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Places to study at medical schools are scarce, which makes well-designed selection procedures employing criteria with predictive validity for good students and doctors necessary. In Germany, the pre-university grade point average (pu-GPA) is the main selection criterion for medical school application. However, this is criticised. According to a decision by the Federal Constitutional Court, selection must be supplemented with a criterion other than the pu-GPA. Empathy is a core competency in medical care. Therefore, it seems to be an appropriate criterion. This study evaluates the feasibility of an empathy questionnaire and empathy appraisal by a panel for applicant selection. We employed a sequential explanatory mixed-methods design. Results of self- and external assessments of empathy were compared in a quantitative analysis. Thereafter, the concept of empathy and the approach to empathy appraisal by the selection panel members were explored qualitatively in six focus groups with 19 selection panel members using a semi-structured guideline. Transcripts were content analysed using both deductive and inductive coding. We found no significant correlation of self- and external empathy assessment (ρ(212) = − .031, p > .05). The results of the focus groups showed that, while panel members judged the external empathy assessment to be useful, they had neither a homogenous concept of empathy nor an implicit basis for this assessment. This diversity in panel members’ concepts of empathy and differences in the concepts underlying the Davis Interpersonal Reactivity Index seem to be the main reasons for the lack of correlation between self- and external empathy assessments. While empathy is a possible amendment to established selection criteria for medical education in Germany, its external assessment should not be employed without training panel members based on an established theoretical concept of empathy and an objective self-assessment measure.