Established as a partnership between Cleveland Clinic and Case Western Reserve University, Cleveland Clinic Lerner College of Medicine (CCLCM) is a unique medical school program that sets standards for the training of physician investigators through innovative approaches to the integration of basic science, research, and clinical medicine. CCLCM is unique in several ways. Five years are needed to accommodate the research thesis requirement, with many students pursuing an optional master's degree from Case Western Reserve University; the class size each year is limited to 32 students, all of whom receive a full-tuition scholarship; and there are no grades or class rankings throughout the five-year curriculum, with assessment being driven instead by a unique portfolio system. CCLCM was established in 2002 as a partnership between Cleveland Clinic and Case Western Reserve University with a $100 million gift from Al and Norma Lerner.