title: Standardized patient assessment of medical student empathy: ethnicity and gender effects in a multi-institutional study.
abstract: OBJECTIVE
  To examine, primarily, the effects of ethnicity and gender, which could introduce bias into scoring, on standardized patient (SP) assessments of medical students and, secondarily, to examine medical students' self-reported empathy for ethnicity and gender effects so as to compare self-perception with the perceptions of SPs.
  
  
  METHODS
  Participants were 577 students from four medical schools in 2012: 373 (65%) were white, 79 (14%) black/African American, and 125 (22%) Asian/Pacific Islander. These students were assessed by 84 SPs: 62 (74%) were white and 22 (26%) were black/African American. SPs completed the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) and the Global Ratings of Empathy tool. Students completed the Jefferson Scale of Empathy and two Interpersonal Reactivity Index subscales. The investigators used 2,882 student-SP encounters in their analyses.
  
  
  RESULTS
  Analyses of SPs' assessments of students' empathy indicated significant interaction effects of gender and ethnicity. Female students, regardless of ethnicity, obtained significantly higher mean JSPPPE scores than men. Female black/African American, female white, and female Asian/Pacific Islander students scored significantly higher on the JSPPPE than their respective male counterparts. Male black/African American students obtained the lowest SP assessment scores of empathy regardless of SP ethnicity. Black/African American students obtained the highest mean scores on self-reported empathy.
  
  
  CONCLUSIONS
  The significant interaction effects of ethnicity and gender in clinical encounters, plus the inconsistencies observed between SPs' assessments of students' empathy and students' self-reported empathy, raise questions about possible ethnicity and gender biases in the SPs' assessments of medical students' clinical skills.
authors.affiliation: Dr. K. Berg is professor of medicine and codirector, University Clinical Skills and Simulation Center, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. Dr. Blatt is professor of medicine and director, Clinical Learning and Simulation Skills Center, George Washington University School of Medicine, Washington, DC. Dr. Lopreiato is professor of pediatrics and associate dean for simulation education, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. Jung is assistant professor of emergency medicine and associate director, Simulation Center, Johns Hopkins University, Baltimore, Maryland. Ms. Schaeffer is a medical student, Tufts University, Boston, Massachusetts. Mr. Heil is a research assistant, University Clinical Skills and Simulation Center, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. Ms. Owens is director, Clinical Skills and Simulation Center, Howard University, Washington, DC. Dr. Carter-Nolan is assistant dean for medical education, vice chair for education, and assistant professor, Department of Community and Family Medicine, Howard University, Washington, DC. Dr. D. Berg is G. Fritz Blechschmidt, MD, Professor of Clinical Skills and codirector, University Clinical Skills and Simulation Center, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. Mr. Veloski is director, Medical Education Research, Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. Ms. Darby is standardized patient educator, Uniform Services University of the Health Sciences, Bethesda, Maryland. Dr. Hojat is research professor of psychiatry and human behavior and director, Jefferson Longitudinal Study, Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Katherine
authors.initials: K
authors.lastname: Berg
authors.forename: Benjamin
authors.initials: B
authors.lastname: Blatt
authors.forename: Joseph
authors.initials: J
authors.lastname: Lopreiato
authors.forename: Julianna
authors.initials: J
authors.lastname: Jung
authors.forename: Arielle
authors.initials: A
authors.lastname: Schaeffer
authors.forename: Daniel
authors.initials: D
authors.lastname: Heil
authors.forename: Tamara
authors.initials: T
authors.lastname: Owens
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Carter-Nolan
authors.forename: Dale
authors.initials: D
authors.lastname: Berg
authors.forename: Jon
authors.initials: J
authors.lastname: Veloski
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Darby
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Hojat
mesh_terms: D004645:Empathy; D005260:Female; D006801:Humans; D008297:Male; D008873:Mid-Atlantic Region; D015999:Multivariate Analysis; D016544:Patient Simulation; D044469:Racial Groups / Q000523:psychology* / Q000706:statistics & numerical data; D063505:Racism / Q000523:psychology; D057566:Self Report; D012737:Sex Factors; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires