Forum Focus – AIAMC National Initiative IV: Mastering the Clinical Learning Environment


By Dan Paloski, Communications Specialist, AHA’s Physician Leadership Forum

In 2007, the Alliance of Independent Academic Medical Centers (AIAMC), a national membership organization of major independent academic medical centers and health systems, was searching for opportunities to provide greater resident involvement in hospital safety and quality efforts. As part of their mission to help members integrate medical education and research into the organizational clinical mission, AIAMC felt focusing on resident quality improvement efforts had the potential to improve safety and quality quickly and with the greatest impact. To test this hypothesis, AIAMC created National Initiative I with the goal of improving patient care through graduate medical education (GME). Nineteen member academic teaching centers participated, integrating residents and GME into quality and patient safety initiatives. Participants found that integrating residents into existing efforts greatly increased the strategic value of their academic programs to the organization. The December 2009 issue of Academic Medicine featured five articles regarding the results of National Initiative I.

Two years later, AIAMC launched National Initiative II, this time focusing on residents and their involvement in five specific quality improvement areas: effective communication, hand-offs, infection control, readmissions, and transitions of care. Thirty-five institutions participated with results shared in a variety of publications including the May/June 2012 special supplement issue of the American Journal of Medical Quality, which recapped the June 2011 “Integrating Quality” meeting sponsored by the American Association of Medical Colleges. Thirteen AIAMC members that participated in National Initiative II and their project results were featured at this meeting.

In 2011, National Initiative III involving 35 teams was launched. It built on the strength of the first two phases and addressed the development of medical education faculty and teaching leadership. One of the main outcomes of National Initiative III was the development of a national network for improvement and sharing of best practices across the United States. Participants were also able to show how GME and continuing medical education (CME) play a central role in quality improvement, and how GME and CME can align with hospital leadership to improve quality of care. The proceedings of National Initiative III were published in the spring 2014 issue of The Ochsner Journal.

Last year, AIAMC launched National Initiative IV, which focuses on navigating the Accreditation Council for Graduate Medical Education’s (ACGME) new Clinical Learning Environment (CLE) review program. Created in 2012, CLE provides residency sponsoring institutions feedback on resident and fellow engagement in the following six areas:

  1. Patient safety
  2. Quality improvement
  3. Transitions in care
  4. Supervision
  5. Duty hours oversight, fatigue management, and mitigation
  6. Professionalism[1]

Each CLE site visit provides an opportunity for feedback and evaluation of how the institution addresses each of the six areas and begins and ends with a meeting with the senior leadership of the institution and the residency programs. Feedback is viewed as formative and the aggregate results of the CLE visits will help inform the ACGME’s next accreditation system, which emphasizes resident outcomes and learnings indicating they’re on the right path toward individual practice. The goal of CLE is for sponsoring institutions to use the feedback to continually improve in the six areas. In addition, ACGME hopes to learn how to best engage and involve residents and fellows in hospital efforts regarding patient safety and quality in the clinical environment.[2]

AIAMC’s current effort, National Initiative IV, began last October with 34 teams. Each team consists of a resident, faculty member, quality improvement professional and additional staff as needed. To begin, each of the teams completed a self-assessment survey against the six areas of CLE to determine which area would be their focus. The teams were subdivided by area for monthly teleconferences and discussions to share progress. As with the other initiatives, the groups convene for monthly conference calls, as well as attend four live meetings throughout the 18 months of the initiative. The four in-person meetings allow the six subgroups to collaborate and share best practices across the spectrum.

According to AIAMC, National Initiative IV is providing teams the training and guidance to:

  1. Identify strengths and weaknesses across the six areas
  2. Prioritize areas for improvement
  3. Outline, streamline and implement improvement strategies
  4. Significantly and measurably advance the institutional level of preparedness for addressing the CLE focus areas[3]

The next group meeting will be in Fort Worth, Texas in October 2014 with the final one taking place in March 2015. Led by AIAMC’s steering group, the Committee on the Integration of Academics and Quality, three scholarship teams have been formed to disseminate findings in the form of research, resource materials, and program descriptions at the conclusion of the initiative.

Overall participation has increased over the life of the National Initiatives and yielded results that have echoed throughout the organizations that have participated. “Ochsner Health System’s participation in all four AIAMC National Initiatives (NIs) has yielded far more than just finalized projects and presentations,” said Ronald Amedee, MD, Designated Institutional Official and Chairman, Otolaryngology, Ochsner Health System, and President, AIAMC Board of Directors. “In addition to substantial patient safety improvements, the NIs have provided us with the ability to submit manuscripts, create a robust Resident Quality Council and be recognized by our C-Suite for the value of GME and its integration in quality improvement efforts.”

For National Initiative V, AIAMC plans to involve residents and fellows in addressing health care disparities from the front line. National Initiative V participants will be selected in the summer of 2015 with the first meeting in October 2015.

For more information on the AIAMC and their National Initiatives, contact Kimberly Pierce-Boggs, Executive Director, at or visit



[1] Weiss KB, Wagner R, Bagian JP, et al. Advances in the ACGME Clinical Learning Environment Review (CLER) Program. Journal of Graduate Medical Education. Dec. 2013; 718-21.

[2] Ibid.

[3]Background of the AIAMC National Initiative. The Alliance of Independent Academic Medical Centers. Accessed 7/11/14 at