Forty years ago, the OSCE was introduced as a more reliable and valid way of assessing clinical competence of medical students. The OSCE quickly assumed prominence, both in medical schools and other settings, and the paper in Medical Education that introduced the exam remains one of the most cited publications in the journal's 50-year history. However, in recent years, there have been observations that for all its resource-intensiveness, the OSCE has some shortcomings. In particular, the mechanistic use of checklists for marking and the"one and done" nature of the OSCE can leave assessors and students alike feeling that the exam fails to reflect the iterative and formative process of acquiring clinical skills. Around 2005, discussions of Entrustable Professional Activities (EPAs) began to circulate in the literature. With the goal of ensuring that appropriate competency-based decisions are being made about trainees, particularly with regard to the level of supervision they required to execute their clinical duties, the authenticity of EPAs is surely part of their appeal. Like the OSCE, EPAs have gained considerable ground as a method of ensuring that trainees are fit for practice. Given that OSCEs and EPAs have similar goals, the question addressed in this focus session is whether both are necessary, or whether EPAs could replace OSCEs as a summative measure of clinical competence.