Since their inception in the 1970s, objective structured clinical examinations (OSCEs) have become popular and now are part of the US Medical Licensing Examination for all US medical graduates. Despite general acceptance of this method, there is debate over the value of OSCE testing compared to more traditional methods. A review of reliability and validity research does not clearly show superiority of OSCE testing. To use OSCEs in a valid and reliable way, attention must be paid to test content, test design, and implementation factors, especially when the results will be used for high-stakes decision making. While questions remain around the application of OSCE testing, there are also both known and hidden benefits to students, faculty, and organizations that use OSCEs. This paper reviews the pros and cons of the OSCE method and outlines important issues for medical educators to consider when planning to use OSCEs in their programs.