The Duke University Medical Center Internal Medicine Residency Program did not reach its anticipated quota of applicants during the 2008 National Residency Matching Program. Post-Match feedback regarding workload prompted an effort to redesign the general medicine service. As part of that effort, Duke program leaders sought to learn how peer programs accommodated Accreditation Council for Graduate Medical Education (ACGME) regulations. They launched the Resident Site Visit Project (RSVP).In 2008, Duke resident teams visited six other academic internal medicine residency programs based in university hospitals in the eastern United States. They conducted a systematic survey using a standardized questionnaire, interviewed program leaders and residents, and observed workflow directly. The RSVP identified strategies for accommodating ACGME rules in service design and also highlighted challenges shared by all of the programs.Discussion of the shared challenges yielded six core principles that directly guided Duke's general medicine service redesign: emphasize patient safety, reduce resident work compression, create educational opportunities, ensure automatic duty hours compliance, preserve essential program attributes, and involve stakeholders in the process of change.The Duke RSVP is an approach to programmatic change that applies information collected during site visits in defining core principles for program redesign. Collaboration between programs through resident site visits facilitates innovation, creates a foundation for change that increases stakeholder involvement, and generates opportunities for multicenter research.