Background: Empathy has long been thought to be an important characteristic of a good physician, and a measure of empathy is needed to provide feedback to medical students, residents, and physicians on this important aspect of their clinical performance. The standardized-patient-testing format provides a simple but intuitively convincing approach to the assessment of empathy. Purpose: To determine the extent to which 4th-year medical students were checked "empathic" by standardized patients (SPs) on a performance-based examination, to evaluate the psychometric properties of this simple empathy measure, and to see whether empathy was related to clinical performance on history taking and physical examination. Method: Analyses were performed on examination data for 1,048 senior medical students in the 8 member schools of the New York City Consortium tested at The Morch and Center of Mount Sinai School ofMedicine. Results: The percentage of students who were checked "empathic" ranged from 59% to 98% (M = 79%) across the 7 SP cases. Of the 1,048 students, 268 (26%) were checked "empathic" on all 7 cases; however, 221 (21%)were checked on ≤4 cases, 90 (9%)on ≤3 cases, and 26 (3%)on ≤2 cases. The generalizability coefficient of the overall empathy scores was. 43; the dependability index with cutoff was. 81 for detecting students checked "empathic" on fewer than half of the 7 cases. The correlations of the empathy item with the other checklist items suggest that the empathy construct refers to behaviors that make the patient feel comfortable and important. Also, students who were checked "empathic" on fewer than half of the 7 cases performed lower on history taking and physical examination. Conclusions: Empathy appears to be reasonably acceptable in this sample of students, although it is of concern that, on average, more than 200 students per case were not seen as empathic, and more than 200 were checked "empathic" on ≤4 of the 7 cases. These results show the potential usefulness of this simple measure of empathy and illustrate the need for feedback to address any problems.