The current terminology, goals, and general competency framework systematically utilized in the education of residents regardless of specialty is almost unrecognizable and quite foreign to those who trained before 2010. For example, the clinical and professional expectations for physicians-in-training have been placed onto a developmental framework of milestones. The expectations required during training have been expanded to include leadership and team participation skills, proficiency in the use of information technology, systems-based knowledge including respect of resources and cost of care, patient safety, quality improvement, population health and sensitivity to diversity for both individual and populations of patients. With these additions to physician training, the Accreditation Council for Graduate Medical Education (ACGME) hopes to remain accountable to the social contract between medicine and the public. With a focus on psychiatric practice, this article provides a general background and overview of the major overhaul of the accreditation process and educational goals for graduate medical education and briefly highlights possibilities for the future.