OBJECTIVE: The healthcare system accounts for 8%-10% of all greenhouse gas emissions in the United States and hospital buildings are significant contributors. Operating rooms account for 20%-33% of all hospital waste. This may contribute to significant climate change and negatively affect public health. Physicians and surgeons must act to reduce our collective carbon footprint to improve the health of our patients. The traditional graduate medical education curriculum does not routinely train future generations of physicians in healthcare sustainability. We describes a fellowship program designed to change this. DESIGN AND SETTING: The Cleveland Clinic surgical residency has implemented a unique educational program. Here we describe the 5-year results of our novel fellowship program in health care sustainability, primarily focused on greening the operating room. PARTICIPANTS: Selected General Surgery residents interested in healthcare sustainability and greening the operating room. RESULTS: We have successfully implemented a novel resident focused fellowship program in healthcare sustainability. Fellowship projects have led to significant reductions in our hospitals' collective carbon footprint. CONCLUSIONS: Surgeons have a unique responsibility to reduce the carbon footprint of the Operating Room. Implementing a dedicated fellowship program or similar intensive educational experience in healthcare sustainability within the framework of a graduate medical education curriculum will help to ensure future generations of surgeons are thoughtful leaders in environmental stewardship.