Academic ability is an essential requirement for entry, and the ability to pass examinations remains important throughout the course and the subsequent years of postgraduate training. Less competitive than A levels, but no less intense, were the traditional end of first and second year examinations on the sciences underpinning medicine. New curricula that emphasise understanding and integration of knowledge rather than “facts” are tested more by continuous assessment, a less destructive process than a series of annual crises but not without a constantly recurring academic tension. Professionally, the hardest examinations are those for the higher specialist diplomas of fellowship or membership of the Medical Royal Colleges, requiring a broad and solid grasp of the clinical skills, knowledge, and, to an increasing extent, the attitudes appropriate to a specialist. “Finals” – the examinations for the Bachelor of Medicine and Surgery degree, the degree which acts as the basis for a provisional licence to practise as a doctor, are largely a matter of hard slog, particularly in the later years. They used to be taken as a big bang at the end of the course but are now broken up at most universities over a period of about 18 months.