For the past 12 years, directors of residency training programs in internal medicine have had the responsibility for evaluating and reporting on the clinical competence of their residents who pursue certification by the American Board of Internal Medicine ( ABIM ). The board requires that residents demonstrate satisfactory clinical skills to take its certifying examination. In this article, the authors review the evaluation processes of 75 internal medicine residencies visited by the board in 1978-1982. The methods of evaluation used by the residencies are described and compared with the findings from an earlier cycle of visits in 1972-1975. In addition, information is presented on residents persuaded to leave the field of internal medicine. The results are encouraging, since they signify increased attention to the clinical method by graduate medical educators. This has been demonstrated by an improved, continuing commitment to the assessment of residents' clinical skills by program directors since the inception of the ABIM 's Hospital Visit Program.