Mastering the cognitive knowledge within a field such as general surgery is a formidable task. It is even more difficult to draw on that knowledge, procure and filter through the clinical and laboratory data, develop a differential diagnosis, and finally, form a rational treatment plan. To gain these skills, the student often learns best at the bedside, guided and instructed by experienced teachers and inspired toward self-directed, diligent reading. Clearly, there is no replacement for education at the bedside. Unfortunately, clinical situations usually do not encompass the breadth of the specialty. Perhaps the best alternative is a carefully crafted patient case designed to stimulate the clinical approach and decision making. In an attempt to achieve this goal, we have constructed a collection of clinical vignettes to teach diagnostic or therapeutic approaches relevant to general surgery. Most importantly, the explanations for the cases emphasize the mechanisms and underlying principles rather than merely rote questions and answers.