Pharmacy students need to develop self-awareness to effectively evaluate their progress in skills, particularly in affective areas like empathy. While outside input can support growth, reliable tools are essential for precise evaluation. Therefore, this research aimed to gather additional validity support for the updated Kiersma-Chen Empathy Scale (KCES-R), contrast students' own views of their empathy with those from simulated patients via a matching patient instrument (KCES-PV), and explore students' thoughts on their patient interactions. Pharmacy students rated their own empathy levels (using KCES-R) prior to and following a patient interaction. Right after the interaction, simulated patients rated the students' empathy with the KCES-PV. Students then reviewed video recordings of their sessions and provided written thoughts on how they applied empathy. Quantitative data underwent statistical examination, while qualitative reflections were analyzed thematically. The analysis indicated that the KCES-R consists of two dimensions with strong reliability and sensitivity to empathy shifts. Students tended to rate their empathy higher than simulated patients did. Students strongly valued demonstrating empathy in patient care and recognized areas for improvement. Findings offer supporting validity for applying the KCES-R and introduce a companion tool for use by simulated patients. Combining reliable matching instruments with reflection practices may enhance self-awareness and empathy development, enabling students to compare external feedback with their own perceptions of performance.
