A pain and palliative care pharmacotherapy elective with a culminating experience requiring students to be "on-call," make a pharmacotherapy or monitoring decision in a short, specified period of time, and return the call of the health care professional (HCP) with an appropriate answer is described. The changing roles of pharmacists in pain management and end- of-life care are addressed. The structure of the experience and results from the first 74 students to complete it are discussed.