Eighteen questions are posed that the authors believe address the major technical issues involved in the application of standardized patients (SPs). Following each question, selected empirical evidence and commentary are provided in response to the question and as background for further consideration of the issues. The authors conclude that the evidence from this large and systematic knowledge base about SP examinations is encouraging and should be cause for optimism. Moreover, it is noted that far less is known about the measurement properties of conventional procedures for clinical assessment in medical school courses and clerkships. The collective evidence from this extensive SP research base suggests that medical educators should move ahead to realize the benefits of the high-fidelity standardized approach provided by standardized-patient examinations.