Background and Objectives: Curricula in US medical schools concentrate most of their explicit teaching of professionalism, ethics, and communication skills in the preclinical years. The first clinical year, however, is the time that these topics become more relevant to "physicians to be." Case Western Reserve University and the University of Pennsylvania each developed, as part of their UME-21 curricula, longitudinal small-group courses for medical students in their first clinical year. Each addressed topics of ethics, professionalism, humanism, and communication skills. Methods: This paper describes the goals of each course, as well as the context in which they were developed, their structure, implementation, and how "buy-in" from faculty and students was achieved. We compare the two programs and describe the implications for other medical schools contemplating development of such a course. Results: The courses were successfully implemented at both schools. Student ratings were positive. Conclusions: Important issues in incorporating the small-group courses into the curricula are ensuring the buy-in of clerkship directors, providing faculty development, keeping students in the same small groups if possible, fitting the new course into the existing curricular structure, and striving to evaluate the students and the course.
