임상 학습환경(Clinical Learning Environment) : 졸업후교육의 기반

(출처 : http://www.medscape.com/viewarticle/727993)

졸업후교육(GME)의 질적 향상을 위해서는 

그 대학병원이 추구하는 진료의 질과 안전과 가치의 핵심적 부분으로서 

레지던트와 펠로우 수련 과정을 포용하는 리더십이 필요하다.

미국 의료의 질과 안전 향상에 대한 대중의 요구에 부응하려면, 

의료기관들은 시스템 기반의 진료의 질 향상(systems-based improvement in patient care)을 위해

 어떻게 해야 하는지를 인지할 수 있는 의료진을 훈련시켜야 한다.

CLER(Clinical Learning Environment Review, 임상 학습환경 평가)프로그램을 통해서 

ACGME는 미국의 대학병원을 비롯한 교육병원들이 진료의 안전, 질, 가치를 발전시키기 위한 

가장 효과적인 방법을 찾아내서 도입할 수 있도록 할 것이다.

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MORE THAN A DECADE AFTER THE INSTITUTE OF Medicine reported problems with the quality and safety of US health care,1,2 formal training of the health care workforce in quality and patient safety is still inadequate

The AHA report identified deficiencies in newly trained physicians in...

systems-based practice, 

communication skills, 

and the ability to work within teams.

The Accreditation Council for Graduate Medical Education (ACGME) recognizes the public’s need for a physician workforce capable of meeting the requirements of the rapidly evolving health care environment. This effort dates to the late 1990s, when the ACGME, collaborating with the American Board of Medical Specialties, established 6 core competencies creating a framework for attaining the skills needed for the modern practice of medicine

The next step in the evolution of resident physician training is the Next Accreditation System (NAS), which is now being implemented by the ACGME. The NAS emphasizes outcomes instead of processes for resident learning.

The Clinical Learning Environment Review (CLER) program is the first component of the NAS5 to be operationalized nationally. 

The CLER program identifies US teaching hospitals’ efforts to engage residents in 6 focus areas: 

patient safety; 

health care quality, including reduction in health care disparities; 

transitions in care; 

supervision; 

duty hours and fatigue management and mitigation; 

and professionalism.

Site visitors gain knowledge about residents’ engagement in the 6 focus areas through group meetings and visits in clinical service areas.

At the end of the visit, the site visit team provides the institution with feedback and a written report soon thereafter.

With time, the aggregated experience regarding institutional performance in these areas will shape future ACGME accreditation requirements. Early experience with CLER visits revealed numerous interesting improvement projects and some efforts in the education and training of residents and fellows in the 6 focus areas.

High-quality graduate medical education requires the executive leadership of teaching hospitals to recognize and embrace resident/fellow training as an integral part of organizational initiatives to enhance quality, safety, and value in patient care.

Given the broad public need and mandate to improve the quality and safety of medical care in the United States, the future workforce must be trained to recognize opportunities for improvement and actively engage their health care organizations to implement systems-based improvements in patient care.

Through its CLER program, the ACGME seeks to engage US teaching institutions in identifying and implementing the most effective quality improvement strategies that focus on the safety, quality, and value of care

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JAMA. 2013 Apr 24;309(16):1687-8. doi: 10.1001/jama.2013.1931.

The clinical learning environment: the foundation of graduate medical education.

Weiss KB, Bagian JP, Nasca TJ.

Source

Institutional Accreditation, Accreditation Council for Graduate Medical Education, 20th Floor, 515 N State St, Chicago, IL 60654, USA. kweiss@acgme.org

PMID:

 

23613072

 

[PubMed - indexed for MEDLINE]