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Medical Students' Self-Reported Empathy and Simulated patients' Assessment of Student Empathy: An Analysis by Gender and Ethnicity Berg K, Majdan J, Berg D et al. Academic Medicine 2011;86:984-988

Reviewed by Margaret Golden

What was the study question?
What is the contribution of students' ethnicity and gender to the assessments of student empathy by standardized patients (SP)? How do SP scores compare to students' own assessments of their empathy?

How was the study done?
For one class of 248 students, during the school's summative OSCE with standardized patients, students' self-assessment scores of empathy were compared to the SP's scores of how well students were able to convey both empathy and support.

What were the results?
Standardized patients rated female students higher than male students in terms of empathy. They also rated white students higher than Asian American students (effect size 0.56 and 0.43, for the itemized and global scales respectively.) Meanwhile, the self-ratings for empathy were the same for students self-identified as white and those self-identified as Asian.

What are the implications of these findings?
The authors wonder if and worry that these findings point to an important bias against Asian students on high stakes exams both locally and nationally. Their discussion addresses the need to fine tune the measurement tools and SP training to reduce this bias. An alternative approach is to accept that the SPs are assessing their own experiences of the encounters accurately: not all students in their 4th year of medical school are equally able to connect with patients. If this is the case, medical schools need to carefully diagnose each student's communication skills early in the curriculum, and provide ongoing, individualized interventions. Admittedly, this is a huge task; but, can we do less?

Editor's note: A second article about empathy but with a completely different focus! While the literature is quite clear that self-assessment can not be done well, this study is important because it raises an important question: Are standardized patients biased by ethnicity and gender when dealing with medical students. As the authors conclude, this needs further study.

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