This application seeks the competitive renewal of an R-25 grant-funded project whose long-term goals are to design, implement, evaluate and institutionalize comprehensive programs of hospice and palliative care education at the University of Maryland School of Medicine. In the last funding period, we integrated a required, 20-hour palliative care educational program into tile medical school curriculum, dispersed in pre- clinical and clinical years. Satisfactory completion of the palliative care educational program is now a requirement for graduation. Evaluation indicates that the students are able to meet the learning objectives; hence, we are now graduating medical students with basic competency in palliative and end-of- life care. Surveys of our senior medical students who have completed the program indicate they perceive they are more competent to handle end-of-life issues than senior medical students in other medical schools that lack formal end-of-life curricula. For the next funding period, we intend to focus on palliative care educational programs designed for residents in internal medicine. The Internal Medicine residency at the University of Maryland School of Medicine is a 3-year program with approximately 35 residents in each year, and four chief residents. The specific aims are: 1) To develop and institutionalize required training for residents in Internal Medicine that will provide them with basic competence in palliative I and end-of-life care upon the completion of the residency program; and 2) To develop and implement a plan for m formative and summative evaluation of the program to determine validity and the retention of the program goals by program graduates. Behavioral objectives for the internal medicine resident as learner have been delineated. A multidisciplinary educational team will be responsible for the design of educational modules, content integration, and pilot/field testing. The team includes respected physician-educator role models, and key individuals for effecting change in the residency program. Content will be integrated in venues where all residents can participate, including required rotations in critical care, geriatrics, Cancer Center, web-based learning modules, and a rotation in palliative and end-of-life care. Plans for formative and summative evaluation are outlined.