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* Context.--The Accreditation Council for Graduate Medical Education (ACGME) established a new system for accreditation of residency and fellowship programs in 2013. One key aspect of the Next Accreditation System is the 10-year self-study, which requires programs to conduct a comprehensive self-evaluation, including development of program aims and analysis of strengths, weaknesses, and environmental context, in order to plan improvements and take the program to the next level. Objective.--To provide a review of the recent changes and current state of ACGME accreditation, with a focus on the new 10-year self-study, and to share our institution's experience with conducting the first self-study of our pathology residency and accredited fellowship programs in 2018. Data Sources.--Review of English-language literature, published resources from the ACGME, and materials/data from our department's 2018 self-study. Conclusions.--The self-study process now required for ACGME accreditation is a useful way to assess program strengths and weaknesses in the context of current environmental and institutional factors, and helps develop an effective framework for improvements geared at achieving program aims and taking the program to the next level. Additionally, conducting residency and fellowship self-studies together allows for collaboration, effective use of shared resources, and the development of a cohesive educational mission. (Arch Pathol Lab Med. 2019;143:1271-1277; doi: 10.5858/arpa.2018-0467-RS), In 2013, the Accreditation Council for Graduate Medical Education (ACGME) established the Next Accreditation System (NAS), which included several new concepts in residency/fellowship accreditation, including the 10-year self-study. Although self-study [...]