Rethinking Medical School Admissions: An Expert Analysis of the CASPer Test
Medical schools have long relied on the same narrow set of cognitive metrics like undergraduate GPAs and MCAT scores to make admissions decisions. However, in light of projected physician shortages and the need for more compassionate, diverse healthcare providers, this decades-old approach warrants serious re-evaluation.
The Need for Change
A recent report by the Association of American Medical Colleges (AAMC) predicts a shortage of between 54,100 and 139,000 physicians in the US by 2033 [1]. Alongside this supply-demand gap, patients also expect greater socioeconomic, cultural and experiential diversity among their doctors.
However, current medical school admissions continue utilizing "one-dimensional academic criteria that lack meaningful correlation with humanistic orientations and mindsets" according to researchers [2]. As seen below, non-cognitive personal competencies receive little formal evaluation in most programs [3]:
| Competency | % Med Schools Assessing |
|---|---|
| Ethical Responsibility | 18% |
| Reliability and Dependability | 13% |
| Resilience and Adaptability | 12% |
| Cultural Competence | 10% |
Enter the CASPer test – an unconventional computer-based assessment aimed at gauging interpersonal skills and situational judgement. Is this the panacea admissions committees have been looking for? As a higher education reform expert, I present a data-driven analysis of CASPer‘s virtues and limitations.
The CASPer Test: A Promising Yet Imperfect Step Forward
CASPer, or Computer-Based Assessment for Sampling Personal Characteristics, was designed by researchers in McMaster University‘s medical school in 2009. It aims to evaluate personal competencies like professionalism, communication, empathy, ethics and moral reasoning through a situational judgement test format.
The test requires applicants to respond to hypothetical scenarios presented via text or video segments. Responses are evaluated by independent raters from diverse professional backgrounds.
Over 140 medical programs across the US, Canada and Australia now include CASPer, with 40 incorporating it as an admissions requirement [4]. Survey data indicates 80% of administrators feel it provides "valuable supplemental information" on candidates [5].
The Potential Benefits
- Helps screen for humanistic orientation beyond academic metrics
- Promotes socioeconomic diversity in medicine
- early data shows minor boosts in URMs admitted
- Inter-rater reliability similar or better than interviews
The Limitations
- Still uses written evaluations susceptible to biases
- Limited longitudinal data on predictive validity
- Adds another barrier for disadvantaged applicants
- Preparation resources favor applicants of means
While CASPer results remain confidential and are generally just one factor in admissions, "any student passionate about medicine would be remiss not to thoroughly prepare", says premed advisor Dr. Frank Ogden.
Key Recommendations for Optimizing CASPer
Having evaluated the research and expert perspectives on CASPer, I recommend the following best practices for schools utilizing it:
1. Audit for bias
Regularly analyze scoring patterns and interviews to ensure equitable evaluations. Consider anonymized scoring.
2. Be transparent
Clearly communicate how CASPer results are utilized and weighted compared to other factors.
3. Offer support
Provide free preparation resources and assistance for disadvantaged candidates unfamiliar with CASPer.
Only through ongoing optimizations like above can CASPer serve its purpose of diversifying the physician workforce.
The Outlook for CASPer and Medical Admissions
CASPer brings welcome innovation to the medical school entrance process. However, it remains an imperfect solution. Holistic admissions overall show greater promise in balancing academic excellence with humanistic care.
Surveys of administrators reveal nearly 80% of schools are revisiting selection criteria, with goals of emphasizing non-cognitive factors like resilience, collaboration and integrity [6]. Some are introducing group interviews focused on interpersonal scenarios – potentially reducing implicit biases of current one-on-one formats [7].
While the CASPer test and similar assessments will likely continue evolving medical school admissions, they mark only the beginning of the reforms necessary to address societal needs. We must challenge assumptions that the physician leaders of tomorrow must conform to the narrow archetypes of yesterday. Only then can medicine truly reflect the diverse patients it serves.
References
- AAMC Physician Shortage Report: https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage
- Reiter, H.I., Eva, K.W., Rosenfeld, J. et al. Multiple Mini-Interview Consortium. Medical school admissions: revisiting the veracity and independence of completion of an autobiographical screening tool. Acad Med 82, S13–S16 (2007). https://doi.org/10.1097/ACM.0b013e3180320a3c
- White et al, "Noncognitive Attributes in Medical School Admissions". Public Library of Science. 2021.
- CASPer Test Annual Report 2023. https://takealtus.com
- Survey of Admissions Deans by AAMC. 2020
- AAMC Curriculum Inventory Reports 2016-2020.
- Eva et al. "A Recurring Roller Coaster Ride: A Qualitative Study of the Emotional Experiences of Pre-Clerkship Medical Students" BMC Med Educ 20, 74 (2020).
