The Liaison Committee on Medical Education (LCME) requires that medical schools employ a variety of measures, including direct observation, to assess a medical student’s core clinical skills. Medical students spend the majority of the time on their family medicine clerkship in the office setting, working one-on-one with a family physician. Clerkship directors work to balance needing a valid, “real world” assessment of the student’s patient care skills with minimizing impact on the much-needed and often over-burdened community faculty. Students crave observation and feedback, both of which are difficult to implement in a busy clinic environment1. Direct observation allows for observation and assessment of actual clinical care, but variability in the skill of the evaluator and the validity of the assessment tool can lead to wide variation in final grade assignment. Some schools use standardized patients with medical school faculty observers to simulate an actual clinical environment and provide a more standardized assessment and valid feedback. Others use a separate clinical environment to complete the observed history and physical. We will present on the strategies used to provide direct observation of clinical skills at six different institutions, including the tool used, strategies to ensure valid assessment, and weight placed on the assessment. We will work with symposia attendees to develop best practices for the observed clinical encounter in the family medicine clerkship, be it in the clinic setting or in a simulated environment.This attachment includes notes taken during the meeting.