The assessment and accreditation of medical education training in the United States is rapidly moving from experience-based to competency-based measurement. The Accreditation Council for Graduate Medical Education (ACGME), the governing body for this process in the United States, is transitioning to a system of collecting annual program performance and attainment of competencies by trainees as key measures of training program performance. This presentation will describe this new accreditation system and introduce, with examples, the concept of achieving “milestones” based on six core competencies. These competencies include: patient care, medical knowledge, practice-based learning and improvement, interpersonal/communication skills, professionalism, and systems-based practice. This new approach recognizes that process measures and relying on clinical exposure alone may not be adequate in assuring that trainees have acquired the skills to practice independently in their field.