Participants of the Residency Review and Redesign (R(3)P) Project have created a challenging strategic plan for pediatric residency education. In place of a list of prescriptions for immediate change, the R(3)P Committee recommends an ongoing project of goal-directed change, a quality improvement approach to resident education. It argues for changes based on evidence of important education outcomes that improve the health of children, adolescents, and young adults. Creation and maintenance of a process of ongoing, adaptive change will depend on the combined efforts of the Association of Pediatric Program Directors, the Association of Medical School Department Chairs, the American Board of Pediatrics, the Resident Section of the American Academy of Pediatrics, and the Accreditation Council for Graduate Medical Education Review Committee for Pediatrics.