Purpose Empathic communication with patients is an essential component of quality primary care. This study examines the ability of physician assistant (PA) students to communicate empathically in clinical interviews with standardized patients. Methods In their first year of training, PA students conducted 3 clinical interviews with standardized patients over a 6-month period in 2014, during the second half of their didactic year. Each interview was evaluated for empathy by 4 individuals: The students themselves, their standardized patients, their clinical instructors, and third-party observers. Results Students consistently rated their empathic abilities more favorably than did patients, clinical instructors, or observers, with mean differences ranging from 0.56 to 1.92 and averaging 1.09 on a 9-point scale. Students’ evaluations were most dissimilar from those of patients (difference M = 1.12) and most similar to those of observers (difference M = 1.06). The assessments of all 4 raters varied over time: Students rated themselves as significantly more empathic in April (time 2) than in July (time 3) of their didactic year. Patients rated students as significantly less empathic in January of the didactic year (time 1) than at time 2 and as significantly more empathic at time 2 than time 3. Instructors rated students as significantly less empathic at time 1 than at either time 2 or time 3. Finally, observers rated students as significantly more empathic at time 1 than at either time 2 or time 3. Conclusions PA students consistently overestimate their empathic abilities during their first year of training. Given the importance of empathy in clinical care, increased didactic efforts focused on developing and conveying empathy may be warranted in PA education.