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Seven years ago the Institute of Medicine’s report, Crossing the Quality Chasm1, issued a challenge to transform America’s healthcare system. If this challenge is to be met any time soon, it will require profound leadership by general internists. This, in turn, requires that the next generation of internists be trained in residency programs with a commitment to transforming healthcare in the settings where those future physicians train and practice. In 1999, the Accreditation Council for Graduate Medical Education (ACGME) radically redefined physician competence by framing two of the six core physician competencies as system redesign and improvement—Systems-Based Practice (SBP) and Practice-Based Learning and Improvement (PBLI).2 The American Board of Medical Specialties adopted the same competencies for specialty certification, thus acknowledging the importance of the continuum of a physician’s learning. These two competencies redefined healthcare and health professions’ education by acknowledging physicians’ professional responsibility to improve healthcare and systems.

The Evidence Is at Hand for Improving Care in Settings Where Residents Train