PURPOSE. To conduct the first of a series of pilot projects of the clinical competence assessment (CCA) of the Educational Commission for Foreign Medical Graduates (ECFMG) in order to provide profiles of clinical competencies of graduates of foreign medical schools for residency directors in the United States and for governments and institutions in other countries. METHOD AND RESULTS. In September 1992 the first pilot project of the ECFMG CCA was conducted for a program director who wanted to evaluate ten first-year residents in a midwestern U.S. program. The CCA consists of integrated clinical encounters with ten standardized patients, 60 laser videodisc pictorials, and analysis of test items of previously completed ECFMG certification examinations. Profiles of the following clinical competencies were provided to the program director: data gathering (history and physical examination), interviewing and interpersonal skills, diagnosis and management skills, interpretation of diagnostic and laboratory procedures, written communication of information to the health care team, and spoken-English proficiency. The profiles were provided as individual scores compared with mean scores of a reference group of 525 first-year residents who took the CCA at four U.S. assessment centers, and as percentile scores with a range of one standard error of measurement. CONCLUSION. The individual performance data in this first pilot project were valuable to the program director, who used them to supplement scores on a written examination during the first residency year. The pilot project has shown the ECFMG CCA to be a useful tool for program directors to evaluate applicants and residents who are graduates of foreign medical schools.