PURPOSE. To assess students' learning and other aspects of an innovative elective (based on contextual learning) in surgical critical care for second-year medical students. METHOD. In 1990–91, 13 second-year students at the University of Colorado School of Medicine took a 12-week elective in surgical critical care. The elective required the students to be on night call four times in the surgical intensive care units of two university-affiliated hospitals, where they were supervised by second-year surgical residents and collected information about patients. Weekly tutorial sessions were held for case presentations by the students and for lectures by attending surgeons on pertinent clinical entities. At the conclusion of the course, the students took a shelf test from the Society of Critical Care Medicine. RESULTS. All 13 students scored above 70% on the shelf test, a passing grade for the Additional Qualifications in Critical Care. CONCLUSION. That the students passed an examination at the level of the Additional Qualifications in Critical Care without completing a surgical residency, let alone a critical care fellowship, suggests that contextual learning (where the clinical problem is presented initially and is then followed by self-directed study and group discussion) would prove highly effective in medical education. Students would enter clinical clerkships more prepared than presently if clinical skills were introduced contextually into the basic science curriculum.