The author states that she became interested in standardized patients (SPs) around 20 years ago as a means of developing a more uniform and effective way to provide instruction and evaluation of basic clinical skills. She reflects upon in detail: (1) the logistics of using SPs in teaching; (2) how SPs are used in assessment; (3) what aspects of performance SPs can be trained to record and evaluate; (4) issues concerning checklists; (5) evaluation of interviewing skills; (6) evaluation of written communication skills; (7) importance of defining what is being tested; (8) various kinds and uses of inter-station exercises and problems of scoring them; (9) case development and the various sources for case material; (10) ways to generate scores; (11) selecting and training SPs; (12) role of the faculty and primary importance of bedside training with real patients; and (13) pros and cons of national versus single-school efforts to use SPs. She concludes by cautioning that further research must be done before SPs can be used for high-stakes certifying and licensing examinations.