Johns Hopkins All Children’s Hospital (JHACH) residents have the unique opportunity to be leaders contributing to the development of a new academic enterprise. Residents have the chance to work with interdisciplinary teams to change pediatric health care delivery and systems of care for the future. We believe that resident physicians can lead these changes with their peers and faculty colleagues. At JHACH, we promote the pursuit of individual academic excellence in patient care, education, research and leadership. Our new pediatric residency program incorporates standard components of residency training such as progressive responsibility and exposure to multiple subspecialties. Innovative elements of the curriculum include a second year focused on outpatient experiences, an ACGME competency-based curriculum, and novel opportunities for career development. In addition, residents create individual learning plans that form the basis for their rotation schedules and promote each resident’s distinct career goals, including frequent faculty exposure and guidance.