The Royal College of General Practitioners' Membership examination, the only postgraduate qualification in family medicine in the United Kingdom, has developed a direct assessment of candidates' interpersonal skills performance using videotaped consultations of the actual doctor-patient encounters. At present about 1,200 doctors are examined each year. The methodology has been developed and piloted over a period of eight years. The central tenet of the methodology is a clear definition, which is known both to the candidate and to the examiner, of the clinical and consulting competencies that are required to be demonstrated in order to pass the examination. The candidate is required to provide evidence of his or her competence usually by selecting appropriate patient encounters that demonstrate the fulfillment of the required performance criteria, effectively producing a portfolio of his or her communicative competence. The methodology is intended to encourage the learning and teaching of communication skills by making it part of an important examination and clearly defining the competencies required to pass. Reliability has been demonstrated to be satisfactory and refinement of the marking processes is likely to improve this further.