Can simulations measure empathy? Considerations on how to assess behavioral empathy via simulations

Standardized patient simulations have been used as an assessment tool, providing teachers an opportunity to observe learner clinical and communication skills while eliminating the fear of harm to patients. Yet the vices and virtues of these simulations in measuring clinical and communication skills have been deliberated. Based on our standardized patient examination experience, we believe standardized patient simulations can be used to assess certain forms of learners' empathic behaviors. We advocate that, in properly designed and conducted simulations, the scores and feedback comments from standardized patients to learners regarding their empathic behaviors can identify learners with important deficiencies. We conclude our discussion by recommending that reflective practice, challenging cases, decision moments, and raters training to provide feedback can supplement and enrich the use of standardized patient simulations in evaluating empathy.