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Background Postgraduate medical education programs would benefit from a robust process for training and assessment of competence in resuscitation early in residency. Objective To describe and evaluate the Nightmares Course, a novel, competency-based, transitional curriculum and assessment program in resuscitation medicine at Queen's University in Kingston, Ontario, Canada. Methods First-year residents participated in the longitudinal Nightmares Course at Queen's University during the 2015–2016 academic year. An expert working group developed the entrustable professional activity and curricular design for the course. Formative feedback was provided following each simulation-based session, and we employed a summative objective structured clinical examination (OSCE) utilizing a modified Queen's Simulation Assessment Tool. A generalizability study and resident surveys were performed to evaluate the course and assessment process. Results A total of 40 residents participated in the course, and 23 (58%) participated in the OSCE. Eight of 23 (35%) did not meet the predetermined competency threshold and required remediation. The OSCE demonstrated an acceptable phi coefficient of 0.73. The approximate costs were $240 per Nightmares session, $10,560 for the entire 44-session curriculum, and $3,900 for the summative OSCE. Conclusions The Nightmares Course demonstrated feasibility and acceptability, and is applicable to a broad array of postgraduate medical education programs. The entrustment-based assessment detected several residents not meeting a minimum competency threshold, and directed them to additional training.