Validation of the competence of laboratory medicine (LM) residents for independent practice and to sit for the examination in clinical pathology rests with the program director. Assessing knowledge and basic skills were the primary measure of residents until 2000. The Accreditation Council of Graduate Medical Education and the ABMS launched the Outcome Project in 2000 as a response to the public. A shift in emphasis from "process" to a more "utcomes driven" assessment came with the Outcome Project. As of July 2006, the training of LM residents must incorporate the six competencies of the Outcome Project within each resident experience (rotation). In this article, comparison of historic and current methods of assessing residents is noted. Current and future outcomes and the pivotal role of consultation in LM are noted. © 2007 Elsevier Inc. All rights reserved.