This is part 1 of our 5-part series on medical school interviews. For information on the other posts in this series, see our overview post here.


Almost two decades ago, two professors in the Department of Medicine at McMaster University in Ontario, Canada, confronted what they saw as medical school admissions’ big defect: the process of evaluating which candidates should be invited for interviews relied only on stats and facts.

“We were only able to use reference letters, personal essays, CVs. They don’t tease apart the applicants who excel in terms of their communication, ethics, or empathy from those who don’t,” said Dr. Kelly Dore. “I’d be signing rejection letters for thousands of applicants every year based upon the grade point average and MCAT, but no good reliable measure of their personal professional characteristics,” said Dr. Harold Reiter. “We needed a screen so that one could properly select those to come to interview.”

Ask about our Med School Candidacy Evaluation Package: Find out if you’re ready to apply!

Development of Casper

Over the next ten-plus years, Dore and Reiter researched options for screening applicants’ social intelligence traits and other professional characteristics and developed a test called Casper. A Situational Judgment Test (SJT), Casper would enable medical schools to efficiently assess applicants’ soft skills, such as empathy and collaboration, along with the rest of their application materials, before they selected applicants to come interview in person. The aim was “to make sure that they will be good fits within their community both within training and in future practice,” Dore said, and for the selection process to include soft skills earlier on. Situational Judgment Tests like Casper and AAMC PREview, which we cover in our next post, present test-takers with hypothetical dilemmas that are used to evaluate how an individual would react or behave.

McMaster University began requiring that med school applicants take Casper, and other medical schools followed. Now, a substantial number of medical schools request or require that applicants submit their Casper results as part of their applications. As of 2022, 45 allopathic and 12 osteopathic schools require or accept Casper scores for the current 2022-23 applicant cycle.

Addition of Snapshot and Duet

Dore and Reiter co-founded Altus Assessments in 2014 with the goal of improving decisions and outcomes for both students and academic programs. The organization uses research-backed assessment methodology to strengthen the quality and efficiency of medical school admissions. In recent years, Altus Assessments has launched two new assessments, Snapshot and Duet (both required less frequently than Casper). The three assessments—Casper, Snapshot, and Duet—now form the Altus Suite. These assessments measure different competencies and attributes, with the aim of providing a comprehensive evaluation of each applicant. For a list of allopathic and osteopathic programs that require one or more components of the Altus Suite, see this page.

In this post, we’ll walk you through the three assessments of the Altus Suite: Casper, Duet, and Snapshot. These elements are completed virtually, and your results are sent to schools once Casper has been scored. While you have to sign up for Casper in advance, you can take Snapshot and Duet “any time after reserving your Casper test until the earliest program distribution deadline.” Taking the Altus Suite costs $85, which includes distribution of your scores to eight med schools; sending your scores to additional programs costs $15 extra per program.



As described on the Altus Assessments website, Casper is an “online, open-response situational judgment test that evaluates aspects of your social intelligence and professionalism such as ethics, empathy, problem-solving and collaboration.” Candidates are presented with 15 scenarios to respond to via typing (for nine of the responses) and video (for the remaining six). These scenarios will not necessarily be related to medicine. The goal is not to get the “correct” answer, but rather to demonstrate to admissions committees the process by which you arrived at your decision. As Reiter put it, “For Casper, there is no right or wrong answer. It’s a controversial situation that’s presented, making it much more attuned to why the applicant is choosing to do what they do.”


In the first section—the one you’ll respond to via typing—you’ll be presented with three scenarios that are described in writing, and six that will be enacted in a video you’ll watch. For each, you’ll get thirty seconds to think, then five minutes to respond to a total of three open-ended questions.

In the second section—the one you’ll reply to via a video recording of you speaking—you’ll be presented with two scenarios that are described in writing and four presented in a video you’ll watch. Here, too, you’ll be asked to answer three open-ended questions—but rather than typing your responses, you’ll record a one-minute-max video of yourself talking through them. (As in the previous section, you’ll get half a minute of reflection time before you have to respond.) Casper takes, in total, 100-120 minutes to complete, with two optional breaks.


For a sense of the kinds of scenarios you’ll be asked to respond to, take a look at the examples on this page. In one video scenario, a man whose wife is about to have a baby confides in his coworker that he’s conflicted about whether to take paternity leave or not. At the end of the video, the coworker turns to you—the applicant—and asks, “What do you think he should do?” The questions you’d be asked to respond to in this hypothetical scenario are:

  1. Would you recommend he take paternity leave? Why or why not?
  2. What strategies could you offer to help him make a decision that he feels comfortable with?
  3. Maintaining work life balance can be challenging. Why do you think people struggle to find balance?


Each scenario of a given test is scored by a different rater, the purpose of which is to minimize bias. As Altus puts it, “The group of raters reflects the diversity of the population. All raters are extensively trained, put through implicit bias training, vetted, and understand the importance of their work as a Rater and the impact it has on an applicant’s future.” An important note: spelling errors do not affect your score (raters are trained to ignore them). Your scores will be sent to the med schools you’re applying to within two to three weeks after your test date.

The score you receive will be a quartile (which indicates whether you fall into the first, second, third, or fourth quarter of all applicants who took the test on the same day and time), whereas the score schools receive—called your “z-score”—indicates with more specificity where you stand in comparison to all Casper takers that took the test on the same day and time.

Our Tips

Prepare. The best way you can prepare for this unique test is to familiarize yourself with the test format so that you can effectively move through its elements on test day. Beyond reading this article, scour the Altus website and take a practice test. As for studying for Casper, though, you really can’t! It requires thinking calmly and clearly in the moment. So get a good night’s sleep the evening before and use any strategies to relax that you have at your disposal.

During Test Day. On test day, wear a smart casual outfit since you’ll be replying to some of the scenarios on video. And during the test itself, give yourself time to think through each scenario before you respond, then explain your answer clearly and in detail.

Timing. Although Casper is offered at least monthly, we recommend taking it in the spring before you apply to med schools, so that admissions committees receive your scores by the time you submit your primary application. We also recommend taking all three components of the Altus Suite even if the schools on your list only appear to require Casper, in case schools’ requirements change or you decide to apply to another program later on. After you take Casper, try to take Snapshot and Duet within two weeks so that these scores are included when your Casper score is sent to the medical schools that accept it.



Altus describes the second part of its three assessments, Snapshot, as a “short, one-way video interview to highlight your communication skills, self-reflection and motivation for the profession so you can bring your personal statement to life.” Unlike a traditional interview, Snapshot is conducted sans interviewer. Snapshot’s questions are also standardized rather than tailored so a specific program. Finally, med schools receive your Snapshot responses as they’re reviewing your application, which means your personal qualities, communication skills, and motivations for applying to medical school can shine through on your application earlier in the process than—or in some cases instead of—the traditional, on-campus interview.


You’ll be given three questions and will have two minutes to respond to each (after a 30-second reflection period); in total, the interview takes between 10 and 15 minutes to complete.


Each individual med school program rates your Snapshot performance. As described on the Altus website, “Like our Casper raters, those who rate Snapshot responses go through extensive training, including implicit bias, and they’re provided rubrics to guide their reviews.”

Our Tips

Prepare. Unlike Casper, for Snapshot, there’s a real opportunity to prepare. Do so like you would for a traditional one-on-one interview: review and practice responding to common medical school interview questions. Sample questions include “Why do you want to become a doctor?,” “What is the biggest challenge you have overcome and what did you learn from the experience?,” and “What experience have you had with diverse populations?”

Review your application. Comb through the materials you’ve prepared for your application and practice telling stories about your experiences that align with the messages your written materials put forth. Look over AAMC’s Core Competencies and come up with answers that demonstrate your talents across these realms.

Conduct mock interviews. Working with a med school advisor can be a huge help in preparing for interviews; at Collegiate Gateway, we offer practice interview sessions. You can also give a parent or a friend a list of questions to ask you, in addition to practicing on your own.

Timing. While you have to reserve your Casper date in advance, once you’ve done so, you can take Snapshot whenever it’s convenient for you, up to the earliest score distribution deadlines of the schools you’re applying to. Your Snapshot interview will be made available to programs as soon as you’ve completed the assessment. We recommend taking Snapshot within two weeks of taking Casper.

Dress appropriately. As with Casper, you’ll be on camera for this assessment, so dress appropriately, such as business casual.



The final assessment of the three-part Altus Suite, Duet, is designed to assess how well your values and priorities align with those of the medical school program and vice versa: “With Duet, your individual preferences are compared with programs’ unique profiles to help assess your mutual alignment in a standardized way,” as Altus puts it.


First, you’ll be given various pairs of characteristics (like “rural medicine focus” versus “primary care focus”) within certain categories and asked to choose which of the two options in each pair you gravitate toward. Next, you’ll be asked to compare the broader categories with each other, and to choose which in a given pair is more important to you. The test, in total, should take no more than 15 minutes to complete. Keep in mind that you complete Duet only once, not separately for each medical school.


Scores are generated automatically based on the degree to which your rankings of characteristics match those of the programs you’re applying to, resulting in an alignment score for each applicant to each program. The individual programs complete Duet before you do, so each program already has a profile.

Our Tips

Prepare. You can prepare for Duet by reflecting on the features of medical schools that are the most important to you. We also suggest researching in detail the schools you’re applying to that appeal to you the most. Are there features, goals, or values that these schools have in common, that align with your own preferences?

To find out information about a med school’s values and priorities, check out their mission statement on MSAR (Medical Schools Admissions Requirements) on the AAMC website. See our blog post on “What Mission Statements Reveal about Medical Schools.” In addition, go on the med school’s website and learn as much as you can about their curricular programs, values, and institutional priorities.

Also try to go with your gut, and you will then be more likely to end up at a program that genuinely suits your personality and needs!

Timing. As with Snapshot, Duet can be taken any time after you’ve made your Casper reservation until the earliest score distribution deadlines of the programs you’re applying to. Duet scores are available to programs as soon as you’ve completed the assessment. We recommend that you take Duet within two weeks of taking the Casper test.

Applying to medical school is a complicated process, and interviews are no exception. We encourage you to read through the rest of our blog posts on med school interviews, as well as to contact Collegiate Gateway if you would like guidance on any aspect of the application and admissions process. As always, we’re happy to help!