Mission Statement We improve health care by assessing and advancing the quality of resident physicians' education through accreditation.

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1 ACGME Mission Statement We improve health care by assessing and advancing the quality of resident physicians' education through accreditation. Vision We imagine a world characterized by: a structured approach to evaluating the competency of all residents and fellows; motivated physician role models leading all GME programs; high-quality, supervised, humanistic, clinical educational experience, with customized formative feedback; residents and fellows achieving specialty-specific proficiency prior to graduation; and residents and fellows prepared to become Virtuous Physicians who place the needs and well-being of patients first.

2 The actions of the ACGME must fulfill the social contract, and must cause sponsors to maintain an educational environment that assures: the safety and quality of care of the patients under the care of residents today the safety and quality of care of the patients under the care of our graduates in their future practice the provision of a humanistic educational environment where residents are taught to manifest professionalism and effacement of self interest to meet the needs of their patients

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4 The Building Blocks or Components of The Next Accreditation System 10 year Self-Study Visit 10 year Self-Study prn Site Visits (Program or Institution) Continuous RRC and IRC Oversight and Accreditation Clinical Learning Environment Review CLER Visits

5 CLER Focus Areas Supervision Patient Safety Healthcare Quality Professionalism Healthcare Disparities Duty Hours Fatigue Management Transitions of Care

6 CLER visits Short notice, 2-3 day visits, every months Visits occur at clinical learning environments of ACGME accredited sponsoring institutions

7 CLER Program Development Experience: > 3,600 residents > 2,800 faculty > 2,100 program directors > 220 CEO/Exec Directors, their C-suites, quality and safety leadership Scores of nurses, other care providers and members of staff Occasional Deans May 9, 2014

8 CLER Program 5 key questions for each site visit Who and what form the hospital/medical center s infrastructure designed to address the six focus areas? How integrated is the GME leadership and faculty in hospital/medical center efforts across the six focus areas? How engaged are the residents and fellows? How does the hospital/medical center determine the success of its efforts to integrate GME into the six focus areas? What are the areas the hospital/medical center has identified for improvement?

9 CLER Evaluation Process* Oral Report: end of visit Written Report: 6-8 weeks after Optional response to report National aggregated deidentified data for comparison In development * Approved by CLER Evaluation Committee 10/2012

10 Where is CLER program today Well over half 1 st (beta) cycle complete Nearly fully staffed-- a few more site visitors, and a couple of program staff Volunteer program (beta testing) well underway Synthesizing learning from 1 st cycle Preparing for Cycle 2 and smaller SI s (cycle 1)

11 CLER Evaluation Committee Includes national expertise in GME and the six focus areas Co-Chairs: James Bagian, MD and Kevin Weiss, MD Meets quarterly Receives data from site visits

12 Overall Early Impression Health systems (clinical learning environments) undergoing dramatic change and related stress Nationally, an executive leadership community that is seeking to be responsive to these changes in our health care system Remarkable talented and dedicated GME community

13 Preparing Doctors for 21 st Century Practice: Optimizing the Clinical Learning Environment to Meet the Needs of an Evolving Delivery System Washington, DC Monday, January 27, 2014

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15 Clinical Learning Environment Review (CLER) CLER Pathways to Excellence Expectations for an optimal clinical learning environment to achieve safe and high quality patient care

16 Program Staff Robin Wagner, RN, MHSA VP CLER Program Regional Vice Presidents Baretta Casey, MD Robin Newton, MD Carl Patow, MD CLER site visitor staff Administrative Staff Anne Down Mary Cleveland

17 CLER Pathways to Excellence Expert Input Experience from CLER visits Published Literature

18 CLER Pathways to Excellence

19 Early Impressions Patient Safety Low engagement in resident and faculty reporting Lack of knowledge regarding range of reportable events, especially recognition of close calls (near misses) Common to have multiple options/mechanisms for reporting (e.g. online, chain of command); may lead to incomplete event capture May 2014

20 Early Impressions Healthcare Quality Often residents and fellows have little knowledge of QI terminology and methods Variation in resident and faculty participation in QI across programs and institutions Variable alignment (often little) between resident projects and the clinical site s priorities May 2014

21 Early Impressions Healthcare Disparities Majority of focus is on providing access Highly variable training in cultural competency Little institutional effort to study variations in care or outcomes for vulnerable patient populations May 2014

22 Levers for Change GME CLE Hospital Discussions ad activities within GME Strategic planning involving GME Strategic planning outside of GME

23 Levers for Change Within GME Anecdotal feedback from site visits No more modules Information overload (e.g. orientation, blasts) Faculty and program directors feeling overburdened residents have no time within current curriculum to add anything else

24 Next year in CLER Completing Cycle 1 Planned report of findings Annual Meeting Begin Cycle 2 Based on CLER Pathways document Larger Institutions: second visit Smaller Institutions: first visit Sub-protocols, governance, O.R., patient experience CLER Conversations Launching CLE National Collaborative

25 CLER Conversations Planned four 2-day workshops with executive leadership teams about CLE strategy. The CLE National Collaborative Outgrowth of two years of periodic ACGME sponsored meetings with other organizations on faculty development around CLE