The Objective Structured Clinical Examination (OSCE) was introduced in the mid-1970s as a method of testing students' clinical skills with more objectivity. The University of South Dakota Sanford School of Medicine (USD SSOM) administered its first OSCE to third year students in 1996. At a national level, the U.S. Medical Licensing Examination (USMLE) incorporated clinical skills testing for all medical students in the form of Step 2 Clinical Skills (CS) in 2004. The USMLE Step 2 CS exam has both proponents and opponents, but at this time will continue to be used. The USD SSOM OSCE has evolved over the years to include standardized patients, simulations, and note writing in an effort to better assess students and prepare them for Step 2 CS. Currently, the USD SSOM OSCE administered at the end of Pillar 2 is a requirement for graduation. The formal OSCE committee works diligently throughout the year to provide students with ample opportunity to prepare them for success. A significant ongoing part of student preparation is the clinical training that they receive in the offices of dedicated community preceptors.