Introduction: It is not known whether a Standardized Patient's (SP's) performing arts background could affect his or her accuracy in recording candidate performance on a high-stakes clinical skills examination, such as the Comprehensive Osteopathic Medical Licensing Examination Level 2 Performance Evaluation. The purpose of this study is to investigate the differences in recording accuracy of history and physical checklist items between SPs who identify themselves as performing artists and SPs with no performance arts experience. Methods: Forty SPs identified themselves as being performing artists or nonperforming artists. A sample of SP live examination ratings were compared with a second set of ratings obtained after video review (N = 1972 SP encounters) over 40 cases from the 2008-2009 testing cycle. Differences in SP checklist recording accuracy were tested as a function of performing arts experience. Results: Mean overall agreement rates, both uncorrected and corrected for chance agreement, were very high (0.94 and 0.79, respectively, at the overall examination level). There was no statistically significant difference between the two groups with respect to any of the mean accuracy measures: history taking (z = -0.422, P = 0.678), physical examination (z = -1.453, P = 0.072), and overall data gathering (z = -0.812, P = 0.417) checklist items. Conclusion: Results suggest that SPs with or without a performing arts background complete history taking and physical examination checklist items with high levels of precision. Therefore, SPs with and without performing arts experience can be recruited for high-stakes SP-based clinical skills examinations without sacrificing examination integrity or scoring accuracy. © 2011 Society for Simulation in Healthcare.