Physicians must be ready to assume an active role in the design, implementation, and improvement of emerging models of health care delivery. Knowledge and skill in continuous improvement prepare them to engage seriously in the processes of change, on the basis of the same scientific principles they always have relied on in the use of evidence to improve outcomes. This includes include the ability to 1) identify the health needs of the individuals and communities for which they provide health services; 2) assess the impact of current practice with appropriate outcome measures; 3) discover what in the process of health care may be contributing to less than desired outcomes; 4) design and test interventions to change the process of care to improve outcomes; 5) act as an effective member of the interdisciplinary team required to complete these tasks; and 6) consider ethical principles and professional values when making decisions about change in health services delivery. Graduate medical education presents special opportunities and challenges for learning about continuous improvement. Early experiences at Rainbow Babies and Children's Hospital in Cleveland and Children's Hospital in Boston suggest how we might prepare pediatricians and other physicians to create positive change and continually improve health care. Pediatrics 1998;101:768-774.