An eight-station OSCE is administered to students in the 4th year of the curriculum. This examination has several aims: a) to assess 4th year students' skills of history-taking, physical examination, doctor-patient communication, and skills in identifying an appropriate differential diagnosis and diagnostic plan, b) to allow early detection and intervention with students who have not achieved an acceptable level of proficiency in their clinical skills (and may who may be at risk of failing the USMLE Step 2 CS), and c) to identify strengths and areas that needs greater emphasis in the clinical curriculum. The Standardized Patients (SPs) assess students' skills in taking a focused history, performing a physical examination, and communicating with the patient. Students write a patient note that allows assessment of their abilities to write a coherent patient note as well as their ability to formulate a reasonable differential diagnosis and to identify a plan to further narrow the differential diagnosis. Students are given 15 minutes to complete each patient encounter and 10 minutes for the note. Total exam time per student is about 4-hours.