The development and evaluation of graduate medical education in the United States from the late 19th century to the present are founded on the structure, role, and function of the accrediting bodies (the Accreditation Council for Graduate Medical Education and the Residency Review Committees). The general and specific requirements for accreditation of orthopedic programs, the processes for accreditation of existing and new residency programs, and the current status of fellowship accreditation are continuously under evaluation.