Using the CLER Pathways to Excellence to Evaluate the Learning Environments at a Multi-Site Institution

The Accreditation Council for Graduate Medical Education Clinical Learning Environment Review (CLER) program visits 1 participating site per sponsoring institution. While valuable, feedback on that site does not necessarily generalize to all learning environments where trainees and faculty provide clinical care, and institutions may be missing significant insight and feedback on other clinical learning sites.

We explored how the Emory Learning Environment Evaluation process-modeled after CLER-could be used to improve the learning environments at 5 major clinical training sites.

Participants were recruited via e-mail. Sites hosted separate 60-minute sessions for medical students, residents and fellows, and faculty. We used the CLER Pathways to Excellence to develop a combination of fixed choice and opened-ended questions deployed via an audience response system and verbal queries. Data were analyzed primarily through descriptive statistics and graphs.

Across sites, per session, medical student participants ranged from 9-16, residents and fellows ranged 21-30, and faculty ranged 15-29. Learners agreed that sites: (1) provided a supportive culture for requesting supervision (students 100%; residents and fellows 70%-100%), and (2) provided a supportive culture for reporting patient safety events (students 94%-100%; residents and fellows 91%-95%). Only a minority of residents and fellows and faculty agreed that they were educated on how to provide effective supervision (residents and fellows 21%-52%; faculty 45%-64%).

Data from this process have helped standardize improvement efforts across multiple clinical learning environments within our sponsoring institution.