David Moyes expects there to be more changes behind the scenes at the Stadium of Light.
Club doctor Ishtiaq Rehman and assistant academy manager Danny Philpott have both parted company with Sunderland in the past week.
Dr Rehman resigned earlier this week and the Echo understands the split was amicable, with both parties deciding it was the best decision moving forward.
Highly-rated Philpott joined from Everton in November 2014 on the understanding that he would eventually replace academy chief Ged McNamee.
Sunderland appointed new chief executive Martin Bain and Moyes as manager in the summer and changes are being made behind the scenes across all areas.
Moyes says the club doesn’t want to make huge changes, but he admitted: “I do expect more changes, in time.
“I don’t want – or the club doesn’t want – to be making sweeping changes.
“There have been changes made for different reasons, for different scenarios.
“I think Danny had come in probably with an assumption of becoming an academy manager, but the club has chosen that wouldn’t be the way to go.
“The doctor handed in his own resignation.
“It has meant they weren’t necessarily things we would have been doing right away, but, because of the situation we were in, things had to be stepped up and moved on.”
Moyes was asked whether Dr Rehman’s resignation was specifically to do with the incident involving the late withdrawal of Patrick van Aanholt at Tottenham Hotspur after a heart scare last month.
“I genuinely don’t think so, I don’t know if it was a culmination of things,” added Moyes.
“It is not an easy job being a club doctor now.
“Someone needs a scan, someone is away for this or that.
“It becomes quite a big job.”