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Background Cost is a barrier to creating educational resources, and new educational initiatives are often limited in distribution. Medical training programs must develop strategies to create and implement cost-effective educational programming. Objective We developed high-quality medical programming in procedural instruction with efficient economics, reaching the most trainees at the lowest cost. Methods The Just-In-Time online procedural program was developed at the University of Toronto in Canada, aiming to teach thoracentesis, paracentesis, and lumbar puncture skills to internal medicine trainees. Commercial vendors quoted between CAD 50,000and 100,000 to create 3 comprehensive e-learning procedural modules—a cost that was prohibitive. Modules were therefore developed internally, utilizing 4 principles aimed at decreasing costs while creating efficiencies: targeting talent, finding value abroad …