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One recommended method to evaluate residents’ competence in practice-based learning and improvement is chart audit. This study determined whether residents improved in providing preventive care after a peer chart audit program was initiated.Residents audited 1,005 charts and scored their peers on 12 clinical preventive services. The mean total chart audit scores were compared across five time blocks of the 45-month study.Residents’ performance in providing preventive care initially improved significantly but declined in the last ten months. However, their performance remained significantly higher than at the beginning.By auditing their peers’ charts, residents improved their own performance in providing preventive care. The diffusion of innovations theory may explain the prolonged implementation phase and problems in maintaining a chart audit program.