Over the past decade, patient safety concerns have prompted reconsideration of the working conditions and supervision of medical trainees. In 2003 ACGME regulations came out and, for the first time, limited housestaff work hours. In late 2007, the Institute of Medicine (IOM)—responding to strong concerns voiced by the US Congress—assessed the evidence between these relationships and published a landmark report that recommended further limits on work hours and workload, a focus on improving handoffs, and increased faculty supervision of trainees. This white paper grew out of a conference of 26 expert stakeholders, held to discuss implementation of the IOM recommendations. The report serves as a guide and foundation for policymakers, hospital administrators, and residency program directors who are working diligently to meet these requirements. Of note, the authors point out that the new July 2011 ACGME requirements that tightened the 2003 mandates still fall considerably short of the IOM recommendations and those in this white paper. A past AHRQ WebM&M conversation and perspective discuss the role of graduate medical education and patient safety.