A performance assessment was developed to assess multiple skills from a new competency document. Faculty members developed the tasks that each student would perform, the evaluation criteria, and the testing procedures. Grant project leaders consolidated these materials into the Senior Exit Examination (SEE). The 11 tasks included interpreting a research article, solving an ethical dilemma, and developing a community intervention. An objective, structured clinical examination had stations for interpreting radiographs, describing oral lesions, taking vital signs, taking and analyzing health histories, and communicating with "difficult" patients. Pilot administration of the SEE was conducted in April 1995 and 1996. The majority of the students passed 4 of the 11 tasks on the first attempt in 1995, and 7 passed in 1996. Following changes to the exam and the curriculum, the SEE was conducted four times from 1997 to 2000. Student performance for all tasks in 2000 was at the approximate level of > or = 80% pass rate. Pearson chi-square tests showed that student performance significantly improved over the years from 1995 to 2000 for 9 of the 11 tasks (p < 0.001); a high performance level was maintained in ethics and community intervention with no significant change. The SEE is now considered an important measure for assessing student competence and program outcomes.