The practice of medicine is becoming increasingly onerous for doctors, with growing demands coming from both patients and peers. Therefore, we need to equip doctors of the future with the appropriate skills to negotiate a very complex environment. Assessment should be central to this goal with a renewed focus on a more rounded examination process. Rather than a compete reliance on summative assessment, an increased focus should be placed on formative assessment, which has been historically neglected in medicine. In addition, it is important for educators to realise that a mutimodal approach is required to establish competence in a valid fashion and that each assessment modality should be used for both summative and formative assessment where possible. This will not only serve to address the external pressures placed on the teacher to streamline students but it will facilitate student learning as they become active participants in assessment. Other areas of development in medical education going forward include peer assessment, which may be the answer to increasing cohort sizes. We also need to address the issue of maintaining adequate standards of assessment. Furthermore, we need to conduct further research to ensure that our assessment methods are an adequate predictor of future performance otherwise we as educational leaders will be failing both our students and the wider community.