CLER Pathways to Excellence: Expectations for an Optimal Clinical Learning Environment (Executive Summary).

T he Accreditation Council for Graduate Medical Education (ACGME) recognizes the public’s need for a physician workforce capable of meeting the challenges of a rapidly evolving health care environment. The ACGME has responded to this need by implementing the Clinical Learning Environment Review (CLER) program as a part of its Next Accreditation System. The CLER program is designed to provide US teaching hospitals, medical centers, health systems, and other clinical settings affiliated with ACGME-accredited institutions with periodic feedback that addresses the following 6 areas: patient safety, health care quality, transitions in care, supervision, duty hours and fatigue management and mitigation, and professionalism. The feedback provided by the CLER program is designed to improve how these clinical sites engage physician trainees in learning to provide safe, highquality patient care. To further the aim of the CLER program, the ACGME has developed the CLER Pathways to Excellence as a tool to promote discussions and actions that will optimize the clinical learning environment. The CLER pathways are designed as expectations rather than requirements. It is anticipated that by setting these expectations, clinical sites that provide training will strive to meet or exceed them in their efforts to provide the best care to patients and train the highest-quality physician workforce.