Postgraduate training of pathologists in the United States dates from 1926. From 1926 to 1936, certification was developed as a measure of competence for the public. In 2000, competence was redefined by the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project for all physicians-in-training as mastering "the six competencies." These consist of (1) patient care, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism, and (6) systems-based practice. The Outcome Project emerged in parallel with the American Board of Medical Specialties' Maintenance of Certification Project for all physicians. Outcome measures and benchmarks are the methods by which competence in medical practice will be measured for the public. Trends in pathology graduate medical education previously reported in 2001 (Hum Path 2001;32[7]:671-676) are updated through 2005 and reviewed. Demographic data regarding number and size of programs, curricula initiatives for pathology, changes in assessment, and outcomes information on certificates issued are discussed. Factors shaping pathology residency training are reviewed, as well as future trends that will impact training curricula.