Comments: ACGME Response.

Abstract

In his letter to the editor,1 Dr Nagy raises important issues about faculty skills in advancing quality improvement (QI) within their clinical learning environments, and faculty skills and experience in supervising and guiding residents and fellows in the conduct of QI activities during their graduate medical education experience. Dr Nagy presents these issues as the challenge of trying to define and assess faculty proficiency. While achieving proficiency would seem like a reasonable goal for such an important set of clinical skills, at this point in time the Accreditation Council for Graduate Medical Education's (ACGME's) Clinical Learning Environment Review (CLER) program is focused on more basic issues, specifically faculty knowledge of and engagement in QI efforts. Early findings from CLER visits to date demonstrate wide variability in faculty members' awareness of basic QI concepts and the QI methods used in the hospitals and medical centers where they practice and teach clinical medicine. Similarly, there is variation in faculty's and program directors' level of engagement with residents and fellows in conducting QI activities. For these reasons, Health Care Quality Pathways 1 and 2 were included as part of the CLER Pathways to Excellence document.2 By highlighting these issues, the CLER program is signaling the need for faculty development in this area. It is our hope that, over time, the graduate medical education community will come to a general understanding of what defines proficiency for faculty as they train residents in QI. We agree with Dr Nagy that the Association of American Medical Colleges' effort to elucidate competencies for faculty3 is a useful step in advancing these skills, and improving the clinical learning environment.