To test the hypothesis that the clinical skills of many foreign medical graduates entering residencies in the United States are deficient, the Medical Skills Committee of the Educational Commission for Foreign Medical Graduates (ECFMG) developed an examination called the Clinical Skills Assessment. The committee constructed the test after identifying those clinical skills it considered to be suitable for testing in a large-scale examination to be conducted at multiple locations. The test was given to 117 foreign medical graduates (including 37 U.S. citizens) who had been certified by the ECFMG and to a reference sample of 64 graduates of U.S. medical schools. All of the graduates took the test prior to their first postgraduate year of training. Thirty-two percent of the graduates of foreign medical schools who took the examination were found to have inadequate clinical skills when compared with those of graduates of U.S. schools. The committee concluded that a clinical skills examination could be developed and administered successfully.