Title: Patient Perspective of the Clinical Learning Environment

Presenters: Nancy Koh, Robin Dibner, Robin Newton, Kevin Weiss, Accreditation Council for Graduate Medical Education, Chicago, United States

Introduction: The Accreditation Council for Graduate Medical Education (ACGME) accredits all postgraduate medical education programs for physicians in the US. The ACGME’s Clinical Learning Environment Review (CLER) Program conducts periodic site visits to the hospitals and other clinical sites that serve as clinical learning environments (CLEs) for more than 150,000 postgraduate physicians in training. Between October 2023-April 2025, the CLER Program is implementing a special protocol designed to understand the patients’ perspective of the CLE, including their experiences with postgraduate physicians.

Specifically, the protocol is exploring how patients (1) perceive health care is delivered in a respectful environment; (2) know the physicians who are taking care of them; (3) receive care that incorporates the views of culturally diverse patient populations; (4) perceive care provided is patient centered; (5) receive clear and consistent information from the healthcare team about their plan of care; (6) know how to and are able to express their concerns regarding care provided by the healthcare team; and (7) know how and are able to express their concerns regarding the well-being of their physicians and its potential impact on their care.

Methods: For this special protocol, the CLER Program is conducting site visits to a stratified random sample of 25 clinical sites that collectively oversee 1,171 ACGME-accredited post-graduate residency programs and 15,021 postgraduate physicians in training. These visits primarily involve brief interviews with patients in their inpatient rooms. The visits also include a meeting with the institution’s leader responsible for patient experience as well as interviews with postgraduate physicians and nurses on clinical units about their interactions with patients. All visits are conducted using a standardized, structured questionnaire with open-ended questions that allow for richer discussions and in-depth understanding of the experiences and perspectives of patients. The information obtained from these visits will contribute to a national report of aggregated de-identified data regarding patient experience in teaching hospitals and medical centers.

Results: Several early findings are emerging from the visits to date, such as: (1) many patients do not appear to know the attending physician in charge of their care and they vary in the way they identify their physician, including by name and physical description; (2) when patients are able to identify the attending physician in charge of their care, few are able to identify the postgraduate physician(s) assisting the attending physician; (3) a limited number of patients appear to understand the structure of their physician team and the roles within the clinical care team; (4) while patients generally indicated that their doctors go over their plan of care in a way that they can understand, there were patients who also noted experiencing a doctor leaving their room before they understood the plan and asking their nurse for further explanation; (5) on occasion, patients indicated there were times when they felt there was a lack of coordination between their doctors in planning their care; and (6) some patients indicated not knowing how to report or express concerns about their care.

Conclusion: The patient perspective is integral to attaining a more comprehensive understanding of the CLE by looking at various aspects of patient experience in terms of patient safety, health care quality, professionalism, and other areas of focus that impact patient care. The findings that emerge from this special protocol will highlight opportunities to better shape and improve the CLE to optimize the learner experience and patient care.