This article analyzes the development of the small group case conference format, historically, elsewhere, and at the authors' institution, as a way of introducing second-year medical students enrolled in a basic pharmacology course to the practicalities, nuances, and challenges of contemporary drug therapy. A number of goals and purposes for these conferences have been identified and incorporated into the development and execution of a plan carried out over the past 14 years. Two examples of the conferences were presented, including an analysis of their teaching features. A listing of the general topics of 40 individual conferences used by the authors was provided. The authors reviewed evidence based on several methods of evaluation that the conferences are enthusiastically accepted by second-year medical students as an adjunctive approach to teaching both basic and applied clinical pharmacology. In addition, the authors find that the conferences subserve a number of other teaching functions such as problem-solving, information retrieval and presentation, and peer co-instruction. The conferences provide a mechanism for faculty-student interaction and an additional way to evaluate student knowledge and performance beyond the more conventional examination approaches.