The Loma Linda University (LLU) pediatrics program offers a unique opportunity for outstanding education in a large academic tertiary setting while maintaining a more intimate small program feel. This dichotomy is in part due to the program’s strong relationship with a unique faith-based university that has maintained a steadfast commitment to service and medical education since its establishment in 1902. The program is based at Loma Linda University Children’s Hospital (LLUCH), a 299-bed tertiary hospital serving ~1.3 million children. LLUCH offers experience in all pediatric sub-specialties; however, there are very few fellowship programs. Consequently, residents function as primary consultants and experience close working relationships with both sub-specialty and general pediatric faculty. This learning environment creates a strong sense of camaraderie and collegiality with both faculty and fellow residents. The environment of ownership and inquiry also provides residents more autonomy and leadership opportunities than standard fellowship-driven academic programs of this size.