Background One in every six adults (16.3% of the U.S. adult population) has high total cholesterol levels, and they are at double the risk of heart disease compared with people with optimal levels. Objective To evaluate compliance of internal medicine residents with the latest National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) guidelines in treating patients with hyperlipidemia. Design Retrospective observational study. Setting Ambulatory Clinic, Saint Vincent Hospital, Worcester, Massachusetts. Patients Patients with a diagnosis of hyperlipidemia who attended the clinic during a 1-ear period, from December 2009 to November 2010. Measurements A review of medical records was conducted to evaluate residents’ compliance with the NCEP-ATP III guidelines for LDL cholesterol and non-HDL cholesterol management. Results Seven hundred seventy charts were reviewed. Only 212 (27.5%) met the inclusion criteria. Analysis of data revealed better compliance with drug therapy (44%−77%) and therapeutic lifestyle changes (44%−83%) when compared with follow-up recommendations (22%−31%). An increase in compliance also was noted in all areas of intervention when patients had an abnormal lipid profile. Limitations Compliance was assessed on the basis of electronic medical record documentation alone and hence we may be underestimating compliance with therapeutic lifestyle changes and follow-up recommendations. Conclusion Compliance among internal medicine residents in the diagnosis, treatment and follow-up of patients with hyperlipidemia according to NCEP-ATP III guidelines was suboptimal and needs improvement.