This paper reviews methods commonly used to assess the clinical competence of residents in internal medicine, including the In-Training Examination, medical record audits, rating scales, clinical evaluation exercises, and the use of standardized patients. Studies were identified through a MEDLINE search (1966 to present) and from the bibliographies of relevant articles and were selected for inclusion according to consensus between the authors. Whenever possible, original studies were chosen over reviews and editorials. No single assessment method can successfully evaluate the clinical competence of residents in internal medicine, and educators need to be cognizant of the most appropriate applications and the advantages and disadvantages of the available evaluation tools. A combination of assessment tools provides the best opportunity to evaluate and educate physicians-in-training.