This paper describes a situation where an alteration in the final-year assessment scheme led to changes in student learning activities which were the exact opposite of those intended. Students were seen to be spending a disproportionate amount of time studying the theoretical components of the course relative to the practical and clinical aspects. The paramount importance of the assessments and examinations in influencing student learning behaviour led the departments concerned to develop a new clinical examination which more clearly reflected the objectives of the course. A questionnaire survey was undertaken to determine how the different sections of the final assessment affected the students' approach to studying. The questionnaire was administered to graduates during their intern year for the 3 years following the introduction of the new clinical examination. Results were also obtained for the year preceding the change. The survey showed that the students developed a high regard for the new examination and its validity as a test of clinical competence. The students found that an increase in ward-based learning activities was essential for success in the final examinations. The new clinical examination has thus influenced students' learning and successfully restored the balance of their learning activities between the clinical and theoretical components of the course.