The new "Ärztliche Approbationsordnung" aims at a curriculum in which clinical aspects and skills are already taught in year 2 with integration of theory and practice. This integrated approach is realized as a blended learning scenario by the project "CliSO -Clinical Skills Online" at CAU Kiel and LMU Munich. Students exercise clinical skills under the supervision of experts. Skills lab sessions are closely combined with tailored e-learning courses on the theoretical basics of the skills and paradigmatic clinical scenarios in which they are applied. The e-learning courses combine case based and systematic knowledge on two different platforms (CASUS and Nickels/JaTeK). Cases based on real patients are adapted to the knowledge of medical students in their 2nd year. Starting from a certain case the necessary examination skills, e.g. auscultation of the heart of a patient with aortic stenosis, are introduced together with their physiological and anatomical basics using multimedial elements. Four to six further patient cases represent paradigmatic situations and diagnoses in which the respective skills must be applied. A pilot course on the examination of the heart and circulatory system has been formatively evaluated at LMU Munich by students with a high level of acceptance and motivation.