner, MD, MPA
Vice Dean for GME &
Designated Institutional Official
University of Washington
School of Medicine