For internal medicine residents, ambulatory care poses challenges to learning and retention different from inpatient medicines. This is often compounded by the heterogeneous ways in which internal medicine residents experience primary care clinic, ranging from traditional models (1-2 care sessions per week) to block schedules such as the x+y format. It is the authors observation at a 3+1-week program where residents rotate in primary care clinic for 1 week out of 4, that residents can lose medical knowledge gained via didactics or patient experience over the course of their residency. A pilot curriculum design project to provide ambulatory internal medicine residents with focused education, "clinical pearls," for clinical problems that are less commonly encountered, commonly misunderstood/applied (I. e. screening) or frequently updated.