The rationale for this ambitious endeavor stems from the "sea change" in medical education as its reflected in curricular reforms that are occurring in every medical school in Texas. The themes and tone of this application suggest that the CATCHUM Project is positioned to optimize its value within the respective host schools by demonstrating the worth of a diffusion model based on principles of adult education and performance certification. The heavy reliance in medical education over the last three decades on multiple-choice examinations has resulted in assessment methods that are highly reliable but lack face validity. They do not closely simulate tasks that the physician in training should be expected to perform nor that the public expect.