Graduate medical education encompasses the training of medical school graduates in their chosen field of specialty. This includes both residency and fellowship training. Residency and fellowship programs in the US must be accredited in order for a resident to be board-eligible upon graduation. The accreditation of all Family Medicine residency training in the US is the purview of the Accreditation Council for Graduate Medical Education’s (ACGME) Review Committee for Family Medicine (RCFM). This chapter reviews the history and growth of Family Medicine residency training. It outlines and explains the structure, process, and function of the ACGME and the Review Committee for Family Medicine in residency program accreditation, as well as future directions.