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Orthopaedic residency has undergone continual evolution since the early 1900s. Training has evolved from a preceptorship to a highly evolved and structured educational system which largely standardizes training throughout the United States. Approval and accreditation of training programs, as well as content, is now overseen by a hierarchical group of organizations with representations from a variety of medical societies and boards. The evolving process has served the public well, providing competent care of the musculoskeletal system.