This article describes an assessment system that has been developed to focus on application of knowledge. Its two major features are case-based testing and the use of multimedia and computer tools. The case material for this testing type is based on the key-features concept, reporting the most relevant characteristics of a case and asking a limited number of questions, each aimed at essential decisions. These cases are produced in daily practice using real patients. Subsequently an extensive review process if used to check for flaws in description, phrasing or answer keys. Cases are stored in an item-bank out of which an automated random stratified selection can be drawn, according to a pre-specified blueprint. Cases are then presented to the students by way of a specially developed interface using multimedia when indicated. The article further describes advantages, disadvantages and experiences.