Clinical Learning Environment Review (CLER)
ACGME's institutional site visit program that evaluates how sponsoring institutions support patient safety, quality improvement, and resident well-being.
Definition
The Clinical Learning Environment Review (CLER) is an ACGME initiative that conducts site visits to sponsoring institutions — separate from program-level accreditation reviews — to evaluate the clinical learning environment across six focus areas: patient safety, health care quality, care transitions, supervision, fatigue management and mitigation, and professionalism. CLER visits are unannounced and involve interviews with residents, fellows, faculty, and institutional leadership.
Why it matters for your program
CLER findings directly influence institutional accreditation status and can create pressure across all programs at an institution. Because CLER visits are unannounced and involve direct resident interviews, institutions cannot prepare in the traditional sense — they have to actually have the systems and culture in place. Poor CLER outcomes have resulted in institutional accreditation actions that affected dozens of programs simultaneously.
Related terms
ACGME Accreditation
The formal process by which the Accreditation Council for Graduate Medical Education evaluates and recognizes residency and fellowship programs.
Designated Institutional Official (DIO)
The individual at a sponsoring institution who has the authority and responsibility for oversight of all ACGME-accredited programs.
Duty Hours
ACGME-regulated limits on the number of hours residents and fellows may work, designed to protect patient safety and resident well-being.
Sponsoring Institution
The organization — typically a hospital or health system — that takes ultimate responsibility for all ACGME-accredited programs it sponsors.
Related Service
ACGME Compliance Consulting
Ashley Wood, PhD helps programs navigate clinical learning environment review (cler) requirements with director-level expertise from HCA Healthcare and Vanderbilt.
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