The Accreditation Council for Graduate Medical Education’s required Annual Program Review of Educational Effectiveness (APREE) has helped us improve our program and change its culture to one of continuous quality improvement. This report outlines our systematic process and describes specific outcomes it has produced over a 10-year period. We identified ways to enhance our APREE after reading articles that described various ways to conduct the process found in a PubMed and OvidSP search and relevant policies from our local Graduate Medical Education Office. After discussing options, we incorporated new ideas into our APREE and tasked our Program Evaluation Committee to track outcomes from objectives developed by faculty and residents during each APREE. Objectives from faculty and residents in 10 years of our APREE led to major improvements (e.g., increased board pass rate) in our program. In addition, the enhanced APREE process gradually changed our residency’s culture to one that embraces continuous quality improvement. A systematic APREE process can engage residents and faculty in improving specific components of a residency. Besides providing outcomes for Web Ads and Self-Study items, the APREE models quality improvement techniques to residents, involves a wide array of stakeholders, and helps program stakeholders embrace continuous quality improvement.