Aim: During objective structured clinical examinations (OSCEs), perceived empathy can be rated by medical students, simulated patients (SPs) or external observers. This study aimed to examine how different ratings of medical students' perceived empathy correlate with each other, as well as with measures of behavioral empathy using a standardized coding system.

Methods: Voluntary medical students who participated to a formative OSCE self-rated their empathy using a global empathy score. SPs and an external observer rated students' perceived empathy using the Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE-Patient; JSPPE-Observer) and global scores. The Verona Coding System (VR-CoDES) captured patients' emotions and students' responses (verbal empathy). Non-verbal behavior and five sub-behaviors were assessed via an ordinal scale (1-5). Associations were calculated using correlation analyses.

Results: 56 medical students participated. There was no significant association between students' self-perceived empathy and other measures of perceived empathy. Global SPs' and observer's measures of perceived empathy as well as JSPPPE scales correlated with verbal empathy (VR-CoDES) (global ρ =0.27 p < .05; respectively 0.56, p < .01), JSPPPE-P (ρ = 0.34, p < .05), and JSPPPE-O (ρ = 0.41, p < .01). Non-verbal behavior correlated with global scores (SP ρ = 0.39 p < .01; observer ρ = 0.66, p < .01) and verbal empathy (VR-CoDES) (ρ = 0.38, p < .01).

Conclusion: SPs and observers' ratings of perceived empathy using global scores as well as measurement of non-verbal behavior are valid ways to assess medical students' behavioral empathy.

Innovation: Standardized coding systems are useful to assess which measures of medical students' perceived empathy used in OSCEs best correlate with behavioral empathy.