The traditional approach to final clinical competence assessment has many shortcomings in terms of validity and reliability. Strategies for improving this traditional approach are presented, which include a degree of standardisation, coupled with increased variety. The advocacy of standardised or simulated patients by some researchers is discussed with the incorporation of patient feedback into the competence assessment mix. The relevance of examiner bias and the negative effects of being observed on candidate performance are considered, together with the significance of examiner training and the manner of their deployment. Consideration is given to alternative assessment modes with a concluding argument in favour of continuous assessment in place of the final examination.