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The Preparing the Personal Physician for Practice (P4) project has been like a coastal lighthouse, helping us navigate the shoals of transforming residency programs and guiding us to the next harbor. Carney and colleagues’ report1 in this issue of Family Medicine is a valuable summary of the immense amount of work of the P4 residencies and an outstanding research team. It is important to reflect on where we are. The major messages of P4 for our specialty are clear: a. Family medicine residencies are interested in and capable of significant experimentation in design and conduct of residency training. Eighty-four residencies—about a sixth of all residencies in the country—applied to participate, undeterred by significant data submission requirements and lack of funding. b. The external evaluation team played a key role, requiring common data collection and surveying all graduates 18 months out. Their engaged approach supported individual residencies in asking and answering important questions in a way that others can learn from. c. Accreditation Council for Graduate Medical Education (ACGME) residency review is compatible with innovation. When P4 started, a common concern was that our residency review committee was not supportive of innovation. It is now clear that substantial innovation, when thoughtful and proactive, is possible within the ongoing accreditation process. Citations happen—but not significantly more frequently than in programs which have not chosen to change. We are grateful to the Family Medicine Review Committee and its leadership for being clear about this. d. What residencies have chosen to change is also important. Given the opportunity, they chose a wide variety of areas, from duration of training, to process of care in residencies, to core competencies of teambased care, and many other topics. These are the hot spots for future reform of residency training: salient issues are the duration of training (now the subject of a formal trial supported by the American Board of Family Medicine), and scope of practice. So where are we now? Since the publication of the Future of Family Medicine report in 2004,2 half a generation has passed. With respect to residency training, many aspects of the new model of practice (EHRs, team-based care, training in quality improvement) have been incorporated broadly into routine residency training. At the ACGME level, the Next Accreditation System has been implemented, with clinical competence committees and regular review of developmental milestones for residents. For individual residencies, however, it remains unclear how often patients have been engaged in changing the process of their care, how much measured access or quality outcomes have improved, or how widespread teaching of new competencies in team-based care has been. Preparing the Personal Physician for Practice: What We’ve Learned and Where We Need to Go