This article describes the development of an OSCE programme in the problem-based curriculum of the Faculty of Medicine in Maastricht. In each curriculum year students take a skills exam which is based on a sample of the skills taught in the programme. Structured skills training prior to taking an OSCE is advocated as an important tool to overcome problems in defining standards of performance for these exams. The principles of a structured programme are outlined and practical guidelines for the organisation of skills exams for large numbers of students are formulated. Reliability data on the tests used in Maastricht are summarised.