The Methodology for the CLER National Report of Findings 2016

Nancy J.; Robin; Kevin B.

摘要

Introduction This report reflects the findings of the first set of visits of the Clinical Learning Environment Review (CLER) Program1,2 that were conducted from September 30, 2012 to March 20, 2015. These initial visits were aimed at collecting a comprehensive base of evidence on how the nation's clinical learning environments (CLEs) approach the six CLER focus areas. Specifically, the CLER Program explored issues related to the five key questions that were posed to the program at its outset.3 It also sought to enrich understanding of the nation's CLEs and establish a benchmark for subsequent site visits. Owing to these broad objectives, the CLER Program employed a mixed methods approach, utilizing both quantitative and qualitative information gathering and analysis methods. It is the collective results of this effort that informed the aggregated findings in this report.;Selection of Clinical Learning Environments In 2012 there were 696 ACGME-accredited Sponsoring Institutions (SIs) with 1,767 participating sites,a which are the hospitals, medical centers, and ambulatory units where graduate clinical training takes place. This report examined 297 CLEs that had three or more ACGME-accredited core specialty programs. The CLEs visited were affiliated with 297 SIs that included 8,878 residency programs (92% of all ACGME programs) and 111,482 residents and fellows (90% of all residents and fellows in ACGME-accredited programs).b Many of the SIs had several institutions that served as participating sites. Due to resource limitations, it was necessary to select one clinical site for each CLER visit. The selection was based on two factors: (a) the CLE that served the largest possible number of programs for that SI and (b) the availability of both the Designated Institutional Official (DIO) and the Chief Executive Officer (CEO) of that CLE to be present at the opening interview and the exit interview. If the preferred site could not be scheduled based on these selection factors, an alternative site was selected.;CLER Site Visit Protocol The CLER site visit protocol was designed as a structured visit with a schedule of events (see Figure 1). View larger version (88K) The institutions were notified of the CLER visit at least 10 days prior to arrival. The relatively short notice was intended to maximize efforts to gather real-time information from those who would be interviewed. The visits were conducted by teams of from two to four site visitors and over two to three days. The visit length and number of site visitors varied primarily by the number of programs and residents and fellows at the site. Each CLER visit team was led by a full-time salaried employee of the ACGME. Additional team members were either other ACGME staff or trained volunteers from the graduate medical education (GME) community. The group sessions during each visit were always conducted in the same order: (1) an initial group interview with the CEO, members of the executive team (e.g., Chief Medical Officer, Chief Nursing Officer), the DIO, and a resident representative; (2) a short interview with patient safety and health care quality leadership; (3) a group interview with residents and fellows; (4) a group interview with faculty members; (5) a group interview with program directors; (6) a second interview with patient safety and health care quality leadership; and (7) an exit meeting with the CEO, members of the executive team, the DIO, and a resident representative. All interviews took place in a quiet location without disruption and did not exceed 90 minutes. The purpose of the initial meetings with executive leadership and patient safety/quality leaders was to become familiar with the basic language and culture of the CLE's current activities in the six CLER focus areas. This information helped inform subsequent interviews and observations during the CLER visit. The resident and fellow group interviews were conducted with six to 30 participants per session who we

机译：简介本报告反映了从2012年9月30日至2015年3月20日进行的临床学习环境评估（CLER）计划1,2的第一批访问的结果。这些初始访问旨在收集全面的证据基础关于美国的临床学习环境（CLE）如何处理六个CLER重点领域的信息。具体来说，CLER计划探索了与计划一开始就提出的五个关键问题有关的问题。3它还寻求加深对该国CLE的了解，并为以后的实地考察建立基准。由于这些广泛的目标，CLER计划采用了混合方法方法，同时利用了定量和定性的信息收集和分析方法。正是这些努力的共同结果为本报告的汇总结果提供了参考。;临床学习环境的选择2012年，有696家获得ACGME认证的赞助机构（SI）拥有1,767个参与站点，这些站点包括医院，医疗中心，以及进行研究生临床培训的门诊部门。该报告检查了297个CLE，这些CLE具有三个或更多个经过ACGME认证的核心专业课程。所访问的CLE与297个SI关联，其中包括8,878个居住计划（占ACGME所有计划的92％）和111,482名居民和研究员（占ACGME认可计划的所有居民和研究员的90％）。充当参与站点。由于资源有限，每次CLER访问必须选择一个临床站点。选择的依据是两个因素：（a）为该SI提供尽可能多的计划的CLE，以及（b）该CLE的指定机构官员（DIO）和首席执行官（CEO）的可用性出席开幕面试和退出面试。如果无法根据这些选择因素来安排首选站点，则选择其他站点。CLER站点访问协议CLER站点访问协议被设计为具有事件时间表的结构化访问（请参见图1）。查看较大的版本（88K）至少在抵达之前10天通知了CLER访问机构。相对较短的通知旨在最大程度地努力从接受采访的人员那里收集实时信息。这次访问是由两到四个现场访问者组成的小组进行的，历时两到三天。访问时间和站点访问者数量主要随计划的数量以及站点中居民和研究员的数量而变化。每个CLER访问团队均由ACGME的全职领薪员工领导。其他团队成员是ACGME的其他工作人员或研究生医学教育（GME）社区的训练有素的志愿者。每次访问期间的小组会议始终以相同的顺序进行：（1）对首席执行官，执行团队成员（例如首席医疗官，首席护理官），DIO和居民代表的初始小组访谈; （2）对患者安全卫生质量负责人的简短采访; （三）对居民和同乡的小组访谈; （4）与教职员工进行小组面试; （5）与计划主管进行小组面谈; （6）对患者安全卫生质量负责人进行第二次面试; （7）与首席执行官，执行团队成员，DIO和居民代表的退出会议。所有采访都在一个安静的地方进行，没有中断，并且不超过90分钟。与执行领导和患者安全/质量负责人举行的初次会议的目的是要熟悉CLE在六个CLER重点领域中当前活动的基本语言和文化。这些信息有助于在CLER访问期间为以后的采访和观察提供信息。居民和团员访谈每节有6至30名参与者，我们

The Methodology for the CLER National Report of Findings 2016

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