International interest in the teaching and assessment of clinical skills across the professional continuum has fueled extensive use of simulated patients in multiple station events by medical schools and professional organizations devoted to assessment. The author discusses achievements and challenges in the use of the objective structured clinical examination (OSCE) and simulated patient (SP) for medical education and assessment. The author revisits and expands subjects put forth as 'technical issues related to logistics' that summarize group discussions of conference attendees in 1992 by Anderson and Kassebaum, editors of the Proceedings of the Association of American Medical Colleges' Consensus Conference on the Use of Standardized Patients in the Teaching and Evaluation of Clinical Skills. The author describes and discusses current terminology; evolving conceptual and practical applications of the OSCE that utilize simulated patients in medical education and high-stakes assessment for licensure and certification; standards of practice in SP case materials development, recruitment, training and quality assurance; operational and research questions for the future in the use of SPs, centralized SP programs and staffing; faculty development in the use of the SP and OSCE; program costs, event space, test and web-based video access and security issues; document and data management of SP programs; development of web-based and online resources and the founding of the Association of Standardized Patient Educators (ASPE), a specialist professional organization.