(HealthDay News) — A framework has been established to advance clinical learning environments that promote change in the quality and safety of care, according to a perspective piece published online January 27 in the New England Journal of Medicine.

Thomas J. Nasca, MD, from the Accreditation Council for Graduate Medical Education (ACGME) in Chicago, and colleagues discuss findings from the first year of the Clinical Learning Environment Review (CLER) program.

The authors note that early findings indicate a lack of resident engagement in a “systems-based practice” of medicine, with staff failing to model approaches to planning and implementing systems-based action plans to improve care. Traditional didactic techniques designed to familiarize trainees with patient safety, quality, care transitions, fatigue management, supervision, and professionalism are necessary but insufficient. Based on findings from CLER, the leadership of teaching institutions must be engaged with efforts to ensure that care provided in the clinical environment is high quality and safe. A recent document, “CLER Pathways to Excellence,” has been developed to serve as a guide for teaching institutions and to help create environments to support competence development.

“Our goal for this conversation is to advance clinical learning environments that meet the public’s need for physicians who are prepared not only to deliver excellent technical and humanistic care but also to participate in or lead constructive change in the quality and safety of our delivery system throughout their careers,” the authors write.

The authors disclosed financial ties (including employment) to the ACGME.

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