Background: Empathy is critical to clinician-patient communication and patient outcomes. Perspective-taking, an intervention demonstrated in other contexts to induce empathy, has never been studied in a medical context. As a first step in evaluating its potential clinical value, the studies described below assess perspective taking in a series of clinical skills examinations. These examinations are simulated clinical encounters: students encounter and are evaluated by standardized patients (SPs)--actors trained to take on patient roles. Though not real clinical encounters, clinical skills examinations have been demonstrated to test clinical competency well enough to be incorporated into the licensure examination of the National Board of Medical Examiners.

Objective: To assess if perspective-taking improves the satisfaction of standardized patients in three clinical skills examinations.

Hypothesis: Students receiving a perspective taking intervention will receive better standardized patient satisfaction scores than control students.

Design and Setting: Three randomized, controlled studies. Studies 1 and 3: Junior medical students(N = 503), 6-station clinical skills examination. Study 2: physician assistant students (N = 105), 3-station clinical skills examination.

Intervention: The intervention students received a perspective-taking instruction prior to their examination asking them to put themselves in their "patients" shoes and to imagine what they were thinking and feeling. The control students received standard pre-examination instructions. Simulated patients were blind to study condition. Main Outcome Measure: Simulated patient satisfaction scores.

These studies assess the interaction of students and simulated patients (actors)--no real patients were involved.

Inclusion Criteria:

• All third year medical and first and second year physician assistant students, George Washington University School of Medicine and Health Sciences

Exclusion Criteria:

• None