Situational Judgement Tests for US MD Admissions: AAMC PREview, CASPer, and Duet

FAQ quick sheet

What are these tests (in plain English)? They’re admissions assessments designed to evaluate how you think and act in people-centered, ethically gray situations—not your science knowledge. Most are categorized as situational judgement tests (SJTs). 

Which ones matter most in US MD admissions right now? The big three you’ll encounter are AAMC PREview, CASPer (Acuity Insights), and sometimes Duet (a values-alignment add‑on that only appears alongside CASPer). 

Are these “ethics tests” with one correct answer? Not exactly. They’re designed to see whether your judgement aligns with professional expectations (PREview) or how you reason through dilemmas (CASPer), and how your preferences align with a program’s profile (Duet). 

Do I get a score?
PREview: yes—reported on a 1–9 scale with a confidence band and percentile information. 
CASPer: you can typically view a quartile ranking after scoring is complete (programs receive more detailed results than applicants). 
Duet: it’s a values-alignment output sent to programs; it’s not treated like a “right/wrong” score for applicants. 

Can I retake them?
PREview: up to twice in a testing year y four times lifetime (per AAMC policy). 
CASPer: one attempt per test type per admissions cycle (retakes generally only for verified technical issues). 

How long are they?
PREview: 186 items in 75 minutes. 
CASPer: as of the 2025–2026 cycle change, 65–85 minutes, with 11 scenarios (4 video-response + 7 typed-response). 
Duet: typically described as short and untimed (often around ~15 minutes), but exact experience can vary by cycle/program. 

How do I know whether my schools require them?
PREview: check the AAMC’s official participating schools list for the relevant testing year. 
CASPer/Duet: use Acuity’s “Test date & school information” search (it’s designed to show required assessments and deadlines by program). 

What’s the most effective prep? Become fluent in the competencies being assessed, then do timed, realistic practice (especially for CASPer typing/video pacing and PREview rating calibration). 

What these tests are and why medical schools use them

US MD admissions already has strong “academic readiness” signals (GPA, MCAT). Situational judgement assessments aim to add structured information about the professional and interpersonal dimensions of readiness—things like accountability, judgement, empathy, communication, fairness, teamwork, and how you handle conflict. 

In admissions research (across healthcare contexts), SJTs are widely used to evaluate “non-academic” attributes and have enough evidence supporting their reliability/validity that institutions continue exploring them as part of holistic review—while debate continues about optimal design, fairness, and coaching effects. 

US medical schools adopting PREview are explicit that they are using it to enhance mission-aligned review and give a more standardized lens on professionalism-related judgement. 
Acuity Insights positions CASPer similarly—as an open-response SJT intended to measure social intelligence and professionalism, helping programs compare applicants beyond grades. 

A key implication for applicants: these tests aren’t “extra hoops” in the same way as an additional science exam. They’re trying to measure whether you can think and act like a future clinician-in-training in messy real-world situations—where you must balance respect, safety, fairness, learning goals, and accountability. 

The major tests you’ll see in US and Canadian MD admissions

AAMC PREview professional readiness exam
PREview is the AAMC’s standardized SJT for applicants. It presents text-based scenarios (think: dilemmas you might face working with classmates, faculty, patients, or teams), and asks you to rate the effectiveness of response options. 

The current test format is 186 items (responses) across scenario sets, completed in 75 minutes. 
Scoring is reported as a total score from 1–9, and AAMC score reports also include a confidence band (±1 point) and percentile rank information. 
Conceptually, higher scores indicate your effectiveness ratings align more closely with medical educators’ consensus ratings. 

Logistics matter. AAMC’s official policy states a 2026 registration fee of $105 (with a reschedule fee of $25), and a retake limit of two attempts per testing year y four lifetime attempts. 
AAMC also offers multiple official practice options, including two free full-length unscored PDF practice exams (with keys/rationales) and a Scored Practice Exam that provides a scaled score and percentile-like feedback. 

CASPer by Acuity Insights
CASPer is an open-response SJT. Instead of rating prewritten options, you generate your own responses—typically under heavy time constraints—based on scenarios involving ethics, empathy, teamwork, communication, fairness, problem solving, resilience, and self-awareness. 

As of the 2025–2026 cycle changes announced by Acuity, CASPer’s total time is 65–85 minutes, and the number of scenarios was reduced to 11, with 4 video-response scenarios y 7 typed-response scenarios. 
Acuity’s help content specifies the two-question structure: for applicants in the 2026–2027 cycle, video scenarios present two questions one at a time, and typed scenarios present two questions together. 

Scoring is human-rated. Acuity describes using multiple trained raters, with a different rater for each scenario, and a final score averaging across raters’ impressions—designed to reduce single-rater bias. 
Applicants can view a quartile score after scoring is complete (Acuity notes it often becomes available about 4–5 weeks after your test). 

Retakes are tightly restricted: one CASPer test per test type per admissions cycle (if multiple programs require that test type, you complete it once and distribute to all of them). 
Fees are not a single universal number because pricing depends on where and what you’re applying to. Acuity’s official guidance is that you’ll see a base testing fee plus a fee per program distribution, and that fees are final/non-refundable and not transferable to another cycle. 
For preparation, Acuity directly recommends taking the full practice test available in your account, noting the practice test simulates the real experience and that applicants who complete it tend to perform better. 

Duet by Acuity Insights
Duet is not a scenario-response ethics test. It’s a values-alignment assessment designed to match an applicant’s preferences to a program’s profile in a more standardized way. 
Acuity describes the mechanism as comparing the applicant’s “ranking” output against a program profile, generating Duet Alignment Scores that programs receive. 

Important logistics: Duet is not typically booked as a standalone test in the way CASPer is. It appears as part of the Acuity system, and there is no separate fee—the fee paid when reserving CASPer covers “all applicable Acuity Insights Assessments,” including Duet if required. 

In applicant-facing advising materials, Duet is commonly described as short and untimed (often ~15 minutes), but you should always rely on the instructions in your Acuity account for the most accurate timing expectations. 

Comparison: how PREview, CASPer, and Duet differ

Característica	AAMC PREview	CASPer	Duet
Who runs it	AAMC	Acuity Insights	Acuity Insights
Core task	Rate effectiveness of response options to scenarios	Produce open responses (typed + video) to scenarios	Rank/choose preferences to generate values alignment with programs
Typical time	75 minutes	65–85 minutes (newer format)	Short, untimed (often ~15 min)
Scoring you see	1–9 score + confidence band + percentile	Quartile ranking appears later (often 4–5 weeks)	Program-facing alignment outputs
Retake rules	Up to 2 times per testing year; 4 lifetime	One per test type per cycle (exceptions for verified tech issues)	Tied to CASPer workflow; no separate fee
What “good prep” looks like	Calibrate to competencies + official practice exams with rationales	Timed practice + response structure + platform familiarity via official practice test	Clarify your priorities + research programs honestly

A practical way to think about the differences: PREview is closer to “do you recognize professionalism?” while CASPer is closer to “can you communicate professional judgement under time pressure?” and Duet is “what environment do you say you want, and how does that match what a program says it offers?” 

Which medical schools require which

First, the rule that prevents missed deadlines: requirements change every cycle, sometimes mid-cycle. So use provider-maintained requirement tools as your “source of truth,” then confirm on each school’s admissions page.

For PREview, the AAMC maintains an official list of participating schools for the testing year, and explicitly defines participation levels (requiring vs recommending vs exploring future use). 
For CASPer/Duet, Acuity maintains a “Test date & school information” search intended to show available dates, fees, and required assessments by school/program. 

AAMC PREview participation snapshot (testing year 2026)
For the 2026 PREview testing year (used for the 2027 medical school application year), AAMC reports a confirmed list of participating schools, and notes it will be updated as more schools confirm. 
A widely used third-party summary (Kaplan) lists 10 MD programs that “require” PREview for that testing year, including: Kaiser Permanente, Saint Louis University, University of Utah, Belmont (Frist), UC Davis, UCLA (Geffen), University of Hawai‘i (JABSOM), UMass Chan, UAB Heersink, and University of Minnesota—but you should still verify in AAMC’s tool and each school’s requirements page before paying for an exam seat. 

CASPer requirement patterns (US MD)
Unlike PREview (where the AAMC centrally lists participating schools), CASPer requirements are distributed across many application systems and are easiest to verify via Acuity’s program search. 

That said, here are examples of what “required” can look like:

Burnett School of Medicine at TCU states that all MD applicants are required to complete the Acuity Insights Assessment for the 2026–2027 admissions cycle and specifies that CASPer is required to apply (with test type code CSP‑10111, U.S. Medicine). 
Tulane’s MD admissions page describes CASPer and Duet logistics but indicates applicants may be invited to interview “with or without” CASPer/Duet results, illustrating that some schools treat these assessments as helpful but not necessarily a strict gate for interviews. 

A helpful planning heuristic (not a substitute for verification): applicant-focused directories and advising notes often show CASPer requirements clustering among certain private schools and multiple Texas programs, with some programs also requiring Duet. For example, a Student Doctor Network administrator-maintained list for the 2025–2026 cycle enumerates a set of AMCAS/TMDSAS schools requiring CASPer and flags schools that also required Duet—useful for historical context, but still something you should re-check against current official requirement tools. 

Canadian MD note
While your question is focused on MD programs in the US (and broadly North America), be aware that CASPer has long-standing adoption in Canadian admissions as well, with requirements varying by school and cycle. Acuity’s own retake policy and score validity (one cycle) is especially relevant for applicants applying in multiple cycles. 

How to prepare for each test without “gaming” it

These tests are designed to be harder to cram for than the MCAT. The mindset that helps most is: you are practicing professional reasoning and communication under constraints, not memorizing content. 

Preparation principles that apply to all of them
Start by mapping your own experiences to the kinds of competencies the tests are probing (conflict navigation, accountability, empathy, fairness, teamwork). These competencies are also the kinds of behaviors medical schools say they want to see across holistic review, not just on a test. 
Then practice under realistic conditions so you’re not surprised by pacing or platform friction—AAMC and Acuity both emphasize using official prep resources to reduce test-day surprises. 

How to prep for AAMC PREview
Use the AAMC’s official practice ecosystem as your core preparation: the AAMC provides full-length practice exams with scoring keys and rationales, plus a scored practice exam that mimics score reporting. 
A high-yield routine is: take a full practice exam timed, then spend more time reviewing rationales than you spent testing. You’re training your ability to recognize what medical educators consider “effective” vs “ineffective” behavior in context. 
Because PREview is a rating task (not free response), successful prep is less about writing style and more about calibration: learning when a response is “technically okay but incomplete,” “likely to escalate,” or “good intent but violates boundaries.” That’s exactly what the rationales are designed to teach. 

How to prep for CASPer
CASPer performance is tightly linked to speed + structure. Acuity explicitly recommends the full official practice test in your account, with unlimited re-takes of the practice experience. 
Because the current format includes both typed and video response scenarios, plan to practice both: the 2025–2026 format includes 4 video-response scenarios and 7 typed-response scenarios, in a 65–85 minute total time window. 

A practical response structure that aligns with what CASPer scenarios typically demand: state the key issue (including who might be harmed), identify missing information, choose a reasonable first step, and explain why your approach balances fairness, empathy, and accountability. This matches CASPer’s stated target skills (ethics, empathy, collaboration, problem solving, fairness, etc.). 
Also budget your cycle strategy: you typically cannot retake CASPer within the same admissions cycle for the same test type, so treat your scheduled attempt as high-stakes. 

How to prep for Duet
Don’t “study” Duet like an exam—prepare by clarifying your priorities and doing program research. Duet is expressly about values alignment, with programs receiving alignment outputs based on how your preferences compare to their profiles. 
Before you sit down, write out your non-negotiables (e.g., service mission, grading style, location constraints, research intensity, curricular structure). Then check those against the programs you’re applying to, so your choices are deliberate rather than random. This is consistent with the way Duet is framed in advising resources as a “fit” tool rather than a right/wrong test. 
Remember: there’s no separate Duet fee; it’s bundled with your CASPer reservation if required. 

Timing and logistics strategy for applicants
Because these tests can affect whether your application is considered “complete” at certain schools (AAMC states this explicitly for PREview participation types), schedule early enough that your file isn’t held up waiting for a score. 
For CASPer, plan around scoring timelines, and remember you’ll often see your quartile only after processing (often weeks later), while programs may receive results earlier depending on their workflow. 

Finally, treat integrity seriously. Both AAMC and Acuity position these assessments as part of fair, standardized evaluation; trying to obtain or share confidential live content can put your application at risk and undermines what the tests are designed to measure.