Pediatric residency programs may opt to establish a new training track to align with educational, institutional, and societal priorities. This chapter reviews considerations and practical steps for starting a new training track. New tracks can offer individualized learning that aligns with residents’ interests and career goals in areas such as primary care, public health, advocacy, research, global health, and medical education (Paradise Black et al. J Pediatr 165(6):1076–7, 2014, Lichtenstein et al. Acad Pediatr 17(5):544–9, 2017). At the outset, it is important to identify the educational gap and articulate the rationale for creating a new track. Program leaders should determine the grounds for starting a new track and consider implementing a framework such as Kern’s six-step approach (Thomas et al. Curriculum development for medical education: a six-step approach. Johns Hopkins University Press, 2015) to outline the track’s curricular goals. Early steps necessarily include a needs assessment, generating buy-in from invested parties (Throughout this chapter we will use “interested parties,” “key decisionmakers,” and similar phrasing in place of the word “stakeholder” which has origins in the colonization of Indigenous peoples.), recruiting leaders for the new track, and planning the educational content. Considerations for new positions for the track include funding and recruitment. Lastly, it is critical to evaluate the new track to create improvements, justify its continuation, or secure additional funding.