During their clerkship, students are exposed to end-of-life care issues via a mandatory and intensive eight-week, part-time assignment through a program developed in conjunction with the local hospice. The students are given a thorough didactic orientation to the hospice movement as well as the principles of palliative medicine and are then assigned to one of three hospice staff treatment teams. After observation of the care provided by experienced staff during the first two visits, the students are then expected to make three solo "house calls," which frequently necessitate the student going to difficult-to-access rural areas, similar to those in which many of them will eventually set up primary care practices. These home visits require students to be completely familiar with all aspects of their patients’ illness, including course, treatment history, and psychosocial impact on the family, as well as the patient. The goal of this hands-on experience is to provide an opportunity for the students to learn a great deal about providing emotional support, pain management, coping skills, and working with others on the treatment team in the Appalachian cultural environment.