The best way to manage change in a training program is to expect it. While the details of the challenges will vary, the consistency of its arrival is assured. Change can arrive expectedly or unexpectedly, as a large or small entity, from external or internal sources, from an individual, the institution, or one of the governing bodies of surgery, or from leadership, financial, or structural challenges. The goals of successfully managing these changes are to support your residents and faculty while maintaining accreditation requirements and ensuring that optimal patient care is not compromised. This chapter will review the most common types of changes encountered in a training program, present the challenges and opportunities afforded by each, and will offer best practices in addressing each of them.