The University of Pittsburgh School of Medicine proposes to enhance the third-year clinical clerkships' contribution to medical students' preparation to provide palliative care to cancer patients and others with advanced, life-limiting illnesses. The purpose of the third-year medical curriculum is not to produce the level of clinical expertise expected of residents or fellows. Rather, it is to provide students with opportunities to begin to apply-through observation, practice, and feedback-the principles of the physician-patient relationship, medical diagnosis, and treatment to the care of actual patients. The curriculum changes in this proposal aim to ensure that the principles that relate particularly to end-of-life care receive appropriate emphasis and reinforcement. The specific outcome aims of the proposal are to improve graduating students' (1) knowledge of core end-of-life tasks, (2) attitudes toward end-of-life care, (3) emotional comfort with dying patients, (4) satisfaction with their end-of- life instruction, and (5) feeling of preparedness to provide end-of-life care at the level of a medical intern. To achieve these outcomes, the proposal has the following process aims: (1) to provide faculty and residents with teaching materials and pedagogical strategies to help them take increased advantage of """"""""teachable moments"""""""" related to end-of-life care in six required third-year clerkships: Medicine, Surgery, Clinical Neurosciences (Neurology and Psychiatry), Pediatrics, Family Medicine, and Ambulatory Care; (2) to develop and implement web-based instructional technologies (ePortfolios) that enable students to record systematically their exposure to end-of-life learning opportunities throughout the third year, and to receive just-in-time educational materials and feedback from faculty; (3) to match specific end-of-life learning objectives to the learning opportunities most likely to arise in particular clerkships, while monitoring students' exposure to the full end-of-life curriculum across the clerkship year as a whole; and (4) to provide easily accessible, non-threatening settings in which third-year medical students may explore their emotional reactions to their patients' terminal illnesses or deaths. Process and outcome measures for these aim s includ e maintenance of a centralized data base of student and faculty web activity, faculty, resident, and student surveys, student focus groups, and administration of a palliative care knowledge and attitude survey to the entire medical school class upon entering medical school, at the end of Year 2, and upon graduation. ? ? ?