Since the mid-1980s, the number of osteopathic graduates has increased, and the number of osteopathic hospitals has decreased. This has led to an increasing number of osteopathic students seeking training in Accreditation Council for Graduate Medical Education (ACGME) family practice residency programs. In response to these developments and to a declining pool of allopathic applicants in the early 1990s, at least 35 ACGME programs have completed the American Osteopathic Association (AOA) accreditation process as approved internship sites. This article describes 1) the rationale for becoming accredited, 2) the AOA accreditation process, 3) a model osteopathic curriculum, 4) potential difficulties, 5) issues to consider in approaching a decision to become AOA accredited, and 6) future trends in osteopathic graduate medical education.