Academic Psychiatry

, Volume 38, Issue 4, pp 451–457 | Cite as

Clinical Examiners, Simulated Patients, and Student Self-assessed Empathy in Medical Students During a Psychiatry Objective Structured Clinical Examination

  • Karen O′Connor
  • Romaine King
  • Kevin M. Malone
  • Allys Guerandel
Empirical Report



This tudy aims to assess and compare objective and subjective scores of empathy in final-year medical students by using firstly a validated student self-assessment just prior to the psychiatry objective structured clinical examination (OSCE), and then comparing this to clinical examiner's and simulated patient's (SP’s) assessments of empathy of students using a Global Rating of Empathy scale (GRE) during a psychiatry OSCE.


In 2011, all final-year medical students in the University College Dublin were invited to complete a subjective, self-assessed empathy questionnaire (The Jefferson scale of physician empathy—student version (JSPE-S)). They were also assessed for empathy in four OSCEs by the clinical examiner and the SP acting in that OSCE scenario.


Included in the analysis were 163 of 184 final-year students JSPE-S (88.6 %) questionnaires. The female students scores on the JSPE-S were significantly higher than those of their male peers (t = 3.34, p = 0.001). Concurrent validity was greater between the SPs’ assessments of empathy in the OSCE and the JSPE-S score than between the clinical examiners assessments of empathy and the JSPE-S score (r = 0.23, p < 0.005; r = 0.14, p < 0.08). Inter-rater reliability of SP's and clinical examiner's using the GRE was found to be high (F = 0.868 (df = 171, 171), p value <0.001).


SPs may be valid assessors of empathy in medical students during an OSCE.


Empathy Simulated patients Medical education 



On behalf of all the authors, the corresponding authors states that there are no conflicts of interest.


  1. 1.
    Bleakley A, Bligh J. Students learning from patients: Let’s get real in medical education. Adv Health Sci Educ Theory Pract. 2008;13:89–107.PubMedCrossRefGoogle Scholar
  2. 2.
    Brownell AKW, Côté L. Senior residents’ views on the meaning of professionalism and how they learn about it. Acad Med. 2001;76:734–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Stewart MA. Effective physician–patient communication and health outcomes: a review. CMAJ. 1995;152:1423–33.PubMedCentralPubMedGoogle Scholar
  4. 4.
    Beckman HB, Frankel RM. Training practitioners to communicate effectively in cancer care: it is the relationship that counts. Patient Educ Couns. 2003;50:85–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Coulehan J, Platt F, Egner B, et al. ''Let me see if I have this right''.: words that build empathy. Ann Intern Med. 2001;135:221–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Rees-Lewis JC. Patients views on quality of care in general practice: literature review. Soc Sci Med. 1994;39:655–71.CrossRefGoogle Scholar
  7. 7.
    Levinson W, Gorawa-Bhat R, Lamb J. A study of patient cues and physician responses in primary care and surgical settings. JAMA. 2000;284:1021–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Larson EB, Yao X. Clinical empathy as emotional labour in the patient physician relationship. JAMA. 2005;293:1100–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Shapiro J. How do physicians teach empathy in the primary care setting? Acad Med. 2002;77:323–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136:358–67.PubMedCrossRefGoogle Scholar
  11. 11.
    Shanafelt TD, West C, Zhao X, et al. Relationship between increased personal well-being and enhanced empathy among internal medical residents. J Gen Intern Med. 2005;20:559–64.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: Definition, components, measurement and relationship to gender and specialty. Am J Psychiatry. 2002;159:1563–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Hojat M, Gonnella JS, Mangione S, et al. Empathy in medical students as related to academic performance, clinical competence, and gender. Med Educ. 2002;36:522–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Henry SG. Playing doctors. JAMA. 2005;294:2138–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Berg K, Majden J, Berg D, Veloski J, Hojat M. Medical students’ self-reported empathy and simulated patients’ assessments of student empathy: an analysis by gender and ethnicity. Acad Med. 2011;86:984–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Macnaughton J. The dangerous practice of empathy. Lancet. 2009;373:1940–1.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Stein and Stein. In: Stein E, Stein W, editors. On the Problem of Empathy. Washington DC: ICS Publications; 1989.CrossRefGoogle Scholar
  18. 18.
    Pedersen R. Empirical research on empathy in medicine—a critical review. Patient Educ Couns. 2009;76:307–22.PubMedCrossRefGoogle Scholar
  19. 19.
    Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002;52(suppl):S9–13.PubMedCentralPubMedGoogle Scholar
  20. 20.
    Hemmerdinger JM, Stoddart SDR, Lilford RL. A systematic review of tests of empathy in medicine. BMC Med Educ. 2007;7:24.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Hodges B. Creating, monitoring, and improving a psychiatry OSCE: a guide for faculty. Acad Psychiatry. 2002;26:134–61.PubMedCrossRefGoogle Scholar
  22. 22.
    Wallace J, Rao R, Haslam R. Simulated patients and objective structured clinical examinations: review of their use in medical education. Adv Psychiatr Treat. 2002;8:342–8.CrossRefGoogle Scholar
  23. 23.
    Brenner A. Uses and limitations of simulated patients in psychiatric education. Acad Psychiatry. 2009;33:112–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Mellsop GW, Joanna MD, Selim El B, David M. Patients' appraisal of psychiatric trainee interview skills. Academic Psychiatry. 2012;36:374–79.PubMedCrossRefGoogle Scholar
  25. 25.
    Whelan P, Church L, Kadry K. Using standardized patients’ marks in scoring postgraduate psychiatry OSCEs. Acad Psychiatry. 2009;33:319–22.PubMedCrossRefGoogle Scholar
  26. 26.
    Bennett AJ, Arnold LM, Welge JA. Use of standardized patients during a psychiatry clerkship. Acad Psychiatry. 2006;30:185–90.PubMedCrossRefGoogle Scholar
  27. 27.
    Hojat M, Mangione S, Nasca TJ, et al. The Jefferson Scale of Empathy: development and preliminary psychometric data. Educ Psychol Meas. 2001;61:349–65.CrossRefGoogle Scholar
  28. 28.
    Hojat M, Gonella JS, Nasca TJ, et al. Empathy scores in medical school and ratings of empathic behavior in residency training 3 years later. J Social Psychol. 2005;145:663–72.PubMedCrossRefGoogle Scholar
  29. 29.
    Hojat M, Mangione S, Nasca TJ, et al. An empirical study of decline in empathy in medical school. Med Educ. 2004;38:934–41.PubMedCrossRefGoogle Scholar
  30. 30.
    Mangione S, Kane GC, Caruso JW, et al. Assessment of empathy in different years of internal medicine training. Med Teach. 2002;24:370–3.PubMedCrossRefGoogle Scholar
  31. 31.
    Hojat M, Gonella JS, Nasca TJ, et al. Empathy scores in medical school and ratings of empathic behaviour in residency training 3 years later. J Soc Psychol. 2005;145:663–72.PubMedCrossRefGoogle Scholar
  32. 32.
    Di Lillo M, Cicchetti A, Scalzo AL, Taroni F, Hojat M. The Jefferson Scale of Physician Empathy: preliminary psychometrics and group comparisons in Italian physicians. Acad Med. 2009;84:1198–202.PubMedCrossRefGoogle Scholar
  33. 33.
    Kataoka HU, Koide N, Ochi K, Hojat M. Measurement of empathy among Japanese medical students: psychometrics and score differences by gender and level of medical education. Acad Med. 2009;84:1192–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Rahimi-Madiseh M, Tavakol M, Dennick R, Nasiri J. Empathy in Iranian medical students: a preliminary psychometric analysis and differences by gender and year of medical school. Med Teach. 2010;32:e471–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Berg K, Majdan JF, Berg D, Veloski J, Hojat M. A comparison of medical students' self-reported empathy with simulated patients' assessments of the students' empathy. Med Teach. 2011;33:388–91.PubMedCrossRefGoogle Scholar
  36. 36.
    Hojat M, Vergare MJ, Maxwell K, et al. The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School. Acad Med. 2009;84:1182–91.PubMedCrossRefGoogle Scholar
  37. 37.
    Tavakol S, Dennick R, Tavakol M. Psychometric properties and confirmatory factor analysis of the Jefferson Scale of Physician Empathy. BMC Med Educ. 2011;11:54.PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Schwartzman E, Hsu DI, Law AV, Chung EP. Assessment of patient communication skills during OSCE: Examining effectiveness of a training program in minimizing inter-grader variability. Patient Educ Couns. 2011;83:472–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Colliver JA, Willis MS, Robbs RS, et al. Assessment of empathy in a standardized-patient examination. Teach Learn Med. 1998;10:8.CrossRefGoogle Scholar

Copyright information

© Academic Psychiatry 2014

Authors and Affiliations

  • Karen O′Connor
    • 1
    • 3
  • Romaine King
    • 2
  • Kevin M. Malone
    • 1
  • Allys Guerandel
    • 2
  1. 1.University College DublinDublinIreland
  2. 2.St. Vincent′s University HospitalDublinIreland
  3. 3.Tallaght HospitalDublinIreland

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