Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited. Academic Medicine, Vol. 88, No. 5 / May 2013 1 Article The Accreditation Council for Graduate Medical Education (ACGME) mandates that internal medicine residencies include a didactic program based on the core knowledge content of internal medicine. 1 Many residency programs fulfill this requirement with traditional noon conferences even though the evidence for the efficacy of the classic, lecture- based conference series on long-term knowledge retention is conflicting, 2–5 and the evidence for the impact of that kind of learning model on patient care is, at best, minimal. 6 Over the past several years, work hours restrictions, 7 decreasing pharmaceutical support for food at educational conferences, 8–10 and emerging teaching philosophies 5,11–13 have pushed residency program directors to consider alternatives to the traditional daily noon conference. Leaders of several residency programs have sought to improve the delivery of core curricula by instituting a weekly academic half day (AHD) in which learning is concentrated over a longer block of time. Despite the many narrative descriptions of individual AHD curricula available on program Web sites, little published literature on the AHD exists. 14 This article details the experiences of three distinctive internal medicine residency programs whose leaders replaced the traditional noon conference curriculum with an AHD. Although each program’s AHD developed independently of the other two, retrospective comparative review reveals instructive similarities and differences, which may be useful for other residency directors seeking to redesign their educational programs. In keeping with suggested guidelines for describing innovations in medical education, 15 we describe the generalizable problem that inspired the innovation, delineate alternative solutions at three sites, describe some initial outcomes, and reflect on the potential import for graduate medical education. The Problem: Limitations of Noon Conference Though the three residency programs we describe are diverse in setting and size (see Table 1), similar deficits in the traditional noon conference structure for delivering core curriculum occurred at all three. Sustaining resident attendance at noon conferences was difficult. Clinical responsibilities often kept or pulled learners away from teaching sessions. Duty hours changes packed new pressures into the schedule and curtailed time for shared thinking and discussion. Without pharmaceutical industry support for food, the noon conference was losing its ability to attract learners. The typical noon conferences at all three programs entailed passive PowerPoint (Microsoft, Redmond, Washington) lectures with little audience interaction. Faculty articulated no expectations for residents to prepare for the noon conference in advance and made no attempt, when the conference was over, to assess learner retention of the material Abstract Several residency programs have created an academic half day (AHD) for the delivery of core curriculum, and some program Web sites provide narrative descriptions of individual AHD curricula; nonetheless, little published literature on the AHD format exists. This article details three distinctive internal medicine residency programs (Cambridge Health Alliance, University of Cincinnati, and New York Presbyterian/Weill Cornell Medical College) whose leaders replaced the traditional noon conference curriculum with an AHD. Although each program’s AHD developed independently of the other two, retrospective comparative review reveals instructive similarities and differences that may be useful to other residency directors. In this article, the authors describe the distinct approaches to the AHD at the three institutions through a framework of six core principles: (1) protect time and space to facilitate learning, (2) nurture active learning in residents, (3) choose and sequence curricular content deliberately, (4) develop faculty, (5) encourage resident preparation and accountability for learning, and (6) employ a continuous improvement approach to curriculum development and evaluation. The authors chronicle curricular adaptations at each institution over the first three years of experience. Preliminary outcome data, presented in the article, suggests that the transition from the traditional noon conference to an AHD may increase conference attendance, improve resident and faculty satisfaction with the curriculum, and improve resident performance on the In Training Examination. Dr. Batalden is instructor in medicine, Harvard Medical School, and former associate program director, Residency Program in Internal Medicine, Cambridge Health Alliance, Cambridge, Massachusetts. Dr. Warm is professor of medicine, University of Cincinnati, and program director, Residency Program in Internal Medicine, University of Cincinnati, Cincinnati, Ohio. Dr. Logio is Herbert J. and Ann Siegel Distinguished Professor of Medicine, Weill Cornell Medical College, and vice chair for education and program director, Internal Medicine Residency Program, New York Presbyterian/Weill Cornell Medical College, New York, New York. Correspondence should be addressed to Dr. Batalden, Cambridge Health Alliance, 10 Beacon St., Room 111, Cambridge, MA 02139; telephone: (617) 665-3144; fax: (617) 665-3105; e-mail: mbatalden@ challiance.org. Acad Med. 2013;88:644–651. First published online doi: 10.1097/ACM.0b013e31828b09f4 Beyond a Curricular Design of Convenience: Replacing the Noon Conference With an Academic Half Day in Three Internal Medicine Residency Programs Maren K. Batalden, MD, MPH, Eric J. Warm, MD, and Lia S. Logio, MD Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A122.