Assessment of relational empathy with simulated patients: adaptation and validation of a new instrument

Abstract

Abstract Background: Empathy is a crucial competence in the doctor-patient relationship that can be trained to enhance health outcomes. The Consultation and Relational Empathy (CARE) measure assists patients in evaluating empathy of health care professionals. While the CARE measure has received extensive validation for application in primary and specialty care in diverse languages, no version has been adapted and validated for use in simulation contexts. This study aimed at adapting and validating a CARE measure for simulated patients (Sp-SIMCARE). Methods: The contextual adaptation to simulation contexts was completed in four phases by a panel of five experts, in collaboration with five simulated patients to ensure clarity, relevance, and equivalence in language and content: 1) preparation of a preliminary contextual adaptation proposal; 2) first version drafting; 3) pilot evaluation of the first version with simulated patients; and 4) review and refinement of the Sp-SIMCARE final version. The validation of the new measure was conducted on typical primary care scenarios with simulated patients evaluating performance of undergraduate medical students at the International University of Catalunya (Barcelona, ​​Spain). Simulated patients adopted four prototypical primary care patient roles: a) acute; b) chronic; c) with a high functional component; and d) difficult to deal with. The newly developed scale underwent analysis for convergent validity, acceptability and face validity, homogeneity, and internal reliability. Results: The adaptation process ensured that the content of the Sp-SIMCARE scale was unambiguous, relevant, and presented in a comprehensive manner, with uniform meanings for all users. Validation was performed via 270 interviews involving 95 students (mean age, 23 years; 62.2% females). The final version demonstrated satisfactory convergent validity (Spearman's rho coefficient of 0.730; p < 0.001), high acceptability and face validity (proportion of ‘Does not apply’ responses/missing values at 1.96%), and strong homogeneity (corrected item-total correlations in the range 0.705 to 0.865), and reliability (Cronbach’s alpha of 0.960). Conclusions: The Sp-SIMCARE measure proved to be psychometrically valid and reliable for simulated patients to evaluate undergraduate medical students. The use of this tool could potentially assist in the design and implementation of interventions aimed at fostering empathy in future doctors throughout their training.