“…In the case of clinical practice this has led particularly to involvement of consumers making contributions to service planning, service delivery, and indeed in expressing formed and thoughtful views about the diagnostic classification systems. 6,7 There have been parallel developments in the examination literature with the use of both real and simulated patients making significant contributions to teaching and assessment. 8–10 The great contribution ‘examiner variance’ can make to communication skills assessment has also been demonstrated.…”