Recognizing a number of important gaps in preparing residents for unsupervised practice, the Accreditation Council for Graduate Medical Education (ACGME), in collaboration with the American Board of Medical Specialties, launched the Outcomes Project in 2001.1 Educational outcomes were codified through 6 general competencies to help training programs in all specialties meet 21st century health care needs: patient care, medical knowledge, professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based practice. The internal medicine community was also calling for substantial reforms.2 Implementation was challenging, however.