Supportive program leadership, 3+1 ambulatory block schedule improves clinical service, education, ambulatory clinic building, ultrasound/QI/simulation medicine, individualized learning plans tailored to future career path, residents and faculty mentorship, pulmonary-CCM joint fellowship with CPMC, dedicated primary care immersion weeks for the primary resident program, health justice curriculum, wellness support, dedicated resident counselor, and academic 1/2 day protected teaching Q4 weeks.