Sir,Haranath has given us an excellent outline of the current state of play with regard to medical education in India and the prospects for curricular integration.[1] Haranath's ideas are both evidence-based and pragmatic – he is right to state that the model of delivery of medical education cannot change overnight to a completely new format. He is correct also in stating that medical education has become expensive, but integration will not necessarily lead to higher costs – indeed there are strong reasons to believe that it could deliver efficiencies.Vertical integration refers to integration of the clinical and basic sciences; horizontal integration to integration of different subjects and topics; and in the spirally integrated curriculum the course is divided up into a number of different subjects, which the students work though repeatedly but at continually higher levels of difficulty. All forms of integration can bring efficiencies in curriculum delivery – whereby both time and costs can be saved. Integration can lead to better communication between departments, and as a result to unnecessary and redundant duplication of content being cut out. Although integration requires administration and thus costs, the savings as a result of the cutting of duplicated content would likely be considerably more than administrative costs. Integration can also lead to deeper learning that will be better retained and more easily applied in clinical practice – ultimately resulting in more evidence-based and efficient care. These statements are likely to be correct, but proper and thorough evaluation needs to be carried out in order to prove them.Regardless of this, integration requires multiple steps to become a reality and as Reg Jordan has written, “The first step in integration is coordination.”[2]