The P4 evaluation program represents an observational case series assessment of selected residency programs. It is not an intervention trial; rather each residency program will systematically enroll cohorts of learners who will be exposed to curricular content and learning approaches that will likely be innovative and unique. In the absence of a rigorous study design, core data elements should be obtained from each program including: learner characteristics, program characteristics, and both nationally available data and targeted validated instruments that can link specific educational interventions to learners knowledge, attitudes and skills.