Specialty-Specific Screening Exams for US Students and IMGs: Situational Judgment Tests and Signaling
Some residency programs ask applicants to complete a situational judgment test such as Casper. What these assessments are, how to prepare, and how they differ from program signals.
Beyond USMLE or COMLEX-USA scores, a few residency programs ask applicants to complete an extra screening step. The most common is a situational judgment test (SJT) such as Casper, which looks at professionalism and communication rather than medical knowledge. This applies to U.S. students and international medical graduates (IMGs) alike. It is program-specific: most programs do not require one, and requirements change from one application cycle to the next, so always check each program you apply to. Individual programs in competitive or high-volume specialties, such as emergency medicine, obstetrics and gynecology or ophthalmology, may ask for one, but a specialty name alone does not tell you whether a given program does.
What a situational judgment test measures
An SJT presents realistic workplace scenarios and asks how you would respond. There is no medical content to memorize. Raters look at the professional qualities you show in your answers: ethics and ethical reasoning, empathy, communication, collaboration, fairness and problem-solving.
Casper and Duet (Acuity Insights)
| Assessment | What it is | What to know |
|---|---|---|
| Casper | An online, open-response situational judgment test. | You respond to scenarios in typed and video form. Trained human raters score the responses, and a combined score is shared with the programs on your distribution list. For recent cycles Acuity described the test as about 65 to 85 minutes, but the format changes, so read the current description before you register. You are told your quartile after the results are processed. |
| Duet | A values-alignment assessment. | You compare the characteristics you prefer in a program, and programs compare the result with their own profile. It takes about 15 to 20 minutes, has no time limit and does not have to be completed in one sitting. Only programs that require it will ask you to take it. |
Acuity says the fee to reserve Casper already covers Duet if one of your programs requires it, but check the current fee and dates on its site, as they change by cycle.
How to prepare
- Read the format and sample scenarios on the official test page, and do a technology check of your webcam, microphone and internet connection beforehand.
- Practice answering aloud and in writing within a time limit. Aim for a clear structure: acknowledge the issue, consider the people involved, explain your reasoning, and state what you would do.
- Answer the question you are given. Be specific and realistic instead of reciting generic professional language.
- Take the test early enough for scores to reach programs before they review applications, and list every program that requires it as a recipient.
- If you need an accommodation, read the provider's policy and request it well ahead of your test date.
An earlier approach that was discontinued
From the 2018 ERAS cycle, the AAMC piloted a Standardized Video Interview in emergency medicine to assess interpersonal skills and professionalism. The AAMC announced that it would not continue past the 2020 cycle, citing little interest from applicants and program directors. The idea has not gone away, but the tools used now come from outside providers and are chosen program by program.
Signaling is not a test
You may see preference signals discussed alongside these assessments. A program signal is a way to tell a program that you are especially interested in it, using a limited number of signals in the application. It is not an exam and has no scoring. The number of signals, and whether a specialty uses a single kind or a two-tier gold and silver system, is set per specialty and cycle by the AAMC, so check the current rules for your specialty in the official ERAS materials. Use signals for programs you would genuinely rank, and remember that a signal does not replace a strong application.
Confirm the current requirements
Look for screening requirements on each program's own website and in its ERAS or FREIDA listing, and ask the program coordinator if it is unclear. Read the provider's current information on the Casper test site. This article is general educational information, not advice on your individual applications. See also our exam guides.
Educational content only. Confirm current exam requirements with USMLE.