In Pakistan, education is evaluation-driven. Students spend the entire academic session preparing for the summative examinations. Currently these summative examinations for MBBS final year students consist of theory papers. If the summative examination fails to test/ evaluate the students on all the cognitive, psychomotor and affective competencies, this could have serious even fatal consequences for the community as well as the doctors. To identify valid, reliable yet cost-effective and feasible tools of evaluation in the cognitive, psychomotor and affective domains that will not only lower the economic and psychological burden of evaluation but shall also improve the quality of the product i.e. the Doctors. This was a prospective mixed quantitative and qualitative study of two years duration centered at University of Health Sciences, Lahore (UHS). The student population included final year MBBS students in the academic sessions 2008-2009 and 2010-2011 (Annual 2009 and Annual 2010) in the Medical Colleges of Punjab affiliated with UHS. Stratified random sampling was done to invite two groups of 100 Students each from the population to attend UHS for the Psychomotor and Affective Domains Assessments in this study in 2009 as well as 2010. The data was entered and analyzed using SPSS (Statistical Package for Social Sciences) version 16.0 software. Relevant tests of significance were applied. A p-value of ≤ 0.05 was considered statistically significant. Qualitative data was entered into Ethnograph Version 6 and common themes were identified. The study indicates that a Multiple Choice Question (MCQ) is an objective instrument of assessment. If constructed properly and with care keeping in mind the competency outcomes associated with assessment, this cost-effective instrument is capable of measuring higher order cognitive skills. A large majority of MCQs constructed at UHS testediii higher cognitive skills than the Structured Answer Questions (SAQs). The Long Essay Question (LEQ) can be specifically targeted for assessment of higher order evaluation and creative cognitive skills. In order to reduce the duration related to assessment through this instrument, it should be used sparsely and only where it cannot be replaced by an MCQ or an SAQ. The currently structured standardized format of clinical, viva voce and Objectively Structured Performance Evaluation (OSPE) for assessment of psychomotor and affective domains in the examinations of UHS has support from all the stakeholders. Especially OSPE, through its wider content coverage and direct observation of clinical skills and attitudes, has been well received. Finally, educational, socioeconomic and geographical background has been seen to affect the scores of students. However, no difference in the perception of students towards the examination, as a whole, or the instruments individually was identified based on the same demographic and educational divisions.