Medical specialty systems were launched in 1951 by the National Medical Services Law. The following year, the specialty certifying examination had implemented in the form of portfolio evaluation. A paper-and-pencil type examination was implemented in 1960, and the 55th examination was carried out in January 2012. Currently, 26 specialties are represented, and the overall pass rate is over 90%. The examination consists of a step 1 paper-and-pencil test and step 2 skills test. In the step 1 test, the test items are multiple choice questions and short answer questions. Clinical performance examination is partially applied to the step 2 test. To cope with changes in the social situation and the growth of medical services, developmental changes are needed in the specialty certifying examinations. Performance assessment is an alternative worth considering. CPX should be a major part of the skill test. A computer-based test should be introduced as soon as possible, and it could eventually be developed into an adaptive test.