The outpatient environment has been the leading edge of improvement work in pediatrics and it has similarly served as an effective locale for the training of pediatric residents in the science of improvement. This review summarizes what is known about the measurement of quality and patient safety in pediatric ambulatory settings. The current Accreditation Council for Graduate Medical Education (ACGME) requirements for resident training in improvement and their application in these settings are discussed. Some approaches and challenges to meeting these requirements are reviewed. Finally, some future directions that this work may follow are presented; the goal is to strengthen the effectiveness of improvement methods and their linkage to professional education.