Simulated patient and family medicine examiner assessment of medical student empathy

Abstract

INTRODUCTION: Communication, interpersonal and empathic skills are essential elements of a family medicine consultation which medical students need to learn. Simulated patients’ (SP) assessment of these skills has been suggested to be more authentic as SP respond to the empathic cues directed towards them. However, the best way to assess student empathy in an examination setting is not clear. The aim of this study is to investigate SP assessment of medical student empathy. METHODS: In 2013, 158 final-year medical students at the University of Hong Kong completed a Family Medicine clinical competency test in which they were assessed by a trained SP and a family medicine examiner. The Consultation and Relational Empathy (CARE) measure was used to rate students’ empathy. The relationship of SP CARE scores to examiner CARE scores, to student academic outcomes and to gender were analysed using intraclass correlation, Spearman’s correlation and logistic regression respectively. Results: The inter-rater reliability between SP and examiner CARE ratings was low (ICC=0.228, p=0.002). SP CARE rating was only weakly correlated with overall academic achievement in the Family Medicine clerkship (ρ=0.274, p=0.001). Students assessed by female SP were more likely to have a higher CARE rating (adjusted OR=5.38, p<0.001). DISCUSSION: The weak correlation between SP and examiner ratings of medical student empathy may be due to subjectivity in the perception of empathy. Clinical examiners may be regarding empathy from a cognitive perspective while SP may be more sensitive to the emotive aspects. Further investigation to explore the reasons behind these differences and to establish the utility of a SP assessment of empathy in an examination setting would be beneficial.