Medical schools have always cared about brains. (Shockingly!) But they also care about something harder to spot on a transcript:
how you act when life gets messy, people get stressed, and the “right answer” comes with three footnotes and a side of humility.
A 4.0 GPA can’t tell an admissions committee what you’ll do when a classmate cuts corners, a patient’s family demands information you
can’t share, or your lab partner accidentally turns the group chat into a group complaint.
That’s where situational judgment tests (SJTs) come in. Think of them as a professionalism “simulator”:
not to see if you’re perfect (no one is), but to see whether you recognize what thoughtful, ethical, team-minded behavior looks like.
In a time when medical schools are leaning into holistic admissions, SJTs offer another lens on the qualities that matter
in medicineespecially the ones you can’t cram into a multiple-choice bubble.
What is a situational judgment test (SJT)?
A situational judgment test presents realistic, often uncomfortable scenarios you might encounter as a learner in a
health professionconflicts with teammates, professionalism dilemmas, communication challenges, and moments where values collide.
Instead of asking you to memorize facts, it asks you to judge responses: What would you do? What would you say? What’s most effective?
Different SJTs use different formats. Some ask you to rate the effectiveness of several response options.
Others ask you to type (or record) what you would do and why. Either way, the goal is similar:
to learn how you reason about people-centered problemsthe kind where “being right” includes being respectful, safe,
and accountable.
Why medical schools use SJTs in the first place
Holistic review needs better tools than “vibes”
Medical schools have long said they want applicants who are compassionate, ethical, collaborative, and resilient.
The challenge is that these traits can be hard to measure consistently. Letters of recommendation vary wildly.
Activity descriptions can sound like movie trailers. Interviews help, but they’re time-intensive and can be influenced by
interviewer style.
SJTs are appealing because they offer a standardized way to assess aspects of professional readiness.
Schools can use them to support mission-driven selection and to add structure to the evaluation of
interpersonal and professional competencieswithout pretending a single test can summarize an entire human.
Medicine is a team sport (with higher stakes than intramurals)
Most medical training happens in teams: students, residents, nurses, physicians, social workers, therapists, and staff,
all coordinating care under pressure. The best clinicians aren’t just smartthey’re dependable,
able to communicate, and able to navigate conflict without torching relationships.
SJTs help identify whether an applicant recognizes behaviors that protect patients and promote healthy teamwork:
speaking up appropriately, responding to bias, escalating concerns, owning mistakes, and treating people with dignity.
The two big SJT names applicants see in U.S. admissions
AAMC PREview: judging response effectiveness
The AAMC PREview exam (formerly the AAMC Situational Judgment Test) uses hypothetical scenarios and asks you to evaluate
the effectiveness of different response options. It’s designed to reflect professional readiness in the context of entering
health professions education.
The AAMC frames PREview around two broad areas: relational skills (how you work with, communicate with, and show respect for others)
and personal accountability (reliability, responsibility, and follow-through). In other words:
“Can you be trusted on a team?” and “Can you be trusted with responsibility?”
Many U.S. schools participatesome require it, others recommend itand the list changes by application cycle.
If you’re applying broadly, PREview can matter simply because it’s one more data point a school might use
to understand you beyond metrics.
Casper: open-response judgment under time pressure
Casper is another widely used SJT, often described as “open-response.” Instead of picking from fixed options,
you respond to scenarios by explaining what you would do and why. The format rewards clear thinking, empathy, fairness,
and practical problem-solvingespecially when the scenario has competing priorities.
Some medical schools require Casper, while others don’t. Requirements can differ even within the same institution
(for example, an MD program might require it while another track does not). Schools may also specify which parts of an assessment
suite they want. The takeaway: always check each school’s admissions page rather than relying on rumor, spreadsheets,
or your friend’s cousin’s roommate’s “definitely accurate” group chat message.
What SJTs are trying to measure (and why it matters)
SJTs don’t test organic chemistry. They test your professional reasoningthe kind that shows up when you’re tired,
stressed, juggling responsibilities, and still expected to do the right thing.
Many of the qualities SJTs target overlap with the broader competencies medical schools value, such as:
- Empathy and compassion: recognizing others’ perspectives and responding with humanity.
- Ethical responsibility: protecting privacy, honesty, and patient safetyeven when it’s awkward.
- Teamwork and collaboration: communicating respectfully, sharing credit, and managing conflict constructively.
- Reliability and dependability: following through and taking ownership when things go wrong.
- Cultural humility: noticing bias, seeking to understand, and adapting behavior respectfully.
- Resilience and adaptability: staying functional when plans collapse (as they often do in healthcare).
Notice what’s missing? “Being the loudest person in the room.” “Winning arguments.”
“Having a flawless résumé.” Medicine needs thoughtful professionals, not walking debate trophies.
How admissions committees use SJT results
Most schools treat SJT scores as one component of a broader review rather than a single make-or-break metric.
Think of it like seasoning: important, noticeable, and capable of ruining the dish if used poorlybut not the whole meal.
Here are common ways schools may use SJT information:
- Context for holistic review: An SJT can complement experiences, essays, and recommendations by adding a standardized view of professional reasoning.
- Interview guidance: A committee might probe judgment, conflict skills, or accountability if a score raises questionsor highlight strengths if it supports them.
- Mission alignment: Programs emphasizing community engagement, patient-centered care, or team-based learning may value evidence of strong relational skills.
- Balancing the portfolio: Strong academic metrics show readiness for coursework; strong SJT performance may suggest readiness for the professional environment.
A concrete example: Imagine two applicants.
Applicant A has stellar grades and test scores but consistently chooses responses that avoid accountability or dismiss others’ perspectives.
Applicant B has solid academics and a record of service, and their SJT responses show calm, fair decision-making and respectful teamwork.
Neither applicant is “just a number,” but the SJT can help a committee ask smarter questions about how each person may function
in a demanding, people-centered training environment.
What the evidence says (and what it doesn’t)
Researchers and testing organizations have studied whether SJTs provide information that is meaningfully different from traditional academic measures.
One key idea is incremental value: do SJT scores add something beyond GPA and standardized science exams?
Evidence around PREview, for example, suggests it measures knowledge of effective professional behavior that is
distinct from academic metrics, with demographic group differences generally smaller than those seen on some
traditional academic assessments. That’s part of why some schools see SJTs as a potential tool to strengthen holistic review.
Still, it’s important to be honest about limitations:
SJTs do not directly observe real-world behavior. They assess your judgment about scenarios.
They can be influenced by test-day stress, typing speed, and familiarity with the format.
And no SJT can fully capture qualities like courage, humility, or integrity across every context.
Fairness, access, and the debates around SJTs
SJTs have fans and critics, and both camps have points worth taking seriously.
If you’re an applicant, it helps to understand the debatebecause it explains why schools use SJTs carefully (and why policies can change).
Common concerns
- Cost and logistics: Additional exams can mean additional fees, scheduling, and technology requirements.
- Prep inequality: A prep industry exists, and applicants worry that coaching advantages may widen gaps.
- Transparency: Some applicants want clearer feedback on what “good” performance means and how scores are used.
- Cultural context: Judgment can look different across cultures, and tests must work hard to avoid penalizing difference that isn’t actually unprofessional.
Why schools still find them useful
Many schools argue SJTs add structure to evaluating professional competencies and can complement other tools that are also imperfect.
Some admissions offices explicitly describe these assessments as supporting fairness and objectivity by reducing overreliance
on less standardized signals.
The practical reality is that medical schools must make high-stakes decisions at scale.
SJTs are one attemptimperfect but intentionalto evaluate the part of readiness that lives in
communication, ethics, teamwork, and accountability.
How to prepare without trying to “game” the test
You can prepare for an SJT the same way you prepare to be a good teammate in real life: by building habits of thoughtful judgment.
The best preparation is less “memorize perfect lines” and more “practice a repeatable way to think.”
A simple framework that works for most scenarios
- Pause and clarify: What do you actually know? What information is missing?
- Identify stakeholders: Who could be affectedpatients, peers, supervisors, the public?
- Choose the safest, fairest action: Prioritize safety, respect, honesty, and policy.
- Communicate professionally: Calm tone, clear reasoning, and willingness to listen.
- Escalate appropriately: Handle it at the right level; involve supervisors when needed.
- Reflect and follow up: Prevent repeat issues; own your part; learn.
Also: don’t confuse “nice” with “good judgment.” Sometimes the most compassionate response is setting a boundary,
speaking up, or escalating a safety issuepolitely, but firmly.
Sample scenarios (with what strong judgment tends to include)
Scenario 1: A teammate isn’t pulling their weight
Your group project is due tomorrow. One teammate has been missing meetings and sends a last-minute message:
“Sorry, had a lot going on. Can you cover my part?”
Strong judgment often includes:
- Respectful curiosity (“Are you okay? What’s going on?”) without instantly assuming laziness.
- Clear boundaries (you can help, but you can’t silently absorb everything).
- Fairness to the group (protecting others’ time and grades).
- Appropriate escalation if the pattern is ongoing (involving a TA or faculty per policy).
The “bad” response isn’t always anger; sometimes it’s avoidancedoing all the work, building resentment, and teaching everyone
that the loudest deadline wins. Medicine has enough silent burnout already.
Scenario 2: Confidentiality meets social pressure
During a volunteer experience, a friend asks about a person they think they recognized at the clinic:
“Was that my neighbor? What were they there for?”
Strong judgment often includes:
- A firm privacy boundary (“I can’t discuss anyone I see there.”).
- Brief education (privacy is a safety and trust issue, not a vibe).
- Protecting dignity (no teasing, no hints, no “well I can’t say but…”).
Scenario 3: You witness a biased comment
A classmate makes a stereotype-based joke about a patient population. Others laugh awkwardly. No one responds.
Strong judgment often includes:
- Addressing it (directly or indirectly) rather than pretending it didn’t happen.
- Choosing the right setting: sometimes in the moment, sometimes privately soon afterdepending on safety and power dynamics.
- Focusing on impact (“That could come across as disrespectful and harm patient trust.”).
- Seeking support if needed (faculty, advisors, reporting pathways).
These scenarios aren’t about sounding like a robot who swallowed a professionalism handbook.
They’re about showing you can protect people, work with others, and act responsiblyespecially when it’s inconvenient.
What SJTs can’t do (and why schools still use them)
SJTs don’t replace interviews, essays, experiences, or academic readiness. They can’t fully measure how you behave
in real clinical environments. They’re one snapshot, in one format, on one day.
But in the admissions puzzle, SJTs can still help by:
adding standardized information about professional reasoning,
supporting structured holistic review,
and highlighting competencies that matter deeply in training and practice.
Bottom line
Situational judgment tests are medical schools’ attempt to answer a simple question with a complicated answer:
Can this person be trusted to learn medicine responsibly, respectfully, and safely?
If you’re applying, treat SJTs as more than a hoop. They’re a preview of the professional moments you’ll face in training:
conflict, uncertainty, ethics, teamwork, and communicationoften at the same time.
Preparing well means practicing how to think, not memorizing what to say.
Experiences that bring SJTs to life ()
If you ask applicants what an SJT feels like, many describe the same emotional arc: confidence, confusion, mild panic,
and then a strange sense of personal growthlike journaling, but with a countdown timer.
One student, “Jordan,” described staring at a scenario about a teammate who kept showing up late and thinking,
“I’ve lived this. I just didn’t know it was exam material.” Suddenly, the test isn’t abstract. It’s your group project.
It’s your volunteer shift. It’s every awkward moment where you had to choose between being liked and being responsible.
Another applicant, “Maya,” practiced by reading sample prompts and talking through responses with a mentor.
The surprise wasn’t learning a magic phraseit was realizing how often her first instinct was to solve problems quietly
to avoid conflict. In one scenario, a peer made a risky mistake, and Maya’s gut reaction was, “I’ll fix it and move on.”
Her mentor gently pushed: “What about patient safety? What about accountability?”
By the third practice session, Maya wasn’t trying to sound perfect. She was practicing how to be clear:
clarify facts, communicate respectfully, involve the right person, and follow up. That shifttoward transparent,
safety-first teamworkis exactly the kind of professional habit medical training demands.
Test day stories also tend to be weirdly relatable. One applicant said the hardest part wasn’t the ethicsit was the clock.
“You know what you want to do,” he said, “but you have to organize it fast.” That pressure can be frustrating,
but it mirrors real healthcare moments: limited time, competing needs, and the requirement to stay professional anyway.
The best responses often looked less like speeches and more like action plans:
ask, listen, set boundaries, document, escalate when needed.
Not dramatic. Not heroic. Just responsible.
Applicants also notice how SJTs reward balance. In a scenario about confidentiality, “Leah” initially wrote a harsh response:
“I’d tell them it’s none of their business.” Technically correctsocially disastrous. After reflection, she reframed:
“I can’t discuss anyone I see there, but I get why you’re curious. Privacy is important for everyone.”
Same boundary, better delivery. That’s medicine in a nutshell: truth with tact, firmness with empathy.
Finally, a lot of applicants walk away with an unexpected benefit: clearer self-awareness.
SJTs force you to articulate your values under pressure. They reveal your default movesavoid, confront, escalate, or collaborate.
And even if you never love the format, the practice can shape how you show up in interviews, in clinical volunteering,
and later on the wards. In that sense, SJTs aren’t just an admissions tool. They’re a preview of the professional person
you’re becomingone scenario at a time, hopefully with fewer group chats and more patient-centered decisions.
