To determine resident physician recognition and treatment of hypercholesterolemia, a retrospective chart audit was performed on 300 systematically selected patients seen in an internal medicine resident's continuity care clinic during the spring of 1992. A self-administered resident survey was given after completion of chart selection. Of the 300 patients, 64 (21%) did not have a cholesterol reading on the chart. The frequency of screening was unaffected by cardiac risk factors, patient race or sex, or resident level of training or specialty. Of the 96 patients who had a total cholesterol greater than 240 mg/dL documented in the chart, 48% received diet therapy, 46% received other non-pharmacologic therapy, 24% received drug therapy, 4% were referred to a lipidologist, and 30% received no treatment. Fasting lipid profiles were ordered for 57% of these patients. The frequency of therapy was unaffected by patient race or sex, resident level of training or specialty, or presence of two or more cardiac risk factors, although patients with a diagnosis of hypercholesterolemia and patients younger than age 65 were treated significantly more often. Resident action primarily involved evaluation rather than therapy. Efforts to improve the aggressiveness of treatment for hypercholesterolemia by resident physicians are necessary.