Assessing the Empathy of Medical Students in Family Medicine: Validity of the Consultation and Relational Empathy (CARE) Measure

Abstract

Introduction: Empathy underpins the doctor-patient relationship and has a direct, positive impact on the quality of patient care. Medical student empathy predicts future doctor-patient empathy, underlining the importance of cultivating and assessing this early in training. The Consultation and Relational Empathy (CARE) measure is a 10-item instrument which has been developed and validated in primary care settings to enable patients to assess a doctor’s empathy. The aim of this study is to establish the validity of the CARE measure in assessing medical students’ empathy. Method: All 158 final year medical students who undertook the Family Medicine clinical competency test in 2013 were assessed by trained simulated patients. The patients completed three measure of empathy: the CARE measure, a global rating score and the Jefferson Scale of Patient’s Perception of Physician Empathy (JSPPPE). They also completed a checklist to assess students’ history-taking, a measure of knowledge which is theoretically unrelated to empathy. The construct validity of the CARE measure was determined using exploratory and confirmatory factor analysis with the convergent and divergent validity analysed using Spearman’s rank correlation coefficients. Results: Exploratory factor analysis identified one factor on which all 10 items in the CARE measure loaded significantly, which was supported by the confirmatory factor analysis. The CARE Measure very strongly correlated with both convergent measures: global rating (ρ = 0.794, p < 0.001) and the JSPPPE (ρ = 0.771, p < 0.001), while only weakly correlated with the divergent measure: history taking score (ρ = 0.277, p < 0.001). Conclusion: The CARE measure was shown to be valid in an undergraduate family medicine clinical examination setting. It may be a useful tool to assess and to give feedback to students on specific interpersonal elements of the consultation.