Professionalism and Empathy Assessment in Undergraduate Medical Students: A Systematic Review.

Background: Professionalism and empathy are core competencies in undergraduate medical education, but their assessment remains challenging because these domains are multidimensional and are measured using diverse methods. Existing reviews have often examined empathy or professionalism separately, with less attention to how different assessment modalities capture related but distinct constructs. Methods: A systematic review was conducted following PRISMA guidance to examine literature published from 2000 to 2025 on assessment of professionalism and empathy in undergraduate medical students. Included studies evaluated self-report instruments, observer-based assessments, patient- or standardized patient-perceived measures, simulation-based methods, reflective portfolios, and emerging technology-enhanced approaches. Because of substantial heterogeneity in study design, outcomes, and assessment modalities, findings were synthesized narratively by assessment type and target construct. Results: Thirty-five studies met inclusion criteria. Self-report instruments, particularly the Jefferson Scale of Empathy and related professionalism attitude scales, were the most commonly studied and showed the strongest psychometric structure for assessing empathic orientation and professional attitudes. Observer-based assessments, including faculty ratings, the Professionalism Mini-Evaluation Exercise, and multisource feedback, provided evidence of enacted behavior in authentic settings but were more vulnerable to rater effects and contextual variability. Patient- and standardized patient-based measures captured perceived empathy within specific encounters, while OSCEs and situational judgement tests offered greater standardization for assessing communication, ethical reasoning, and professional judgment. Reflective portfolios contributed insight into professional identity formation and developmental growth. Across studies, convergence between modalities was limited, suggesting that these tools assess overlapping but nonidentical constructs rather than a single unified trait. Overall, the literature supports a multimodal approach in which multiple low- and moderate-stakes assessments are interpreted together. Conclusions: Professionalism and empathy assessment in undergraduate medical education is best understood as a multi-construct, multimethod challenge. No single instrument adequately captures these competencies. A programmatic assessment approach that combines complementary methods over time is therefore more educationally and psychometrically defensible than reliance on any single measure. Future research should emphasize clearer construct definitions, longitudinal validation, fairness, and evaluation of emerging technologies.