Medical school admissions go beyond GPA and MCAT scores. Many programs also use behavioral and situational judgment assessments to evaluate how applicants think, communicate, and make decisions in real-world scenarios.
The most common is Casper, a situational judgment test used by many U.S. medical schools. Some schools also use Duet, which measures value alignment between applicants and institutions. Snapshot, a video-response tool once used to assess communication skills, has been discontinued and is no longer part of any admissions process.
This guide explains what these assessments are, how they work, and how to prepare for both test formats effectively during the 2026/27 application cycle.
99% of students who use our Casper/SJT Prep tool feel well prepared to take the real exam.
Casper and Duet are tests from Acuity Insights (formerly known as the Altus assessments) that evaluate different aspects of an applicant’s profile during the medical school admissions process.
Think of these as your digital interview panel, each offering a unique lens into your qualities, values, and approach to medicine. Rather than testing academic knowledge, these assessments focus on personal and professional attributes that are difficult to measure through traditional application metrics.
Here’s a brief overview of each:
Snapshot was previously included in the same suite as a short video-response tool. It asked applicants to respond to behavioral prompts on camera to help schools assess skills like communication style and professionalism.
Acuity Insights phased it out after the 2022/23 application cycle, determining that its purpose overlapped with existing interview formats. Some schools may still evaluate things like communication skills through interviews or secondary applications, but Snapshot itself is no longer part of the process.
The AAMC PREview exam is a similar assessment tool used to evaluate competencies such as ethics, collaboration, and decision-making. Some programs accept either PREview or Casper, depending on their admissions requirements, but applicants are typically not required to complete both.
Casper is an online situational judgment test used to better understand personal qualities that are important in medicine but not captured by GPA or MCAT scores. These include social intelligence, empathy, professionalism, communication, and ethical decision-making.
During the test, you’ll be presented with short written or video-based scenarios that reflect real-world situations you might encounter in healthcare, teamwork, or academic environments.
After each scenario, you’ll answer a series of open-ended questions explaining how you would respond and why. Casper takes approximately 65-85 minutes to complete and is divided into 2 timed sections:
The test is fully automated, meaning it moves from one scenario to the next without the ability to pause between questions. There is an optional 10-minute break between the sections, and another 5-minute break (if you want it) halfway through your typed responses.
Casper test prep is less about memorizing content and more about learning how to structure clear, thoughtful responses under time pressure. Here’s the advice I always share with my students:
Casper isn’t scored based on right or wrong answers. Trained raters evaluate your responses using a standardized scoring rubric, and individual question scores are combined into a single overall result reported as a quartile ranking.
Applicants receive a quartile score that reflects how they performed compared with other Casper test takers:
Higher quartile scores are generally associated with clear communication, strong reasoning, and thoughtful consideration of multiple perspectives, as well as familiarity with the test format. However, Casper is only one component of the medical school admissions process.
Medical schools evaluate applicants holistically, considering factors such as GPA, MCAT scores, clinical exposure, interviews, and other application materials. Understanding how these factors come together can help applicants better assess their chances of getting into medical school.
Need Casper/SJT coaching? Our Physician Advisors can help you feel prepared for the test. Talk to a MedSchoolCoach team member to learn more.
Duet is an untimed, computer-based assessment that typically takes applicants about 15 minutes to complete. Applicants review paired statements and select the option that best reflects their personal preferences.
Responses are then compared with the priorities and characteristics of participating medical schools, helping applicants and programs better understand potential areas of alignment and fit.
Unlike Casper, Duet does not include situational scenarios or video responses. There are no right or wrong answers, so applicants should respond honestly based on their own values, goals, and approach to their medical school journey.
Like Casper, Duet does not require memorization or extensive studying. The best preparation is self-reflection. Here’s some advice I give my students:
Duet does not have a traditional score based on correct or incorrect answers, and it does not use a quartile ranking system like Casper. Instead, applicants receive a report showing how their preferences align with participating programs. This information may be used by medical schools as one part of their holistic admissions review, alongside other application materials.
Learn More: Answering “Why This Medical School,” Step-by-Step
It’s important to know which schools require Casper and Duet as part of the application process. While Duet is not often required, some schools may recommend completing it to help assess alignment with their values and mission. The table below lists MD and DO schools that require either exam for the 2026/27 application cycle.
|
Institution |
MD or DO? |
Casper Required? |
Duet Required? |
|
Baylor College of Medicine |
MD |
Y |
N |
|
Boston University Aram V. Chobanian & Edward Avedisian School of Medicine |
MD |
Y |
N |
|
Burnett School of Medicine at TCU |
MD |
Y |
N |
|
California University of Science and Medicine |
MD |
Y |
N |
|
Central Michigan University College of Medicine |
MD |
Y |
N |
|
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell |
MD |
Y |
N |
|
Drexel University College of Medicine |
MD |
Y |
N |
|
East Tennessee State University James H. Quillen College of Medicine |
MD |
Y |
N |
|
Louisiana State University New Orleans - School of Medicine |
MD |
Y |
N |
|
Medical College of Wisconsin |
MD |
Y |
N |
|
Meharry Medical College |
MD |
Y |
N |
|
Michigan State University College of Human Medicine |
MD |
Y |
N |
|
Netter School of Medicine Quinnipiac University |
MD |
Y |
N |
|
New York Medical College |
MD |
Y |
N |
|
Renaissance School of Medicine at Stony Brook University |
MD |
Y |
N |
|
Rush University Medical College |
MD |
Y |
N |
|
Rutgers Robert Wood Johnson Medical School |
MD |
Y |
N |
|
Institution |
MD or DO? |
Casper Required? |
Duet Required? |
|
Sam Houston State University College of Osteopathic Medicine |
DO |
Y |
N |
|
Temple University Lewis Katz School of Medicine |
MD |
Y |
N |
|
Texas Tech Health Sciences Center El Paso |
MD |
Y |
N |
|
Touro College of Osteopathic Medicine NY/MT |
DO |
Y |
N |
|
Tulane University School of Medicine |
MD |
Y |
N |
|
University of Colorado Denver Medical School |
MD |
Y |
N |
|
University of Northern Colorado - College of Osteopathic Medicine |
DO |
Y |
N |
|
University of Texas at Tyler School of Medicine |
MD |
Y |
N |
|
University of Texas Health Science Center Houston, McGovern Medical School |
MD |
Y |
N |
|
University of Texas Health Science Center San Antonio, Long School of Medicine |
MD |
Y |
N |
|
University of Texas Medical Branch, John Sealy School of Medicine |
MD |
Y |
N |
|
University of Texas Southwestern |
MD |
Y |
N |
|
University of Vermont Larner College of Medicine |
MD |
Y |
N |
|
Virginia Commonwealth University School of Medicine |
MD |
Y |
N |
|
Wake Forest School of Medicine |
MD |
Y |
N |
|
West Virginia University School of Medicine |
MD |
Y |
N |
|
William Carey University College of Osteopathic Medicine |
DO |
Y |
Y |
Note: This table is accurate for the 2026/27 application cycle and will be updated when dates are posted for the 2027/28 cycle.
Read Next: MD vs. DO: What’s The Difference + How To Choose
Timing your Casper and Duet assessments is an important part of staying on track during the medical school application process.
For most applicants, the best time to complete Casper and Duet is in the late spring or early summer of the application cycle. This is around the time you submit your primary application through AMCAS, TMDSAS, or AACOMAS. This ensures your results are available as schools begin reviewing primary applications and sending secondary applications.
Before scheduling your test date, confirm the requirements and deadlines for each school on your list, as distribution deadlines can vary by program.
Casper fees vary by admissions cycle and are specific to the current application year. For the 2026/27 medical school application cycle, fees for the Casper assessment (CSP-10111) are:
All fees are final, non-refundable, and valid only for the current admissions cycle. Acuity Insights recognizes certain Fee Assistance Programs (FAPs), which may help eligible applicants reduce their Casper fees. Learn more about accepted programs and how to apply your approval on the Acuity Insights website.
Casper and Duet aren’t about knowing the “right” answer. Successful responses demonstrate empathy, communication, and thoughtful decision-making under time pressure. Our experts at MedSchoolCoach provide Casper prep support to help applicants strengthen their situational judgment skills, refine their responses, and feel confident heading into test day.
With personalized guidance and feedback, you’ll gain a better understanding of what admissions committees look for throughout the medical school application process.