CASPer Guide — US Medical School Applicants
CASPer (Computer-based Assessment for Sampling Personal characteristics) is a typed online situational judgment test required by many US MD programs and the majority of DO programs via AACOMAS. This guide covers format, scoring, prep strategy, and the school list current as of the 2026 application cycle. Always verify requirements directly with each school, as participation changes annually.
CASPer format
CASPer is delivered entirely online through the Acuity Insights platform (formerly Altus Suite). You do not attend a testing centre — you complete the test from your own computer. You need a reliable internet connection, a working webcam (required for identity verification), and a microphone.
The test consists of 14 sections. Some sections present a short video clip depicting a scenario involving professional, ethical, or interpersonal themes. Others present a short text-based vignette. After viewing the scenario, you have approximately 5 minutes to type your responses to 3 open-ended questions. A countdown timer is displayed throughout each section.
There is no spell-check, grammar correction, or ability to paste from external documents. Responses are typed directly into the platform. The 5-minute window applies to all 3 questions per section — not 5 minutes per question.
Typing speed matters. At 50 WPM you can produce approximately 250 words in 5 minutes. With 3 questions per section, allocate roughly 1.5 minutes per question and aim for 60-80 words per response — concise and complete beats long and rambling.
How CASPer is scored
Each CASPer section is scored by a different human rater — typically a community member, healthcare professional, or educator trained by Altus Assessments. Because each section has a different rater, a poor response in one section does not affect the rater's impression of your other responses.
Raters assess each response on dimensions including professionalism, empathy, communication, and ethical reasoning. The criteria are not publicly detailed — Altus assesses the overall quality of your response against their professional standards.
Your aggregated score is converted to a quartile (Q1, Q2, Q3, or Q4) relative to the entire applicant cohort who took the same version of CASPer that cycle. Q4 is the top 25%. This quartile — not your raw score or individual section scores — is what schools receive.
Schools receive your quartile — they do not see your raw score or your written responses.
CASPer preparation strategy
1. Build your typing speed to 50+ WPM
Use free tools (Keybr, Typing.com, 10fastfingers.com) to practise. This is the single most actionable preparation step that directly determines how much you can communicate per section. Practise typing in complete sentences — not just random words — since that is the actual task.
2. Use the Altus free practice scenarios
Acuity Insights provides free sample scenarios at acuityinsights.app. Complete these under timed conditions with your actual test computer and setup. This familiarises you with the interface, the timer, and the video quality of scenario clips before test day.
3. Develop a response framework
For most CASPer questions, a structured 3-part approach works well: (1) acknowledge the complexity of the situation and the interests of the people involved; (2) describe what you would do and why, using a specific ethical principle if relevant (autonomy, beneficence, non-maleficence, justice — the four principles of bioethics); (3) acknowledge what you are uncertain about or what you would need more information to resolve. Avoid black-and-white conclusions where the scenario is genuinely ambiguous.
4. Review ethics and professionalism foundations
CASPer scenarios frequently test: informed consent, confidentiality, professional boundaries, disclosure obligations, cultural humility, resource allocation, and conflict resolution. Review the four principles of bioethics (Beauchamp and Childress). The AAMC Core Competencies document is also a useful reference — CASPer and PREview probe similar professional readiness constructs.
5. Complete timed practice sessions
The combination of the countdown timer, the pressure to write coherently, and the unfamiliarity of video scenarios creates a specific kind of test anxiety. Repeated timed practice normalises this environment. Aim for 3-5 full-length practice sessions before your actual test. Third-party prep providers (BeMo, Acuity Insights, Lecturio) offer paid practice tests with scoring rubrics.
US medical schools requiring CASPer
The following lists reflect schools known to require CASPer as of the 2025-2026 cycle. School participation changes annually. Always verify requirements on the Acuity Insights school list at acuityinsights.app and each school's admissions page before registering.
MD programs (representative list)
DO programs (representative list)
Source: Acuity Insights (acuityinsights.app) school list and individual school admissions pages. List is representative — confirm current requirements with each school.
Common CASPer question themes
Ethical dilemmas
Resource allocation, end-of-life decisions, conflicting obligations between patients, colleagues, and institutions.
Professional conduct
Observed misconduct by a colleague, impaired provider, documentation errors, reporting obligations.
Conflict resolution
Disagreement with a supervisor, interpersonal conflict in a team setting, difficult patient or family member.
Cultural humility
Navigating cultural or religious differences in care, interpreter access, family decision-making dynamics.
Informed consent & autonomy
Patient refusal of treatment, capacity assessment, surrogate decision-makers, truth-telling.
Confidentiality
Disclosure obligations (safety threats, infectious disease), protecting patient information in social situations.
CASPer vs AAMC PREview
| Feature | CASPer | AAMC PREview |
|---|---|---|
| Administrator | Altus Assessments / Acuity Insights (third-party) | AAMC (same body as AMCAS) |
| Format | Open-ended typed text | Multiple-choice rank ordering |
| Sections/scenarios | 14 sections | 30 scenarios |
| Time | ~90-110 min total | 75 min |
| Scoring | Quartile (Q1-Q4) | 1-9 scaled score |
| Score transmission | Direct to schools (separate from AMCAS) | Via AMCAS |
| Required by | 30+ MD, most DO programs | 30+ MD programs |
| Key prep | Typing speed, response structure, ethics knowledge | AAMC Core Competencies, rank-choice logic |
See the full AAMC PREview guide at /us/interviews/aamc-preview.
Common CASPer mistakes
- Exceeding the time limit. The timer is absolute — the section closes when it expires. If you are still writing, you lose whatever you have not typed. Practise pacing so you can complete all three questions in 5 minutes. A complete answer to all three questions scores better than one polished answer and two blanks.
- Generic answers. Responses like "I would talk to my supervisor" or "I would ensure the patient's wellbeing" without explanation of how, why, or what ethical principle is at stake read as evasive. Be specific about what you would do and why.
- Ignoring context. Each scenario has specific details — your role, the setting, the relationships involved. Responses that could apply to any scenario regardless of context suggest you are not engaging with the actual situation presented.
- Taking an extreme position without acknowledging nuance. CASPer scenarios are designed to have genuine ethical tension. A response that immediately takes a strong absolute position without acknowledging competing considerations suggests binary thinking rather than professional judgment.
- Forgetting typing practice. Many applicants under-prepare the mechanical component. Low typing speed is the single most preventable CASPer failure mode — you cannot demonstrate your reasoning if you cannot type it in time.
Frequently asked questions
Prepare for CASPer with expert guidance
Live sessions covering response structure, ethics knowledge, and timed practice under real CASPer conditions.
Related guides
- AAMC PREview guide
30 multiple-choice SJT scenarios, 1-9 scale, Core Competencies framing.
- MMI guide
Station-based circuit, 4Cs framework, Kira Talent, and school lists.
- Traditional interview guide
STAR framework, open-file vs closed-file, conversational prep.
- Holistic review
AAMC Core Competencies, post-SCOTUS framing, mission fit.