The goal of pediatric graduate medical education in residency and fellowship programs is to train learners to become pediatricians or pediatric subspecialists that are ready for independent practice. There must be educational and clinical experiences in place to provide for knowledge and skill acquisition with the ability to demonstrate and utilize those skills to provide exceptional patient care. The infrastructure used to help trainees gain the knowledge and skill needed is what forms the curriculum of each training program. While there are certain rules and regulations that dictate what programs must provide to their trainees, how programs go about doing that can be greatly individualized. In this chapter, we will discuss ways to utilize the strengths of the program to provide curricula to guide knowledge and skill acquisition in the clinical arena.