Background: Simulated patients (SPs) are widely used in medical education yet little is known about how individual schools recruit, develop, use, evaluate and maintain SPs. Opportunities for sharing SP development expertise and materials among institutions are not often utilised. Aims: In order for different SP programmes to learn from each other, there needs to be some basis for establishing meaningful comparisons. Method: In 2006, the Association of Standardized Patient Educators (ASPE) piloted a survey instrument that would facilitate comparisons of SP educational practices in different institutions. Four European countries at varying stages of SP programme development were selected as representative of the spread of SP experience in Europe (Belgium, Ireland, Scotland and the Netherlands). Key SP contacts were identified in each medical school. Contacts were asked to complete a 49-item questionnaire developed collaboratively between ASPE and the authors. The overall response rate was 86%. Results: There were considerable differences between countries in terms of their approach to developing SPs and quality assuring their performance. Whilst SP education was regarded as an expensive enterprise, there was little evidence of resource sharing between different centres in the same country. Conclusions: There is a clear need to facilitate closer collaboration between centres in developing and quality assuring SPs.