The Accreditation Council for Graduate Medical Education (ACGME) has recently begun to use educational outcome measures as an accreditation tool. This long-term initiative offers the potential for building knowledge about effective educational interventions and ultimately for using time-variable educational models. This article reviews the progress of the ACGME initiative and plans of the initiative and explores the broader implications of competency. In addition to knowledge and skills the product of a good educational program is a physician who habitually exercises good clinical judgments. Skill sets and accountability proceed along a continuum that is outlined. Crucial is the development of a community committed to discerning and obeying the truth about the effectiveness of educational interventions.