BACKGROUND: Internists are seeing increasing numbers of older patients with comorbidities who are living with life-threatening illness. Therefore, internal medicine residency programs should be active in preparing future internists to handle the challenges of end-of-life care. OBJECTIVE: To determine the current status of end-of-life education in internal medicine residency programs in the United States. METHOD: The study was a cross-sectional, observational study of all internal medicine Residency Directors in the US as of May 2015. A valid and reliable survey was mailed to all directors using a 4-wave mailing technique. RESULTS: Slightly more than half (52%) of all residency directors completed the survey. Although directors strongly believed in the benefits of residents integrating recommended end-of-life care components into practice, only 36% of programs reported having formal end-of-life curriculum in place for more than three years. Of those programs that taught end-of-life care topics or skills, the majority did not formally evaluate residents’ competence in end-of-life care skills. Moreover, 24% of residency programs did not have an end-of-life care curriculum; 34% did not offer a rotation in hospice care; and 31% did not have structured conference teaching in end-of-life care topics. CONCLUSIONS: When further treatment becomes futile and curative approaches give way to palliative and hospice care, many patients rely on their internist to guide, direct, coordinate, and communicate. The results of this study indicate that a significant proportion of internal medicine residents are not receiving the type of education that would help them develop competency in end-of-life care and communication.