Over the past two decades, our internal medicine residency has created a unique postgraduate education in internal medicine by incorporating a formal curriculum in point-of-care cardiac ultrasound as a mandatory component. The details regarding content and implementation were critical to the initial and subsequent success of this novel program. In this paper, we discuss the evidence-based advances, considerations, and pitfalls that we have encountered in the program’s development through the discussion of four unanticipated tasks unique to a point-of-care ultrasound curriculum. The formatted discussion of these tasks will hopefully assist development of ultrasound programs at other institutions.