The following table shows the case overview and communication disorder features targeted for the standardized patient portrayals. These excerpts are from the instructions provided to the standardized patients.

Behaviors targeted for portrayal	Description and examples
Aphasia standardized patient
Case overview	A 60-year-old female status post left-brain stroke about 18 months ago, resulting in moderate aphasia and right upper extremity weakness. Patient is an elementary school teacher who has been on medical leave of absence since stroke. Patient is at the clinic today for a first-time visit to establish care after her prior primary care provider retired. She is married, but her husband is not able to be at the visit today.
Auditory comprehension	Moderate difficulty understanding what people say, particularly if they speak quickly, use long sentences, and present complex information. Patient is generally aware that she does not understand someone. If a student speaks fast or uses long or complex sentences, the patient shakes her head “no” and gives a confused look to indicate that she does not understand. Understands simple yes or no questions about 75% of the opportunities. Responses to all questions should be delayed 3–4 s, indicating that it takes a little longer to understand information.
Word finding	Significant problems coming up with words. Pause for at least 3–5 s before responding. The patient can think of the right word to say about 25% of the time. The rest of the time the patient cannot think of something to say or says a word that is not the intended one (e.g., says “dog” when means “cat”). Frequently perseverates saying the same word over and over. Verbally confuses yes and no about 50% of opportunities. Patient is aware of mistakes and gets frustrated but cannot always fix errors.
Agrammaticism	The patient can think of some of the content words in sentences but cannot put the words together in a grammatically complete sentence. For example, if she wanted to say, “My husband went to the store,” she might say “Brother—no–no—husband. Out.” She cannot say a complete sentence.
Gestures or body language	The patient readily uses gestures, with left hand only, to attempt to convey ideas. Gestures may be vague but will use pointing and simple charades to help convey message.
Reading comprehension a	Moderate difficulty understanding written information. If the interviewer writes down one or two key words, the patient can understand those, although it takes a few seconds to understand the words. If the interviewer writes something sentence-length or hands the patient anything to read that has sentences or paragraphs, that is too overwhelming and difficult, and the patient indicates that she cannot read that.
Written expression a	Has to use left, nondominant hand for any writing attempts. Patient can write first and last name slowly and with effort. Patient can spell husband's name. Beyond that, the patient can make an effort to write the first letter or two of a word (sometimes it is correct and sometimes not) but cannot write more than that. Cannot write well enough to convey ideas through writing.
General behavior and demeanor	Patient is alert, attentive, and eager to communicate. Patient has paralyzed right hand so unable to use it for any function. Patient is already sitting down when interviewer enters the room and remains sitting throughout so walking not part of presentation.
Parkinson's disease standardized patient
Case overview	A 62-year-old male diagnosed with Parkinson's disease about 10 years ago. He is a retired attorney who has just moved to Seattle to live closer to adult children, although he will be living in his own residence. Patient is at the clinic for a first-time visit today to establish care with a primary care provider after moving to Seattle.
Speech movements	Starting speech is difficult—it takes about 3 s to initiate speech each time the patient tries to say something. When speaking, the patient does not move his face or mouth much at all. Mumbled and slurred speech.
Loudness	Very quiet voice. The voice should be kept above a whisper but very quiet.
Intonation	Very little melody or intonation in the speech. Speech is kept monotone showing very little expression.
Rate	Words rush together in short rushes of speech—short phrases come out in a slurred rush with long pauses between.
Flat affect	The face stays largely expressionless. The patient maintains eye contact and follows activities with his eyes but otherwise little or no facial expression. The patient does not smile when meeting someone. Patient does not nod his head to acknowledge or show understanding. Face and head are largely motionless.
Written expression a	The patient's writing is very tiny (micrographia)—so small that it is hard to read—and it is effortful to do. The patient can write to a limited extent but really just a few words—writing is too effortful to do for long periods of time, such as writing out sentences or responses to all questions.
General behavior and demeanor	Demonstrates pill-rolling tremor in hand. Patient is already sitting down when interviewer enters the room and remains sitting throughout so walking not part of presentation. Posture somewhat stooped. Movements with upper extremities are slow and delayed—pauses at least 3 s before initiating movement. The patient understands what is said to him (unless the interviewer talks excessively fast or uses excessively technical jargon that most people would struggle to understand). There are no cognitive impairments.

^aThe standardized patients were trained in how to respond to opportunities for reading and writing. Due to inconsistent opportunities arising for this behavior in the interviews, data regarding believability of these behaviors were not included in this article.