In order to apply to medical school, you have to complete lots of things; from the MCAT to the AMCAS application, there’s many boxes to check off! Included on that list is the ever growing world of virtual interviewing growing and growing.. The most commonly required assessment is the Altus Suite- consisting of Casper, Snapshot, and Duet. In addition, schools are now requiring other virtual assessments including Kira and AAMC PREview. This guide will take you through each virtual assessment and provide key takeaways for each.
Table of Contents
Overview of the Altus Suite
Overview of Casper
Overview of Snapshot
Overview of Duet
Overview of PREview
Overview of Additional Virtual Assessments
The Altus Suite consists of three separate exams:
The following osteopathic and allopathic schools require or recommend applicants to complete the Altus Suite:
Alabama College of Osteopathic Medicine
Temple University, Katz School of Medicine
American University of Caribbean
Arkansas College of Health Education
Michigan State College of Osteopathic Medicine
New York Medical College
University of Colorado
Northeast Ohio University
University of Illinois at Chicago
California Health Sciences College of Osteopathic Medicine
Oklahoma State University College of Osteopathic Medicine
University of Miami, Leonard Miller
Central Michigan University
Oregon Health and Science
University of Michigan, Michigan Medicine
Pacific Northwest University College of Osteopathic Medicine
University of Nevada, Reno
East Tennessee, Quilen College of Medicine
Rosalind Franklin, Chicago Medical School
University of Rochester
Florida Atlantic, Charles Schmidt College of Medicine
Rutgers New Jersey Medical School
University of Texas Health Science, San Antonio, Long SOM
Donald and Barbara Zucker, Hofstra
Rutgers, Robert Wood Johnson Medical School
University of Texas, Galveston
Sam Houston College of Osteopathic Medicine
University of Texas, Southwestern
Idaho College of Osteopathic Medicine
San Juan Bautista
University of Vermont, Larner
Indiana University School of Medicine
State University of New York, Upstate
University of Washington
Renaissance School of Medicine, Stony Brook University
McGovern, UT Health Science Center Houston
Virginia Tech Carilion
Augusta, Medical College of Georgia
Texas Tech El Paso
Medical College of Wisconsin
Texas Tech Health Sciences Center
Touro College of Osteopathic Medicine, Nevada
Western University Osteopathic Medicine of the Pacific
Kansas College of Medicine
Penn State University
William Carey College of Osteopathic Medicine
Because so many schools recommend or require, it is usually best to take the exam so that you can meet the requirements at various schools.
Each school has a particular deadline of when the Altus Suite needs to be taken, typically in the Fall or early Spring. However, you should plan on completing the Altus Suite around the time of submission of their primary application in order to have it done well ahead of time and to ensure your full application is not delayed.
The Duet and Snapshot exams are available once you register for the exam, but must be completed within 14 days of completion of the Casper® exam.
Each school has different requirements regarding which aspects of the Altus Suite an applicant must complete. However, the components can only be taken one time per application cycle, so it is recommended that you take all three components. That way, you will have all three components completed and won’t be missing a test if a school you apply to does require it. You can check the individual school requirements on the school’s website.
For Casper®, raters working at Altus will evaluate each question.
For Snapshot, specially trained raters at the programs where you are applying will rate the exam. For Duet, schools will receive an automatic report based on your alignment with the school’s rankings.
The Altus Suite costs $12 to register and then each school that is added costs $12. Remember, if cost of applying to medical school is becoming high, there are several scholarships that are available to help students. You can read more about medical school scholarships on our blog.
Applicants can always add more at any time during the application cycle and the score will be sent to those schools for a cost of $12 each, so you do not need to know exactly which schools you are applying to prior to taking the tests.
The exam can only be taken once per application cycle. That means that a student’s first attempt of the Altus suite is their last during an application cycle. Medical schools know this, so unlike the MCAT where they may be expecting you to retake the test if your score isn’t as high as you want, for Altus it’s one and done. That means preparation is key. How schools use the exam results is still a debate, with each admission committee using the evaluation slightly differently. Don’t fret if you have to retake the exam or not, simply focus on preparing for the first time!
Yes, the exam is only good for one application cycle. Your retake is not to change your score but Altus only holds the scores for one year and so each cycle you apply, you will have to retake it.
Altus is not something that you have to prepare for months in advance like the MCAT. You should practice and familiarize yourself with the component but you don’t have to study or master specific topics.
However, preparation is still possible. We’ve broken down each of the subsections of the exam to give you a bit more clarity on how to prepare and what you can do to succeed in each one!
Casper® (Computer-based Assessment for Sampling Personal Characteristics) is an online, web-based computer test that takes about 100-120 minutes to complete. It was first utilized in Canada but now has been incorporated by many United States allopathic and osteopathic medical schools. Casper® helps schools screen applicants as part of the admissions process, in addition to their entire medical school application.
Casper® has two sections. The first section consists of 9 scenarios where you will provide a written response. Three scenarios will be word based and six will be video based scenarios. After the first section, you will have an optional ten minute break. The second section consists of two word based and four video based scenarios where you will record a video answer. The scenarios are only about 1-2 minutes in length, you are given 30 seconds after to reflect on the scenario, and then five minutes to type your responses to three questions. For the video recorded responses, you will have 30 seconds to reflect on the scenario, 10 seconds to read the question and then one minute to record your response to each of the three questions.
Your typed responses are automatically saved and your video will be automatically uploaded after one minute, or you can submit if you finish early. You are not able to go back and change any responses. The exam is graded by multiple raters and grammar mistakes, accents or spelling errors are not counted against you.
The Casper® assesses your communication skills, problem solving ability, empathy, ethical decision making, along with other similar qualities. Most of the questions consist of various hypothetical scenarios that represent situations you could encounter in day to day life, and assess how you would respond to them. Some Casper® questions are more personal based and may assess your motivation, self-awareness, resilience, or response to challenges.
Altus does not share the Casper® score with applicants but does share quartiles, which helps applicants understand how they did compared to other applicants. Each question on the Casper® assessment is scored compared to how other applicants did, so scoring in a low quartile doesn’t mean an applicant failed, it just means others typically did better on that assessment. Quartiles represent your scoring on the typed answers only, not the video responses. Each medical school will view quartiles differently and in conjunction with your entire application. So just because you scored in a lower quartile, it doesn’t necessarily mean you won’t get accepted to medical school. Your application consists of many parts, and Casper being one of them and likely weighed much less heavy than say your GPA or MCAT.
Casper® is not a test you necessarily need to “study” for, like the MCAT. In fact, it’s actually designed to not be studied for! It’s more testing your ability to think, handle situations, etc. However, we will provide an introduction to decision making and ethics for you to have a basis in these areas to help you during the exam. In addition, we will take you through a few sample scenarios to get an idea.
The Casper® exam is designed to test your ability to make appropriate decisions and use sound judgment. A lot of your decision making capabilities are based on who you are as a person and your values, but there are some core principles that we will cover that you can consider when making important decisions.
As you move along your medical training, you will be immersed further into the fundamentals of ethical decision making, and how it relates to your practice as a physician and your patients. For now, let’s cover the basics and discuss how you can utilize these for Casper®!
There are four principles of medical ethics:
1. Autonomy. The principle of autonomy refers to an individual’s right to make decisions for themselves. Though there are many complexities to this principle, the key is that decisions made by individuals should be done so without coercion or undue influence.
For example: If a patient is deciding to have a particular medical treatment, it is the physician’s responsibility to educate the patient on the procedure, and its associated risks and benefits, however it is the patient’s choice to have the procedure or not.
The physician may not pressure the patient, or force him/her to have the procedure.
How this can be incorporated with Casper®: Many Casper® scenarios will not be medically related but have to do with everyday situations that people may face. During the exam, you can utilize the principle of autonomy by never forcing or demanding an individual to make a decision. Instead, you can educate, encourage, and help them to a particular decision.
2. Beneficence. Beneficence is the ultimate principle of practicing as a physician.
This is always trying to do good for patients. This principle implies that a physician will always work in the best interest of the patient.
Example: A patient needs an operation. There are two ways that a physician can perform the operation and the physician must choose which procedure is best. One way that the physician can determine the course of action is to pick the procedure that is intended to provide the most benefit, while minimizing harm to the patient.
How this can be incorporated with Casper®: Similar to working in the patient’s best interest, try to always answer the question in the best interest of the individual that is the subject of the scenario. If there is a way that you can help or assist the individual, then that is always the best course of action.
3. Non-maleficence. ‘First, do no harm.’ Most pre-meds have heard this excerpt from
the Hippocratic oath and this is really what the principle of nonmaleficence embodies. Physicians should never harm their patients. This principle goes hand in hand with beneficence as physicians should always work in the best interest of their patients while not causing harm.
Example: A patient comes to the doctor’s office for symptoms of the common cold and wants antibiotics. The physician does not believe antibiotics will help the patient. Although the patient wants the medicine, the physician does not provide them because taking the medication could actually cause harm by unnecessary side effects.
How this can be incorporated with Casper®: Use non-maleficence along with beneficence. As you are trying to help the individual in the scenario make the best decision, try to help them with a decision that will also not hurt them.
4. Justice. Justice is the fourth principle of medical ethics but is likely the one
that is most obscure for the Casper® exam. Justice, in a medical setting, refers to the
equal treatment of every individual.
Example: An emergency room physician is seeing patients and a homeless patient without medical insurance comes in for care. Using the principle of justice, the physician must see the patient and treat him regardless of his socioeconomic status and lack of insurance.
How this can be incorporated with Casper®: Think of treating every individual fairly. For instance, if the scenario involves resolving conflict between multiple people, treat them equally and do not give preference to one individual.
Let’s see how this could potentially be written out as a response during a Casper® exam:
1. What is your greatest concern here?
Sample Answer: Given the information in the prompt, it appears as though my co-worker may not actually be sick, but instead lied to her employer and instead went to the beach. My concern is her being dishonest and how this can potentially affect her and her co-workers.
2. Do you approach your co-worker about this?
Sample Answer: Though I am certainly concerned about her possible dishonest behavior, whether or not I would approach her would depend on my relationship with her and how comfortable I feel discussing the situation with her. For instance, if she was also a friend, then I may discuss her behavior and how this could potentially affect her work and the entire company. However, if she was someone that I have never talked to, I may not discuss the situation with her, understanding that she is able to make her own decisions and I may not be the appropriate person to bring this up with her.
3. If you keep seeing her taking sick days, would you tell your boss about this?
Sample Answer: If I noticed that my co-worker continued to take time away from work, I may approach my boss about the situation. I would first consider how her being away from work is harming the co-workers and/or the company. If I notice that our productivity has decreased or others have had to take on substantially more work, then I think it may be a good idea to bring this up with my boss so he/she can make the determination on how my co-worker may be affecting the group.
Example #1: A co-worker of yours calls in sick but when looking at Facebook, you notice that she has posted a current picture of herself at the beach.
Let’s think through the issues here and use our decision making process to help formulate our response:
1. First, take a second to review the prompt.
2. Understand the issue at hand. The issue here is honesty. You have identified a situation where your co-worker is potentially caught lying as she called into work sick, but posted a picture of herself at the beach.
3. Get more information. Though it seems she is being dishonest, perhaps this was an older photo that she just posted? Or perhaps she asked your boss if she could use a sick day. There could be other explanations here than her just lying about being sick.
4. Determine the course of action. Think about how you would respond to a situation like this and incorporate our ethics lesson. Autonomy: Remember your co-worker is able to make decisions for herself. Beneficence: Who does her actions benefit? Likely they only benefit her and considering non-maleficence, her actions can potentially harm others as they may have to work more to account for her being away. Justice: Imagine if everybody lied and used their sick days for a beach day instead, then the entire company would have an undue burden/workload.
5. Write it out. Let’s look at how this may be written out in a response!
Example #2: You are working in a research lab. One of your peers didn’t finish his work on his project in time, and tells you he made up his results and submitted them to the principal investigator.
1. What do you do?
Sample Answer: First, I would show sympathy to my peer’s situation. I understand he is under pressure to complete his project and this may seem like the best solution so he does not get in trouble with his principal investigator. However, I would talk to him and tell him that I do not believe it is appropriate to make up results. I would then talk to him to see if there is anything I can do to help him expedite his project so he could get real results to report.
2. How could this situation have been avoided?
Sample Answer: Though I may have limited involvement in my peer’s project, I could have been more proactive with checking in on him. It may have been helpful to ask him if he needs any help or if anything was going on that is impeding his progress.
3. Do you tell your principal investigator?
Sample Answer: I would first talk to my peer and try to develop a solution. For instance, can we work together to get the project finished? Could we possibly talk to our principal investigator to see if we could have more time? I would encourage my peer to talk to the principal investigator himself first. If he does not feel comfortable doing so, I would offer my support to talk to the principal investigator with him. If he insists on reporting the false results, then I would feel obligated to talk to the principal investigator myself as this could jeopardize the integrity of our entire lab.
Snapshot is part of the Altus Suite and should be considered an extension of the Casper® situational judgment test. It is a ten minute exercise available only to applicants who have registered or completed the Casper®. Remember you must take Duet and Snapshot within 14 days of completing Casper®.
Snapshot is an opportunity to “put a face” on your Casper® responses. It has the feel of a traditional interview, in contrast to the situational based questions of the Casper®. Basic traditional interview preparation as well as familiarity with the virtual type of online interviewing will help you to prepare!
Snapshot is a video response tool which helps the admissions committee evaluate your communication skills and motivation. You are given three standardized questions with 30 seconds to reflect on the question. Following each question, you are allotted a two minute video response. You can stop the video before two minutes.
The Altus Suite requires you to complete a practice question and response before proceeding to the actual exam. You are able to complete the practice as many times as they would like. However, once you get into the actual exam, Snapshot is a one shot system! This means the applicant has one chance to record their response and it will automatically be submitted once finished. They cannot review it or change it. That is why practicing makes all the difference. Be comfortable in front of the camera at all times. Prepare with mock interviews. Make sure your lighting is good!
The best way to prepare is to practice delivering responses to typical interview questions. You should also record and time their responses. MedSchoolCoach offers a practice Snapshot exam followed by an opportunity to review your responses with a physician advisor. Take advantage of this prep in order to get feedback into your answers and how you can improve.
1. Why do you want to be a physician? What is one of your greatest strengths?
2. Why should you be admitted to medical school?
3. Tell us about someone you admire and why?
4. Describe a non-academic obstacle that you have overcome.
5. What excites you about a career as a physician?
Duet is the latest addition to the Altus Suite enabling institutions to “match” with applicants. Duet can help admissions committees narrow down applicants based on shared characteristics and educational goals.
This component of the Altus Suite is composed of a series of questions requiring about 15 minutes to complete. Schools submit their own questionnaire and generate a “fit profile”. Applicants complete the same assessment with their own personal preferences and characteristics described. Designated programs receive applicant “fit scores” and rankings. Duet compliments the Casper® results to identify the best applicants for that specific school.
Prior to taking the Duet, you should read through the various mission statements of the medical schools you are applying to. While reading the mission statements, take notes on important aspects of the school and areas of particular interest to you.
As the Duet only looks at specific applicant interests versus the school’s offerings, you do not need to ‘rehearse’ answers, rather you should fully consider various aspects of a medical education that are important to you.
Here are top things you should consider at a given school:
Early patient exposure
Problem- based learning
Diversity and inclusivity
Faculty relations and approachability
The AAMC has created a few online virtual interviews, first was the SJT and then VITA. In 2022, they introduced PREview which replaces its previous exams. PREview consists of several hypothetical questions designed to evaluate several core
competencies related to pre-professionalism.
The eight core competencies related to pre-professionalism are:
The following medical schools are listed as either requiring or recommending applicants complete the exam.
AAMC PREview Exam in the 2023 Admissions Cycle
Recommended (Research Only)
Required (either PREview exam or CASPer)
Recommended (Research Only)
The exam presents written hypothetical scenarios related to healthcare, educational settings or other experiences of a potential medical student. After each scenario, there are several action items that the examinee ranks the effectiveness of each action.
There are 30 scenarios and 186 items total. The exam takes about 75 minutes to complete but with the check in, instructions and options at the end, it will take an examinee around 90-105 minutes.
The test is available between June to September of the application year you are applying in. The exam can only be taken once during the application year, similar to Altus.
Only students who are applying to a school requiring it or recommending it are able to take the exam.
Yes. It cost $100 and that includes distribution to all schools requiring or recommending on your school list.
What do I need to do to get ready for the exam?
There are many technical requirements for the exam and you should read the AAMC
instruction manual thoroughly before sitting for the exam.
Your responses are ranked according to how closely they align with those of medical educators’ ranking. Your total score is scaled to account for exam variations and you are given a score of one (the lowest) to a maximum score of nine. A score of nine means you are perfectly aligned with those of medical educators, and a score less than that means your responses are aligned less with those of medical educators.
A confidence band is also presented to account for test variability and to aid in interpretation of where your true score likely lies. Percentile ranks are also reported which help to position your performance amongst other applicants.
Your scores will automatically be added to your AMCAS application meaning your scores will be automatically reported to MD schools. If you wish to have your score submitted to Des Moines University Doctor of Osteopathic Medicine, you can select to have your score sent there on test day.
The AAMC provides lots of free resources to applicants to prepare for the exam. We recommend you visit their website and use their prep materials and practice exam.
Also, PREview tests similar competencies to the Casper exam so we recommend that you use MedSchoolCoach’s Casper preparation material as well.
The PREview is trying to see how you will make decisions in various situations, to try to remember to do the ‘right’ thing, be honest, and do what’s best in the situation. Reviewing the medical ethics section above will also help you prepare
The Kira is either a live interview or asynchronous interview, which is a one-way recording of yourself answering a question, similar to Snapshot. You will not know the questions beforehand but will be given them at the time of the exam and then have a limited time to record an answer. The best way to prepare for this is to review information on Altus Snapshot as they are a very similar type of assessment. The goal of these assessments is to see how you present yourself, how you think ‘on your feet,’ and to get a sense of your personality.
Similar to Snapshot, here are some questions to think about while preparing:
Why do you want to be a physician?
What is one of your greatest strengths?
Why should you be admitted to medical school?
Tell us about someone you admire and why?
Describe a non-academic obstacle that you have overcome.
What excites you about a career as a physician?
Again, review information on Snapshot and practice by recording yourself answering the question. Also, be sure to check the lighting, background, microphone, camera, etc in the room where you plan to record your interview. Some schools that are requiring the Kira interview are the University of California at Irvine and Des Moines University.
1. Make sure you know which schools require which test and when. Get the tests done as early in the application cycle as possible so that you don’t delay your application.
2. Wherever you take the exam (in your room, office, library, etc) be sure to test your internet connection, lighting, sound and camera. You don’t want to have your internet go out when you are recording an answer! Also, be sure you are not disturbed or interrupted during the test.
3. Dress professional! The recordings should really be from about your shoulders up but be sure to have a professional shirt on and your hair/make-up styled appropriately. Also, make sure you background is free of distractions and professional!
4. Remember to practice recording yourself! It may seem easy but record and review practice responses. You may be surprised to see things you may do that you have no idea about! (ie- swiveling in your chair, messing with your hair, etc).
5. Keep going! These exams are only one part of your application. No matter your score, keep focusing on moving forward with your application and always putting your best foot forward!
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