Last Updated on March 19, 2025 by Laura Turner
US medical school applicants are facing a changing landscape where situational judgment tests (SJTs) are becoming a normal part of the admissions process. The AAMC clarified policies about retaking its PREview assessment, including the opportunity to take PREview more than once during an application cycle. Acuity Insights further encouraged schools to include the Duet assessment for applicants who had to take its Casper SJT while discontinuing its Snapshot assessment. To better understand these changes and their impacts on students, the 2024 SJT Experience Survey was conducted as part of the Fall 2024 Applicant Experience Survey between October and December 2024. Our fall survey is intended to capture applicants as they are interviewing and receiving early decisions.
Survey Demographics
In 2023, the Health Professional Student Association released a report on how applicants were preparing for SJTs (Groundbreaking 2023 SJT Survey Completed). In 2024, we wanted to identify helpful courses or subjects and familiar situational contexts for future test-takers. We also sought impressions about how well their competencies were assessed. Finally, we wanted to confirm observations in our 2022 and 2023 surveys.
124 respondents completed the Situational Judgment Test Experience section of the Fall 2024 HPSA/SDN Applicant Experience Survey. 91 described themselves as premed applicants (73.4%), 13 pre-dental (10.5%), 16 pre-vet (12.9%), and 4 pursuing other professions (3.2%). 82 respondents took the Casper exam (47 of 77 took Duet, 61.0%), and 47 took AAMC PREview.
For gender identity, 73 of 122 (59.8%) were female, 47 (38.5%) male, and 2 (1.6%) gender non-conforming. For race/ethnicity, 80 of 117 (68.4%) self-identified as White/Caucasian, 24 Asian (20.5%), 13 Hispanic/Latinx (11.1%), 9 Black/African-American (7.7%), 5 Middle Eastern/North African (4.3%), 3 Native American/Alaska Native (2.6%), and 1 Hawaiian/Pacific Islander (0.9%).
97 respondents claimed membership in an additional group: 31 self-described as economically disadvantaged (32.0%), 30 as first-generation college/undergraduate students, and 30 as LGBTQ+ (30.9%). Other large groups include educationally disadvantaged (19, 19.6%), non-stereotypical two-parent household (17, 17.5%), student-athlete (15, 15.5%), immigrant/asylee/undocumented (14, 14.4%), family of military/veteran (13, 13.4%), medically compromised/disabled (9, 9.3%), experienced homeless/houselessness (6, 6.2%), and military/veteran (5, 5.2%). 66 self-identified as the first in their household to pursue a US health professional degree (first-generation professional student, 68.0%).
Changes for Casper in 2025
Acuity Insights announced some changes to its Casper assessment beginning with the 2025 testing cycle.
The 2025 Casper exam is shorter in length and time. Examinees will address 11 scenarios (instead of 14) with fewer prompts per situation (two instead of three) for typed responses. These changes reduce the testing time from 90-100 minutes to 65-85 minutes.
Examinee performance (quartile reported to examinees and z-scores reported to programs) will be based on individually scored scenarios rather than their answers for all questions in a scenario, similar to how most programs score multiple mini-interviews.
The overall pricing schedule for US medicine and health professions examinees remains unchanged, and waivers can be granted to those approved for any health association fee assistance program.
Go to the Acuity Insights website for more details.
Program Expectations for SJTs
Applicants disclosed how many programs required or highly recommended that they take SJTs as part of their application process (Figure 1a). Respondents took Casper even if it was required by only one program (12 of 76, 15.8%). Similarly, 11 respondents (14.5%) disclosed that 10 or more programs expected their Casper result as part of their process. PREview test-takers responded to 1-3 programs (23 combined of 39, 58.9%) as PREview was less established as a SJT. Most respondents scheduled their SJT’s for the early part of the cycle (May, June, or July).
Confirming Past Observations
40 of 47 respondents reported results for both Casper and PREview, which are shown in Table 1. We confirm our 2022 SJT Pilot survey result that our respondents’ Casper results were evenly distributed among four quartiles, but their PREview results were skewed towards the top/fourth quartile. All respondents with top/fourth Casper quartile results reported top/fourth-quartile PREview results. These results confirm that the two SJTs are designed differently and cannot be substituted for each other during the applicant review.
We looked to confirm our 2023 observation that MCAT CARS scores correlated with their Casper performance. In Table 2, we observed that MCAT CARS scores were lower among those who self-reported low/first-quartile results. This suggests that respondents with low Casper MCAT CARS results may have less developed reading and analytical skills.
Only three pre-dental respondents took Casper (2 reporting second-quartile, 1 fourth-quartile), and they had similar academic average, perceptual ability, and reading comprehension scores. The sample size was too small to determine any trends with Casper performance.
In contrast, a relationship was suggested between low PREview scores and low MCAT overall scores (Table 3). MCAT CARS scores did not correlate with PREview results.
Discuss Situational Judgment Tests
Talk about SJTs, including reviewing sample questions and scenarios, on the SDN Casper/SJT forum.
Academic Content in SJTs
By design, SJTs are meant to gauge desirable professional skills and behaviors. How do respondents learn about proper ways to respond to challenging decisions? Respondents were asked which course subjects helped in their SJT preparation. Figure 2 shows their responses if content or concepts from a specific course subject were featured in most (over 75%), a majority (over 50%), some (over 25%), or rarely (less than 25%) of the situations. As expected, traditional science subject content or concepts were seldom observed. Ethics/philosophy, psychology, and sociology content or concepts were most frequently observed.
Figure 2. Respondents cited the most relevant course content tested in situational judgment tests (red + blue) as ethics/philosophy, psychology, and sociology. The least relevant courses were the traditional sciences, history, and business.
Frequently Observed Contexts
While respondents could not disclose specific decisions or situations, they gave insight into frequent contexts in their SJTs (Figure 3). Respondents were frequently asked about situations in clinical settings (healthcare experience or patient-facing experience) or in academic settings dealing with peer-to-peer interactions (student organizations, peer tutoring/teaching, or recitations/didactic small groups). In contrast, peer-to-peer interactions with peers from race/ethnicity-affinity groups or faith/religious identities were uncommon, suggesting that cultural competency for diverse groups may remain challenging to address.
Figure 3. Respondents identify several situational contexts frequently used in their situational judgment tests (red + blue). Many situations were clinically related (healthcare experience, patient-facing experience). Other situations focused on peer-to-peer relationships in student organizations (member or leader), didactic discussions/small groups, or peer-to-peer tutoring/mentoring. Situations involving identity/affinity groups organized by culture/race or faith/spirituality were least frequently observed.
Competencies Assessed
Respondents were asked how frequently core competencies were evaluated. Figure 4 shows the frequency of tested competencies among Casper test-takers, while Figure 6 shows a similar response for PREview competencies.
Figure 4. Most frequently tested Casper competencies (red+blue) Communication, Professionalism, Empathy, Ethics, Collaboration, Problem-Solving. Least frequently tested Casper competencies: Resilience and Motivation.
Figure 6. Most frequently tested PREview competencies (red+blue): Empathy/Compassion, Teamwork/collaboration, Interprofessional skills, Ethics/Responsibility, Reliability/Dependability
Least frequently tested: Service orientation, Oral communication
Casper respondents recognized all nine competencies during their assessments, but they perceived that specific competencies were more frequently measured. Communication, professionalism, empathy, ethics, and collaboration were observed with the highest frequency. Resilience and motivation were rated as being tested least frequently.
PREview respondents also recognized all ten competencies but also perceived the differing frequency of some competencies. The competencies with the highest frequency are empathy/compassion and teamwork/collaboration. Interprofessional skills, ethics/responsibility, and reliability/dependability were part of a second tier of important competencies. The least frequently observed competencies were oral communication and service orientation.
Duet Examinees
SDN has published an article from Acuity Insights about the Duet assessment, which measures a candidate’s potential mission fit with a program. The Fall 2024 HPSA/SDN survey was the first to query Duet assessment test-takers independently from the test constructors. 47 of 77 (61.0%) respondents took the Duet assessment, with 25 (55.6%) within a day of completing their Casper assessment. Examinees did not feel that Duet helped them better discern any values or expectations they had for seeking a professional program (28, or 62.2%, of 45), nor did they feel the Duet assessment provided insight into expectations or values sought by programs requiring Duet (30, or 68.2% of 44).
In the 2024 cycle, Acuity Insights discontinued the Snapshot assessment, in which 11.6% of Casper respondents participated in the 2023 SJT Experience Survey (Executive Summary).
Initial Impression of 2024 PREview Policies
A new policy on retaking PREview was implemented for the 2024 cycle: examinees can choose to retest within the same application cycle. Only 3 of 44 (6.8%) respondents said they took the PREview exam twice during the 2024 testing cycle.
AAMC also implemented a lifetime limit of four PREview attempts, including voided attempts. Five (11.9%) approved this policy, six (14.3%) disapproved, and the remaining 31 (73.8%) said they were unaware.
Takeaway: Preparing for SJT’s for Prehealth Applicants
The Fall 2024 SJT Experience Survey results captured impressions from the 2024-2025 applicant cohort to prehealth programs. The insights suggest that future professionals should reflect on interactions in clinical settings and academic/professional learning groups where effective, empathetic communication and collaboration are valued. When crafting an answer to a challenging situation on Casper and PREview, corrective actions should emphasize professionalism expectations for ethics and reliability. Coursework and content related to ethics, philosophy, sociology, and psychology were considered most helpful in determining appropriate responses to situations.
Applicants should remain attentive to the less frequently tested competencies as they may be queried in other aspects of a school’s admissions process (such as primary application review, secondary essays, recorded video interviews, or live interviews). Applicants should expect to be tested for their alignment with each program’s stated core values and competencies.
While neither test-maker has suggested textbooks, prehealth applicants should take full advantage of social science courses (ethics, philosophy, sociology, psychology) or participate in university committees focused on student conduct or integrity.
Applicants also benefit by comparing professional conduct expectations for health professional students, residents, and learners. Look for examples of model practices (Heersink University of Alabama at Birmingham, accessed March 8, 2025) or violations (Noorda College of Osteopathic Medicine, accessed March 8, 2025); compare these situations with the sample questions while preparing for these SJTs.
Emil Chuck, Ph.D., is Director of Advising Services for the Health Professional Student Association. He brings over 15 years of experience as a health professions advisor and an admissions professional for medical, dental, and other health professions programs. In this role for HPSA, he looks forward to continuing to play a role for the next generation of diverse healthcare providers to gain confidence in themselves and to be successful members of the interprofessional healthcare community.
Previously, he served as Director of Admissions and Recruitment at Rosalind Franklin University of Medicine and Science, Director of Admissions at the School of Dental Medicine at Case Western Reserve University, and as a Pre-Health Professions Advisor at George Mason University.
Dr. Chuck is an expert on admissions, has been quoted by the Association of American Medical Colleges (AAMC), and has volunteered as a workshop facilitator on holistic admissions for the American Dental Education Association (ADEA). He has also contributed to the essay collection The Perfect Doctor by Pager Publications and has developed competency-based rubrics supporting holistic review.