To the Editor.
—We read the article in the Dec 18, 1987, issue of JAMA by Drs Elliot and Hickam1 with great interest. We were pleased to see the topic of the consistency of patient instructors (we now call them standardized patients) compared with faculty observers appear in THE JOURNAL. To provide a valid and reliable method for evaluating physical examination skills of medical students is one of the challenges facing medical education today.We have trained patient instructors to teach and evaluate physical diagnosis skills for more than 15 years.2-4 They have been used extensively throughout the undergraduate curriculum, as well as for residents and practitioners. Our experience with the use of patient instructors has been even more encouraging than that reported by Drs Elliot and Hickam. For example, we have used patient instructors as a quality control check of the skills of students in physical diagnosis