ACGME has released their initiative on the learning environment. Learning environment is very important, but I worry that we are spending so much time on these issues that we are not focusing enough on the clinical experience.
The Pathways to Excellence document is the latest development in the Clinical Learning Environment Review (CLER) program, an ongoing initiative to assess the learning environment at each accredited teaching institution. It lays out the pathways to improve resident engagement in six core areas:• Patient safety• Health care quality• Care transitions• Supervision• Duty hours• Fatigue management and mitigation• ProfessionalismACGME’s CEO Thomas J. Nasca, MD, called the new guidance “an important step in the delivery of patient care” in a news release.“Building a cadre of young physicians who have the clinical skills to practice medicine in an increasingly complex health care system is the ACGME’s top priority,” Dr. Nasca said.
Dr. Nasca does talk about clinical skills, but the expectations do not include diagnostic acumen, learning the natural history of disease, understanding when patients are really sick, knowing when the diagnostic label they carry is incorrect.
The expectations are reasonable, but we must have a broad discussion of how we best train clinical excellence given these constraints. I hope that we look at the expectations, meet them, but do not overlook our primary focus – outstanding clinical training.
