A total of 8 geriatric medicine fellows participated in an objective structured clinical examination (OSCE) assessing communication skills and clinical reasoning in common geriatric syndromes. To determine their perceptions about the experience, we conducted surveys and semistructured interviews. We analyzed the survey data using descriptive statistics, and two researchers independently utilized the constant comparative method to code themes from the interview transcriptions. Most perceived the OSCE as a formative tool, and many were concerned that the exam did not accurately measure real-world competence. In conclusion, fellows considered the OSCE to be valuable for reinforcing skills relevant to geriatric medicine but had concerns of exam validity. (Contains 2 tables.)