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Orthopaedic surgery residency education is evolving from the historic mantra of “see one, do one, teach one” to incorporating more formal skill programs into curricula. Each training environment possesses unique resources and constraints, with no single one-size-fits-all approach. Cost remains the single greatest barrier to the development of orthopaedic surgery skills programs. Time also is a concern, as trainees have a finite amount of time to spend in the training environment. Furthermore, time spent in simulation or a skills workshop has the potential to interfere with time spent on direct patient care. Training programs must therefore utilize all available resources in a thoughtful and efficient manner to maximize the educational potential of such a program. By enlisting the help of enthusiastic educators and partners, program directors can build a team with shared common goals. This includes collaboration between training programs, medical schools, and industry. Experience across all levels of orthopaedic knowledge can be incorporated in a top-down fashion to both facilitate trainee education and create an environment conducive to future growth. As educational technology becomes more accessible and educational research advances, skills programs will be able to adapt and adopt evidence-based strategies to improve orthopaedic trainee education.