Graduate Medical Education after Implementation of the ACGME CLER Program: Perspectives of Teaching Hospital Leaders, Designated Institutional Officials, and GME Program Directors

Through the implementation of the Clinical Learning Environment Program (CLER) in 2014, the ACGME has established an accreditation activity that obligates Sponsoring Institutions, GME Programs and Teaching Hospitals to assess and evaluate the clinical learning environment and plan effort and improvement collaboratively. This qualitative collective case study explored the experiences of four clinical learning environments. Each case represents a clinical learning environment (CLE) made up of a medical school-based sponsoring institution, GME programs, and a teaching hospital that have participated in the ACGME CLER Program through multiple site visits. Data was collected through semi-structured interviews, participant follow-up, and document reviews. Theoretical proposition analysis and replication logic were the selected analytic strategies for this study and the Dimension of Change framework (Pomey, 2003) served as the theoretical orientation. The theoretical proposition for this study is that organizational learning and change has occurred within the clinical learning environment as a result of the implementation of the CLER program. The findings from the collective case study document evidence of organizational change and learning across CLE sites, with a number of organizational factors negatively influencing further progress. Additionally, the CLER Program is perceived as enabling toward future system improvement in the CLE.