Degree Name

Doctor of Philosophy


School of Psychology


When training clinically competent doctors, most medical schools focus upon components of the interpersonal process between doctor and patient, such as empathy in the doctor-patient relationship. Although empathy is generally seen as a desirable attribute for medical professionals, it has usually been assessed through self report measures, which fail to capture the expression of empathy in the context of the clinical setting. This thesis sought to examine the relationship between clinician clinical competence and empathy in medical care. The participant sample was drawn from training doctors (medical students) due to the potential to influence this group at an early stage in their professional education and career.

Study 1 began this endeavour by investigating the feasibility and interrater reliability of assessing empathy through observer-ratings, using videotaped simulated patient encounters in the context of an Objective Structured Clinical Examination (OCSE). This method of assessment was found to be feasible and to have high interrater reliability, providing a valuable method for examining empathy in the context of patient care.

Study 2 investigated the relationship between empathy and clinical competence among medical students. The results suggested that a doctor-patient relationship fostered by empathy may complement the skills and knowledge required to effectively care for a patient. Strategies that enhance the behavioural expression of empathy may make medical students seem more clinically competent to both examiners and to patients. However, there was also evidence that the medical students' internal attitudes and emotions were discrepant with their behaviour.

Study 3 expanded on this research by exploring the discrepancies between self- and observer-ratings of empathy. It focused specifically on whether medical students who demonstrated discrepancies in self- and observer-ratings of empathy differ from those who did not demonstrate discrepancies, with regards to personality, attachment, and clinical competence. Results suggested that students differ with regards to extraversion, openness, and total competence. It was proposed that a deficit in metacognitive abilities, in addition to lower clinical competence, affects medical student's abilities to provide accurate self-assessments.

There are criticisms that OSCE consultations lack authenticity of real clinical relationships and that expectations are focused upon other agendas when the context is dominated by assessment. Additionally, there are arguments that the OSCE is not an optimal way of assessing a meaningful relationship in which empathy plays a real role. In the minority of circumstances, this may be the case, given it is possible that some medical students may learn that it pays to adopt the view that “if you cannot feel it, fake it”. However, while OSCE simulations may have a high degree of artificiality, they do enable assessment of performance of clinical skills in which the conceptual approach to the health problem, and the quality of the relationship established have to be integrated. This thesis addressed previous limitations in the assessment of empathy in medicine. The combined results of the three empirical chapters contribute to the underlying theory of empathy and suggest that empathy may be a pivotal component of clinical competence.