Introduction The initial visits of the Clinical Learning Environment Review (CLER) Program revealed a number of findings that appeared to be common across many of the clinical learning environments (CLEs) and six focus areas. The CLER protocol did not directly assess for these overarching themes. To derive them, the CLER staff generated a list of findings that were common to many CLEs and presented them to the CLER Evaluation Committee.1 The Committee then prioritized and selected the four overarching themes listed below, all of which they believed could provide graduate medical education (GME) and CLEs with opportunities for high-leverage improvement. Below, each finding is presented in highlighted text, followed by a brief discussion in which the members of the CLER Evaluation Committee share their thoughts on the finding's relevance and the importance of taking a systems-based approach to improving the CLE.;Overarching Themes 1. Clinical learning environments vary in their approach to and capacity for addressing patient safety and health care quality, and the degree to which they engage residents and fellows in these areas.
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