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ABSTRACT.A new approach to assessment design is considered through the process of the development of a set of capabilities for osteopathic practice that start from an understanding of a concept of 'practice' applicable to real, situated osteopathic healthcare. Appropriately framed capabilities inform a variety of assessment needs, allowing different tools to assess common standards across many credentialing, high stakes, summative and formative situations, and through work based practice. An argument is made for the inclusion of a work-based phase of assessment in high stakes examinations for overseas trained candidates as the best way to capture real / situated practice enabling the assessment process to contribute to on-going professional learning. The relationship of assessment to learning is regarded as vital to the development of many aspects of regulatory policy, programme accreditation, continuing professional development and needs to be considered by stakeholders concerned with maintaining and improving standards of practice.

While much has been written on subluxation of the head of the radius, the fact remains that no satisfactory explanation of what produces and maintains the deformity has been given. It is hoped that the following history and the succeeding experiments will throw light on the subject. A boy, aged 5, fairly well developed, was pulled across the floor by his left hand while playing with his brother. The following morning, Jan. 1, 1914, he was brought to me. The hand was in nearly complete pronation, and the forearm slightly flexed and held in front of him. He complained of pain in the elbow; there was no swelling, no redness, no heat. Attempts at supination were painful and were resisted; pronation caused no pain. There was tenderness over the head of the radius. Flexion of the forearm was painful. Several attempts at supinating the hand suddenly resulted in a slight click, felt by the thumb palpating the radial head, and motion in all directions was at once free and painless. The arm was carried in a sling for one day.The following summer, in a fit of anger, the boy hooked the fingers of his two hands together and, while pulling in this position, subluxation of the right elbow occurred. Immediate careful examina¬ tion showed the same charac¬ teristic pronation and slight flexion of the forearm as in the first instance. No attempt at reduction was made, but the patient was sent away Fig. 1.-Lateral view of right and left elbows. with instructions to returnlater when a roentgenologist could be seen. He did not come back, for while playing the arm suddenly "became all right."The accident happened a third time in May, 1915. The patient sat on a chair with his hands clasped in front of one knee, his forearms slightly flexed, rocking back and forth on the buttocks. Suddenly he had pain in his left elbow and could no longer use the arm. The hand was in pronation with the forearm slightly flexed, as in the two preceding instances. A roentgenogram was taken. While an examina¬ tion was being made, the arm was suddenly free of pain and motion was normal. In the second and third instances no dressing of any kind was used. The roentgenograms show the head of the left radius to be about half the thickness of the epiphysis farther from the capitellum than the right.In going over the clinical records of Washington University Dispensary and the St. Louis Children's

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