"Demonstrate insight and understanding into emotion" is a competency amenable to simulation-based assessment. The Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) has validity evidence for patients to assess provider empathy. A version adapted for a third-party observers does not exist. Our aim was to modify the JSPPPE and use recorded standardized encounters to obtain validity evidence. This cross-sectional study used video and data collected from 2 pediatric residencies. In 2018, 4 raters reviewed 24 videos of 12 interns communicating with standardized patients (SP) in 2 encounters and completed a modified JSPPE for observers (JSEO). Reliability between raters was established using Intraclass Correlations (ICC). JSEO mean scores were correlated to Essential Elements of Communication (EEC), JSPPPE, and faculty composite interpersonal communication (IC) scores using Spearman Rank. The mean ICC for all 4 raters was 0.573 (0.376-0.755). When ICC was calculated for pairs of raters, Rater 1 was an outlier. ICCs for mean scores for pairs among the 3 remaining raters was 0.81 to 0.84. Mean JSEO scores from the four raters correlated with the JSPPPE (rho = 0.45, P = .03) and IC (rho = 0.68, P < .001), but not the EEC (rho = 0.345, P = .1). We found validity evidence for the use of a modified JSPPPE for an observer to assess empathy in a recorded encounter with a SP. This may be useful as medical educators shift toward competency-based tracking. The brevity of this tool and potential assessment using video are also appealing. Copyright © 2020 Academic Pediatric Association. All rights reserved.