The Accreditation Council for Graduate Medical Education (ACGME), through its Clinical Environment Review (CLER) Program, is pleased to announce the publication of Version 3.0 of the CLER Pathways to Excellence: Expectations for an Optimal Clinical Learning Environment to Achieve Safe and High-Quality Patient Care. Version 3.0 was announced at the 2024 ACGME Annual Educational Conference in March in Orlando, Florida.

The CLER Pathways document serves as a tool to promote discussions and actions to optimize the clinical learning environment. The document frames pathways and properties in the six CLER Focus Areas of Patient Safety; Health Care Quality; Teaming; Well-Being; Professionalism; and Diversity, Equity, and Inclusion (DEI), a new Focus Area that recognizes diverse, equitable, and inclusive clinical learning environments are essential to improve patient and learner experiences and achieve equity in health care.

The DEI Focus Area includes five pathways for the clinical learning environment to:

• ensure DEI across the clinical care team to optimize learning and patient care;
• create and maintain interprofessional education and training and facilitate learning on DEI;
• maintain the necessary support systems to ensure DEI;
• create and maintain diversity among the clinical care team to optimize learning and patient care; and,
• monitor the effectiveness and outcomes of its efforts to integrate and achieve DEI.

“The ACGME is very pleased to present this latest version of the CLER Pathways to Excellence,” said ACGME President and Chief Executive Officer Thomas J. Nasca, MD, MACP. “Most notably, this version represents our Board of Directors’ support to seek excellence in creating diversity, equity, and inclusion within the clinical learning environments in which residents and fellows are learning and providing care.”

The ACGME and the CLER Program remain committed to continuous improvement toward the goal of optimizing the delivery of safe, high-quality patient care. The CLER Pathways document continuously evolves in step with the dynamic needs of clinical learning environments and is among the ACGME’s many efforts to help shape a physician workforce that can meet the challenges of a rapidly evolving health care environment.

“This new version of the CLER Pathways document, which introduces the new Focus Area of DEI, retains an emphasis on the clinical learning environment’s need to maintain close collaboration with graduate medical education leadership on supervision of residents and fellows to ensure patient safety and the best possible patient care,” said ACGME Chief Sponsoring Institutions and Clinical Learning Environments Officer Kevin B. Weiss, MD, MPH. “This document will serve as the foundation for the fifth CLER protocol that is planned for implementation in 2025.”

The full CLER Pathways to Excellence document is available on the ACGME website.  

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The ACGME is a private, non-profit, professional organization responsible for the accreditation of 13,066 residency and fellowship programs and the 886 institutions that sponsor these programs in the United States. Residency and fellowship programs educate close to 160,000 resident and fellow physicians in 182 specialties and subspecialties. The ACGME's Mission is to improve health care and population health by assessing and enhancing the quality of resident and fellow physicians' education through advancements in accreditation and education.

Susan Holub
Accreditation Council for Graduate Medical Education
sholub@acgme.org