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Sponsoring Institution
By: Tori Hanlon, MS Tori@partnersinmeded.com
End of the CLER Era: What Comes Next for Sponsoring Institutions and Programs
We are no longer in our CLER era. The ACGME is winding down the Clinical Learning Environment Review (CLER) Program, which, for over a decade, has provided sponsoring institutions with structured feedback on patient safety, quality improvement, supervision, well-being, professionalism, care transitions, and teaming. CLER visits were not evaluative, but they offered valuable insights to help institutions strengthen their learning environments and align graduate medical education with healthcare system priorities. It also presented an opportunity for increased engagement from health system leaders and quality/safety leaders in our GME programs.
With the program’s closure, institutions will no longer receive external CLER site visits. Instead, the responsibility shifts to sponsoring institutions and programs to sustain progress internally. The ACGME has emphasized that while CLER visits are ending, the expectations remain: institutions are still required to provide residents and fellows with meaningful participation in patient safety and quality initiatives, support well-being, and ensure effective supervision and professionalism across the system. This is evident as outlined in the ACGME’s Institutional Requirements and Common Program Requirements.
Next Steps for Sponsoring Institutions and Programs:
- Integrate CLER Domains Locally: Continue embedding patient safety, QI, and well-being efforts into everyday operations, with ongoing monitoring and feedback mechanisms.
- Leverage APEs and AIRs: Use internal program evaluations and annual institutional reviews to assess progress in the former CLER focus areas.
- Engage Residents and Fellows: Actively involve trainees in system-level improvement initiatives to reinforce their role as both learners and contributors to institutional culture.
- Sustain Collaboration: Maintain strong partnerships between GME leadership, hospital quality/safety leaders, and clinical departments to carry forward the progress built under CLER.
While the end of CLER marks a shift in oversight, it also presents an opportunity for institutions to take greater ownership of their clinical learning environments—ensuring that the values of safety, quality, and professionalism remain central to graduate medical education.
Program
By Carmela Meyer, MBA, EdD carmela@partnersinmeded.com
Getting the Most Out of Residency Interviews: Strategies for Programs
Residency interviews remain one of the most consequential stages in the selection process, offering programs the opportunity to evaluate applicants beyond their academic credentials. An effective interview process allows programs to identify future physicians who not only demonstrate clinical competence but also embody the values, professionalism, and cultural responsiveness essential to serving diverse patient populations. With many programs now using hybrid and virtual approaches, careful planning and intentional structure are critical to ensuring interviews yield meaningful insights.
Clarifying Program Goals Before Interviews
Before launching the interview cycle, programs should define:
- Core values and mission alignment: What qualities reflect your program’s culture, patient population, and educational priorities?
- Key competencies: Clinical knowledge, teamwork, adaptability, communication skills, and commitment to serving underserved communities.
- Alignment with program design: Describe the type of candidate that would “fit” with program design; a rural site may look for candidates from rural areas, a program that focuses on fellowship development may look for candidates with a research background and a clearly stated goal of fellowship training.
A structured set of competency-based evaluation criteria ensures consistency and fairness while guiding faculty in framing their questions.
Structuring the Interview Process: Balanced Question Design
Programs benefit from using a mix of:
- Behavioral questions (e.g., “Tell me about a time when you navigated a conflict in a team.”)
- Situational questions (e.g., “How would you respond if a patient declined recommended treatment?”)
- Mission-focused prompts (e.g., “What role does community engagement play in your professional goals?”)
Using the STAR method framework for evaluation (Situation, Task, Action, Result) allows faculty to compare responses consistently.
Reading Nonverbal Communication in Candidates
Nonverbal cues often reveal as much as spoken responses. For residency programs, being attentive to these subtle behaviors can help assess professionalism, interpersonal skills, and cultural humility.
Key Nonverbal Indicators to Observe
- Eye Contact
- Positive: Steady but not intrusive eye contact signals engagement and confidence.
- Cautionary: Avoiding eye contact altogether may suggest discomfort, while over-fixation can appear rehearsed or artificial.
- Posture and Body Orientation
- Positive: Upright posture, leaning slightly forward, and open body positioning suggest attentiveness.
- Cautionary: Slouching, crossing arms, or turning away from the camera or interviewer may indicate disengagement.
- Facial Expressions
- Positive: Natural expressions that align with tone (smiling when appropriate, showing concern when discussing patient care).
- Cautionary: A flat affect throughout the interview may suggest a lack of interest, while exaggerated expressions can seem performative.
- Gestures and Hand Movements
- Positive: Moderate hand gestures that complement speech can highlight communication skills.
- Cautionary: Excessive fidgeting, pen-clicking, or abrupt gestures may signal anxiety or lack of focus.
- Tone of Voice and Pacing
- Positive: Clear articulation, appropriate pacing, and modulation convey professionalism and confidence.
- Cautionary: Monotone delivery or rushed speech can reduce clarity and perceived enthusiasm.
Virtual Interview Considerations
Nonverbal cues are harder to interpret on screen, but programs can train interviewers to look for:
- Camera presence: Candidates who position themselves at eye level and maintain screen awareness demonstrate adaptability to professional virtual environments.
- Active listening signals: Nod, brief affirmations (“yes,” “I see”), and appropriate pauses show engagement.
- Minimizing distractions: A focused presence without multitasking conveys respect for the process.
Avoiding Bias in Interpretation
While nonverbal communication is valuable, programs must exercise caution:
- Consider cultural norms — for instance, limited eye contact may reflect respect in some traditions.
- Factor in interview stress, as nervousness can temporarily alter natural body language.
- Use structured rubrics so that nonverbal impressions supplement — but never overshadow — the applicant’s words and credentials.
Resource: G. Gillis. Nonverbal Communication in Medical Interviews. Med Educ Online. 2019.
Maximizing Virtual Interviews
Virtual formats can enhance equity by reducing financial and travel barriers, but require careful planning to prevent biases.
Program Best Practices:
- Standardized technology: Provide clear instructions, platform testing sessions, and backup contact methods for applicants.
- Ensure consistent interviewer training: Virtual settings can magnify differences in interpretation; calibration sessions improve reliability.
- Focus on nonverbal presence: Train interviewers to assess candidate engagement based on digital cues.
- Build community feel: Offer virtual resident panels, program tours, and informal Q&A to showcase program culture.
Spotlight: The Virtual Resident Lunch
One of the most effective ways to replicate the informal, relationship-building aspects of in-person interview days is the Virtual Resident Lunch. This event allows applicants to interact with current residents in a relaxed, unstructured setting, often without faculty present.
Benefits for Programs:
- Provides applicants with a candid view of residents’ life and culture.
- Demonstrate transparency and approachability.
- Offers residents a chance to showcase camaraderie, support systems, and wellness initiatives.
Implementation Tips:
- Keep group sizes small (6–8 applicants with 2–3 residents) to encourage genuine conversation.
- Use breakout rooms for rotation if there are large applicant pools.
- Send meal delivery vouchers or gift cards to applicants to recreate the feel of a shared lunch.
- Encourage residents to share stories about mentorship, patient experiences, and community engagement.
Evaluating and Debriefing
- Use structured rubrics to minimize implicit bias and ensure fairness across all interviewers.
- Collect resident input, as peer impressions often highlight interpersonal strengths not captured in formal settings.
- Conduct post-interview debrief sessions to discuss alignment with program mission and long-term retention goals.
Suggested Resources for Programs
- AAMC Best Practices for Residency Interviews
- National Resident Matching Program (NRMP) Program Director Survey
- The Impact of Virtual Interviews on the Resident Candidate: A Before-and-After Comparison for a Family Medicine Program (Bishop et al., 2022)
- The Impact of Virtual Interviews on Recruitment and Implicit Bias (Family Medicine PDs survey) (Keister et al., 2022)
- Applicant perceptions: Virtual Residency Interviews: Applicant Perceptions Regarding Virtual Interview Effectiveness, Advantages, and Barriers, Journal of Graduate Medical Education, 2022.
GME Office / Administration
Amy Durante, MHA amy@partnersinmeded.com
Make it a Checklist
In the fast-paced world of Graduate Medical Education (GME), program directors, coordinators, Designated Institutional Officials, and academic affairs offices juggle countless responsibilities. With so many moving parts, it’s easy for important details to slip through the cracks. One simple yet powerful tool to combat this challenge is to utilize checklists. While checklists are often associated with onboarding new residents, their value extends throughout the academic year across multiple administrative functions.
Onboarding is a natural setting for using checklists. Coordinators can track the completion of required forms, credentialing, IT access, and orientation activities in a structured and reliable manner. But why stop there? A well-designed checklist can provide structure and accountability during other recurring tasks in GME, reducing stress and ensuring compliance.
- Evaluations
While the resident management suite automates the distribution and collection of evaluations, program leadership must first ensure that the correct evaluations are created and aligned with accreditation requirements. A checklist serves as a guide to confirm that all necessary evaluation types are set up in advance. For example, some evaluations are required quarterly, others semi-annually, and some must be anonymous. A checklist can itemize each of these evaluation categories—faculty evaluations of residents, residents’ evaluations of faculty, rotation evaluations, program evaluations, and 360-degree evaluations—along with their required frequency. It can also note specific content elements required by the ACGME or institutional policies. By using a checklist in this way, coordinators and program directors can be confident that all required evaluations are properly designed and scheduled, thereby reducing the risk of compliance gaps and ensuring that meaningful data is available for program, resident, and/or improvement purposes.
- Program Evaluation Committee (PEC) Preparation
The PEC meeting is a crucial component of program quality improvement. A checklist can guide coordinators and program leaders through gathering annual program evaluation data, faculty and resident surveys, curriculum reviews, and minutes from prior meetings. With each item checked off, the program ensures it enters the meeting fully prepared and aligned with ACGME expectations.
- Clinical Competency Committee (CCC) Meetings
CCC meetings require careful preparation, including compiling milestone data, scheduling, and ensuring that all members have access to necessary evaluations and supporting documentation. A checklist standardizes this preparation process, ensuring that all necessary data are available for meaningful resident performance reviews. It also assists in documenting due diligence for accreditation site visits.
- Graduate Medical Education Committee (GMEC) Agendas and Minutes
At the institutional level, the Academic Affairs office can use checklists to streamline preparation for GMEC meetings. Agendas must include specific items to comply with ACGME requirements, and minutes must reflect the committee’s oversight responsibilities. A checklist helps ensure that no required item is overlooked, providing both structure and assurance of compliance.
A Culture of Consistency and Accountability
Checklists don’t just make tasks easier—they build a culture of consistency and accountability. By incorporating them into daily workflows, coordinators and administrators gain peace of mind, reduce errors, and ensure compliance. Even more importantly, checklists free up cognitive bandwidth, allowing GME professionals to focus on higher-level priorities, such as supporting residents, faculty, and program growth.
In GME administration, the smallest details can have the biggest impact. A thoughtfully created checklist is more than just a to-do list; it’s a powerful tool for enhancing efficiency, ensuring compliance, and driving quality improvement throughout the academic year.
Finance / Public Policy
By: Christine Redovan, MBA, MLIS Christine@PartnersinMedEd.com
Oh, Canada – The Minor Edit with Major Consequences
On June 8, 2025, the ACGME approved changes to Sponsoring Institution requirements 4.2.a.1 and 4.2.a.3, which included graduation from a medical school in the United States or Canada, accredited by the Liaison Committee on Medical Education (LCME), and graduation from a medical school outside of the United States or Canada, respectively. The changes include the removal of the phrase “or Canada” from both requirements.
What happened and why?
- Canada’s MD programs switched to sole Canadian accreditation on July 1, 2025. Prior to this, Canadian MD schools were jointly accredited by LCME and the Committee on Accreditation of Canadian Medical Schools (CACMS). The LCME ceased accrediting Canadian medical schools as of July 1, 2025. (1)
- Prior to this change, we treated U.S. and Canadian medical student graduates the same. Since the LCME is no longer accrediting Canadian medical schools, effective July 1, 2025, Canadian graduates are considered international medical graduates (IMGs) when entering an ACGME-accredited residency program if they graduated on or after July 1, 2025. (2)
- The de-coupling from LCME co-accreditation of Canadian medical schools has gained traction since the introduction of the CACMS social accountability standard in 2013. LCME and CACMS finalized this intention in 2021. (3)
What does this mean for residency programs?
- Canadian medical students must obtain ECFMG certification to be eligible to enter ACGME-accredited residency programs in the U.S. and to sit for USMLE Step 3. (2)(5)
- Pay attention to Canadian applicants this recruitment season to ensure the student has a valid ECFMG certificate and meets NRMP participation rules. (4)
- Monitoring visa and entry requirements is essential for this group of candidates.
- Canadian graduates will be included in IMG reporting data.
While you may not think this change affects you, think again! As GME institutions and programs, we ALL must update our resident recruitment and appointment policies.
References:
- https://lcme.org/directory/accredited-canadian-programs/
- https://ecfmg.org/certification/eligibility-canadian-schools.html
- https://www.cma.ca/latest-stories/why-its-important-canada-accredits-its-own-medical-schools
- https://www.nrmp.org/residency-applicants/get-ready-for-the-match/are-you-eligible/
- https://www.usmle.org/effective-july-1-2025-canadian-medical-graduates-will-be-designated-imgs
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