The Federation of State Medical Boards administers a standardized examination of clinical knowledge, the Special Purpose Examination, to physicians referred by state medical boards or by themselves. If results are questionable, the physician may undergo an additional assessment by The Institute for Physician Evaluation, which is a joint initiative of the Federation and the National Board of Medical Examiners. The Institute's assessments include computer-based case simulations, structured interviews, multiple-choice examinations, cognitive function screening, and interactive judgment analysis. The evaluations were previously administered in Philadelphia, Pennsylvania, and Dallas, Texas, but are now offered exclusively in cooperation with physician enhancement services at 5 locations: the Physician Assessment and Clinical Education Program (PACE) at the University of California, San Diego; the Clinical Competency and Assessment Training Program (CCAT) at Rush University Medical Center in Chicago, Illinois; the Upstate New York Clinical Competency Center at Albany Medical College in Albany, New York; the Florida Competency Advancement Program (CAP) at the University of Florida in Gainesville, Florida; and the Physician Assessment Program at the University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (36). These collaborators use the Institute's tools to assess competence, then strive to remedy the identified deficiencies (37).