Accomplishing medication reconciliation has proven to be a difficult task in the ambulatory setting. Conducted in four academic primary care clinics, this study targeted medication reconciliation through a multifaceted intervention involving patient engagement as well as training and performance feedback for staff members. Although medication list completion and accuracy both improved significantly, half of medication lists remained incomplete after the intervention, and the majority contained errors. In view of the lack of proven strategies for improvement, The Joint Commission no longer formally scores medication reconciliation during on-site accreditation surveys (although it remains a National Patient Safety Goal).