The challenge to train medical students in cost awareness regarding medical care led to a program at the Oregon Health Sciences University that integrates concern for costs with medical ethics. Cost awareness is a perspective that balances the physician's ethical obligations toward individual patients with their duties toward society whose pooled resources pay for medical services. The program integrates the subject of cost awareness into major required courses spanning the four-year curriculum. First-year students see costs in the context of an overview of social aspects of medical care. For second-year students, cost awareness is incorporated into training in basic clinical skills. Third- and fourth-year students are shown the bill for one of their patients and analyze their ward experiences from the perspective of resource utilization. Junior and senior students examine the impact of the legal system and professional ethics on health care costs. Elective course work on cost awareness is also available.