In 1996 the University of Rochester School of Medicine, Rochester, New York, began a major curricular reform called the Double Helix Curriculum, integrating basic science and clinical training over 4 years of medical school. This transition provided a unique opportunity to develop and implement a fully integrated, comprehensive palliative care curriculum. In this three-part paper, we will describe: (1) our process of finding curricular time, setting priorities, and deciding on pedagogical strategies; (2) an overview of how palliative care teaching was integrated into the general curriculum, including examples of different teaching opportunities; and (3) our evaluation process, and some ongoing challenges. Because palliative care is a core element in the care of all seriously ill patients, we chose to integrate our teaching into multiple courses over 4 years of undergraduate medical education, and not isolate it in a particular course. We view this report not as an ideal curriculum to be emulated in its entirety but as a work in progress that may be somewhat unique to our institution. We intend to illustrate a process of incremental curriculum building, and to generate some fresh teaching ideas from which palliative care educators can select depending on their own curricular needs and objectives.