OBJECTIVE As a component of the practice-based core competency of the Accreditation Council for Graduate Medical Education, all radiology residents must receive training to be able to evaluate and improve their patient care practices. To achieve this goal, our quality management section has implemented a comprehensive elective rotation in quality assurance. METHODS We have designed a month-long structured resident elective in radiology quality assurance at the Beth Israel Deaconess Medical Center, Harvard Medical School. This elective provides a combination of didactic teaching, self-learning, and practical experience in the methodology, workings, and clinical applications of quality assurance as these relate to improving technical and clinical performance in a large academic radiology department. RESULTS During this rotation, residents are exposed to the spectrum of commonly used tools and techniques used for performance improvement related to the practice of radiology. By actively participating in department and hospital quality assurance (QA) committee meetings, and through initiation of a mentored project coupled with didactic instruction, residents are exposed first hand to the practice and role of continuous quality monitoring and to the implementation and monitoring of action items. CONCLUSIONS Participation in our QA elective provides our residents with a comprehensive exposure to the spectrum of quality-related problems, and equips them with the necessary tools to resolve many of the clinical or technical problems they are likely to encounter in their future careers. It is thus an appropriate tool to instruct residents in the competency of "practice-based learning and improvement."