Twentieth century postgraduate nephrology training evolved from an apprenticeship model to a defined period in formal fellowship. Subsequently, curriculum content taught by an engaged faculty, including broad clinical exposure, literature review, and investigative experience, established the benchmark of quality education. Self-directed study by the trainee was emphasized, and competence to practice nephrology was presumed in part on the basis of adequate exposure to a program's curriculum. At the close of the century, multiple accreditation bodies of medical education questioned the validity of this educational process in medical training. As a result, the Accreditation Council for Graduate Medical Education instituted 6 general competencies as the foundation of an outcomes-based education philosophy. Although some disciplines have developed an evidence base for educational techniques directed at outcomes, nephrology has few publications in this arena and these principally address curriculum structure. Interventional nephrology is a recent exception. In this area of training, publications have appeared linking educational process with learner outcome. Opportunities are abundant to implement and study new educational techniques, including simulation and e-learning. To keep pace with contemporary medical education philosophy, the nephrology education community is challenged to apply evidence-based education techniques to the training of 21st century nephrologists.