Fool me once: The illusion of empathy in interactions with standardized patients.

Empathy - cultivated through lived experiences - finds itself at the foundation of patient-centered care. Through establishing rapport, medical students learn to acquire unique perspectives of their patients during their training years. Given its basis in cognition, it is generally agreed that empathy is a skill amenable to nurturing, and can thus be evaluated. Unfortunately, when empathy, compassion, and perspective-taking are put under the scrutiny of a standardized examination (e.g. OSCEs - objective structured clinical exams), students find themselves feigning a substandard level of empathy in order to appease their evaluators' criteria. The fact that a standardized clinical encounter is little more than a performance results in both the student and the standardized patient (SP) vying to convince each other that their performances are realistic, and medical students' desire for positive evaluations hinders their ability or willingness to connect authentically with the "patient." Consequently, for many years, medical educators have been faced with a paradox: empathy cannot exist in an inauthentic environment, and if assessment promotes inauthenticity, then it appears that empathy is a quality which cannot be assessed.