Sunday, April 27, 2014

The ACGME, the body that certifies US residency training programs, notes:

As a component of its next accreditation system, the ACGME has established the CLER program to assess the graduate medical education (GME) learning environment of each sponsoring institution and its participating sites. CLER emphasizes the responsibility of the sponsoring institution for the quality and safety of the environment for learning and patient care, a key dimension of the 2011 ACGME Common Program Requirements. The intent of CLER is “to generate national data on program and institutional attributes that have a salutary effect on quality and safety in settings where residents learn and on the quality of care rendered after graduation.”

One requirement of the program is supposed to include "opportunities for residents to report errors, unsafe conditions, and near misses, and to participate in inter-professional teams to promote and enhance safe care."

I've been looking for a "cler" presentation of the results of the site visits on this matter, but I can't find anything on the ACGME website or elsewhere.  According to this document, the ACGME has accredited 9516 programs in 2013-14, covering 121,778 full-time residents.  The page that indicates which programs are on probation (unfavorable status), shows the number to be 39, but it does not list the reasons.

Here are my questions. I know from personal visits and discussions with residents that many hospitals do not satisfy the requirement cited above. Have any of these programs been put on probation?  Whether on probation or not, will the names of hospitals that fail this test be made public?

If a patient-safety-oriented medical student applying for the residency match program wanted to know which hospitals do not satisfy this requirement, how could he or she find out?

Finally, I wonder if the CMS payments to hospitals for residency training should be based in some way on the extent to which core requirements and competencies are met, rather than the current fixed number of dollars per student?  (See the past part of this article by David Mayer on this topic.)


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