Undergraduate medical education has been under the spotlight for many years in Europe. In the United Kingdom the General Medical Council, which validates the final medical examination in all UK Medical Schools, has been trying to influence the curriculum for at least the last 50 years. Following their publication of the document "Tomorrow's Doctors" in 1993 many medical schools in the UK have completely changed their curriculum design away from didactic learning and towards an integrated problem-orientated or problem-based approach. There has been concern that, as the process continues, some of the more traditional learning of pharmacology and clinical pharmacology may be lost with nothing to replace it. This manuscript describe two ways of developing a core curriculum for clinical pharmacology. The first uses a drug orientated approach (almost an essential drug list) where drugs are listed according to whether they are essential for students to know about with just over 120 chemical entities; and a shorter list of drugs that students would be expected to know about but not know in any detail. The second approach is a disease-orientated one with three types of disease process: a list of 67 disease states that students must know how to manage (category M), a list of 158 diseases that students must be able to diagnose (category D) and a list of 36 diseases that students should be aware of. The disease orientated approach, though designed in one EU country (the UK) has been field tested in a second (Germany) with little difficulty in transfer.