Abstract: Situational Judgment Tests (SJTs) are a cornerstone of holistic admissions in U.S. and Canadian medical and health professions programs, designed to assess crucial non-academic professional characteristics alongside traditional cognitive metrics. The two primary instruments utilized are the Computer-Based Assessment for Sampling Personal Characteristics (Casper, Acuity Insights), an open-response test, and the AAMC PREview Professional Readiness Exam, a fixed-response test. Research consistently demonstrates that SJTs measure important professional competencies, such as empathy, ethics, collaboration, and resilience. They offer incremental predictive validity for non-academic performance later in training, specifically signaling “non-academic risk.” However, there is significant debate over their ability to mitigate demographic bias. While the AAMC reports that its fixed-response PREview exam exhibits smaller group differences compared to academic metrics, independent studies concerning the constructed-response Casper test have repeatedly identified significant performance disparities where underrepresented in medicine (URiM) applicants, including Black and Hispanic candidates, and International Medical Graduates (IMGs) score significantly lower than their counterparts. Given the post-2023 U.S. Supreme Court ruling restricting race-conscious admissions, the equitable implementation of these ostensibly “race-neutral” SJTs remains a critical area of scrutiny.

Introduction and Purpose of Situational Judgment Tests

Medical education institutions rely heavily on traditional academic metrics, such as the Medical College Admission Test (MCAT) and undergraduate Grade Point Average (GPA), which effectively predict academic success early in the curriculum (Ellison et al., 2024). However, these cognitive measures fail to adequately assess the non-academic personal and professional attributes essential for effective clinical practice (Patterson et al., 2016; AAMC, n.d.). SJTs were adopted to provide a standardized, scalable method for assessing vital non-cognitive traits such as empathy, collaboration, and professionalism, aligning with the contemporary emphasis on holistic review (Patterson et al., 2016; AAMC, n.d.). The skills measured generally fall into two broad areas: relational skills (e.g., communication, empathy) and personal accountability (e.g., ethical responsibility, resilience, and self-improvement) (AAMC, n.d.).

Structural and Methodological Differences

The two primary SJTs used in North American medical and health professions admissions, Casper and the AAMC PREview Exam, use fundamentally different designs:

1. AAMC PREview Professional Readiness Exam (Fixed-Response): The PREview exam uses a text-based, fixed-response format. Examinees read scenarios based on real-world medical situations and rate the effectiveness of four to eight possible responses using a four-point scale (AAMC, n.d.). The exam includes 186 total items (AAMC, n.d.). Scoring relies on aligning the examinee’s ratings with consensus ratings established by medical education subject matter experts, with full or half credit awarded for close alignment (AAMC, n.d.). This standardized format is intended to create a “level playing field” by ensuring that every examinee provides consistent information, unlike interviews or essays, where response content and length vary (AAMC, 2026). The PREview exam measures two broad skill areas: relational skills and personal accountability (AAMC, 2026). However, service orientation and oral communication skills are not assessed (Fraser et al., 2025)
   
2. Computer-Based Assessment for Sampling Personal Characteristics (Casper) (Open-Response): Casper, developed at McMaster University in Canada (McMaster, 2022), employs an open-response format and often uses video-stem scenarios (Rosales et al., 2024). The test typically consists of 12 sections, where applicants generate their own typed or video-recorded solutions to three follow-up questions within a strict five-minute time frame (Gustafson et al., 2023; Rosales et al., 2024). Scenarios often focus on transferable skills such as ethical decision-making and collaboration, rather than strictly on medical knowledge (McMaster, 2022). Responses are scored by multiple human raters using a 9-point Likert scale (1 = unsatisfactory to 9 = superb) (Gustafson et al., 2023).

Program Usage in the United States and Canada

SJTs are widely utilized across medical and health professional education programs in North America.

• Casper Usage: Casper has expanded substantially, having been licensed by Altus Assessments (McMaster, 2022). It is currently being used at nearly 400 university medical schools and health sciences programs in Canada, the U.S., and Australia (McMaster, 2022). Specifically regarding U.S. programs, a review of the Casper website indicated that 22 US medical schools and osteopathic schools use the exam (Gustafson et al., 2023). The exam is also being marketed and piloted as a screening tool for residency applicants, including a pilot involving 22 residency programs across four specialties during one match cycle (Rosales et al., 2024; Moore et al., 2024).
  
• PREview Usage: The AAMC PREview exam is open to MD- and DO-granting medical schools and other postgraduate degree programs in the health professions (AAMC, n.d.). The AAMC has conducted longitudinal validity studies with partner schools (Ellison et al., 2024; AAMC, n.d.). Every spring, the AAMC lists programs that require or recommend PREview scores as part of the application profile among US applicants; as of 2025, no Canadian programs required PREview.

Predictive Validity and Demographic Gaps

Predictive Validity

SJTs demonstrate value by predicting outcomes distinct from those predicted by academic performance. One study showed that Casper’s design to include video responses predicted interview performance (Robb et al., 2025). Casper scores show a moderate predictive correlation with performance on sections of Canadian national licensure examinations assessing personal and professional characteristics years after admission (Dore et al., 2017). The University of Colorado’s Physician Assistant Program also shows a strong association between a Casper result (z-score) and the likelihood of a student committing a professionalism infraction (Sivahop et al., 2025)

The AAMC’s research confirms that while GPA and MCAT scores strongly predict academic risk (academic dismissal), PREview scores offer a strong signal of non-academic risk (termination for non-academic reasons/professionalism issues) (Royal et al., 2025). Furthermore, scores from a prototype version of the PREview exam correlated with faculty ratings of professional behaviors, providing unique information relative to MCAT scores and GPAs (AAMC, 2023). However, PREview results do not have predictive validity with Multiple Mini Interview (MMI) performance, suggesting that PREview may emphasize other competencies than the investigating school’s MMI (Ellison et al., 2024).

Demographic Performance Gaps

Studies remain divided on whether SJT design can mitigate bias more effectively than cognitive-based tests. 

• Casper Disparities: Independent cohort studies have found significant disparities in Casper scores across racial and ethnic groups.
  • A study of applicants at a U.S. medical school found that Black or African-American, Native American or Alaskan Native, and Hispanic applicants had significantly lower Casper scores than other applicants (Gustafson et al., 2023). 
  • Purdue University College of Veterinary Medicine’s handling of Casper scores may have excluded first-generation, male, URM, and international applicants (Raghavan et al., 2025). 
  • An anesthesiology residency study found that White candidates scored significantly higher than Black and Hispanic candidates (Rosales et al., 2024).
  • The largest published Graduate Medical Education dataset for an SJT (ophthalmology residency applicants) found that URiM applicants scored 17 percentile points lower, and International Medical Graduates (IMGs) scored 32 percentile points lower than their non-URiM and domestic counterparts on Casper (Moore et al., 2024). This latter study noted that the magnitude of bias in Casper against the URiM and IMG groups was even greater than that observed in standardized academic exams such as Step 1 and Step 2 (Moore et al., 2024).
    
• PREview Disparities: The AAMC’s data from early administrations of the PREview exam indicated that group differences were small between White examinees and Black or Hispanic examinees, and these differences were smaller than those observed with traditional academic assessments (Ellison et al., 2024). The AAMC contends that the notable overlap in scores supports the objective of assessing examinees equitably across different ethnic groups (Ellison et al., 2024).
  
  Icahn School of Medicine at Mount Sinai investigated whether PREview scores, which they did not consider in admissions decisions, correlated with their admissions committee’s decisions on applicants. They found that low PREview scores were more common among applicants from lower socioeconomic status and first-generation backgrounds. Furthermore, lower PREview scores were associated with a lower likelihood of receiving an interview invitation. Finally, PREview scores did not show a strong correlation with post-interview committee evaluations. The investigators concluded that PREview scores did not show a strong alignment with their admissions committee decisions (Catlett et al., 2026)

Response Format and Bias Mechanisms

The structural format is likely to influence these discrepancies. Open-response formats, such as Casper, inherently exhibit greater content variability, offering more nuance in how assessors evaluate individual responses (Iqbal et al., 2025). Research suggests that while scoring primarily relies on demonstrating competencies, providing justification, and considering various perspectives, assessors also take into account construct-irrelevant linguistic factors (Iqbal et al., 2025). The requirement for quick, typed answers may place significant cognitive load on non-native English speakers, potentially affecting their performance, even when their ethical reasoning is sound (Iqbal et al., 2025).

Coaching and Preparation

SJTs claim to be generally resistant to explicit coaching, especially the open-response format of Casper, which requires deeper processing than closed-response formats (Acuity Insights, 2021). Internal research by the Casper administrator suggests that participation in commercial third-party test preparation accounts for only about 2% of the overall variance in scores (Acuity Insights, 2021). However, preparation programs explicitly designed for URiMs are highly effective. A Casper Preparation Program (CPP) successfully increased participants’ self-perceived competence and confidence, with 51% of URiM students who participated scoring in the highest quartile on the actual Casper test (Mahmood et al., 2023).

Post-Affirmative Action Context

The role of SJTs has intensified following the 2023 U.S. Supreme Court ruling that prohibited the use of race-conscious admissions (Nguyen et al., 2025). SJTs are viewed as race-neutral tools intended to support holistic review (AAMC, n.d.). Despite this intended purpose, recent AAMC data show that matriculants from all historically underrepresented groups in U.S. MD-granting schools declined in 2024 compared to 2023, with Black or African American matriculants declining 11.6% and Hispanic, Latino, or of Spanish Origin matriculants declining 10.8% (AAMC, 2025). This decline, reflecting an emergent disparity in acceptance rates for URiM applicants relative to Asian and White applicants, emphasizes the need for continuous research to ensure that SJTs do not inadvertently perpetuate existing inequities (Nguyen et al., 2025).

AAMC Professional Competencies Update for 2026

‘Self-awareness” and “Understanding Others” replaced “Cultural Awareness” and “Cultural Humility” in the 2026-2027 application cycle, likely in response to political sensitivity concerning an emphasis on race or ethnicity (AAMC, 2026). The AAMC’s Anatomy of an Applicant workbook has been updated to reflect this change, but it is unclear how the PREview exam will be revised to assess these attributes.  

Frequently Asked Questions

Bibliography

AAMC. (n.d.). About the AAMC PREview® Exam.

AAMC. (n.d.). About the AAMC PREview® Exam | Students & Residents.

AAMC. (n.d.). PREview® Research.

AAMC. (2023). Predicting Medical Student Performance With a Situational Judgment Test in Admissions.

AAMC. (2025). New AAMC Data on Medical School Applicants and Enrollment in 2024.

AAMC. (January 13, 2026). AAMC PREview Testing Year Update for Prehealth Advisors (webinar).

AAMC. (accessed April 6, 2026). The Premed Competencies for Entering Medical Students.

Acuity Insights. (2021). Are situational judgment tests like Casper vulnerable to coaching effects?

Catlett, J. L., II, Sarfo, E. K., Maysonet, J., Parkas, V., & Swartz, T. H. (2026). Validity and equity of the AAMC PREview situational judgment test in U.S. medical school admissions. Medical Teacher, 1–9. https://doi.org/10.1080/0142159X.2026.2621963

Dore, K. L., Reiter, H. I., Kreuger, S., & Norman, G. R. (2017). CASPer, an online pre-interview screen for personal/professional characteristics: Prediction of national licensure scores. Advances in Health Sciences Education, 22(2), 327–336.

Ellison, H. B., Grabowski, C. J., Schmude, M., Costa, J. B., Naemi, B., Schmidt, M., et al. (2024). Evaluating a situational judgment test for use in medical school admissions: Two years of AAMC PREview exam administration data. Academic Medicine, 99(2), 183–191. DOI: 10.1097/ACM.0000000000005548

Fraser, R., Bynum, B., Dunleavy, D., Oppler, S., & Paullin, C. (2025). Incorporating Measures of Professional Competencies in High-Volume, High-Stakes Assessments. Case Studies in IO Psychology: Practical Applications of Science, 206.

Gustafson, C. E., Johnson, C. J., Beck Dallaghan, G. L., Knight, O. J., Malloy, K. M., Nichols, K. R., & Rahangdale, L. (2023). Evaluating situational judgment test use and diversity in admissions at a southern US medical school. PLOS ONE, 18(2), e0280205.

Iqbal, M. Z., Ivan, R., Robb, C., & Derby, J. (2025). Evaluating factors that impact scoring an open response situational judgment test: a mixed methods approach. Frontiers in Medicine, 11.

Mahmood, F., Oguntala, J. O., Henoud, C., Pierre-Louis, L. L., Fuad, A., & Okafor, I. (2023). The CASPER preparation program innovation: increasing self-perceived competence and confidence of underrepresented applicants on the novel CASPER Snapshot and CanMEDS roles. BMC Medical Education, 23(1), 113.

McMaster University. (2022). How a tool sparked at McMaster is helping select medical school applicants worldwide.

Moore, D. B., Rosenberg, J. B., Moon, J., Pettey, J., & Faridi, A. (2024). Underrepresented in Medicine and International Graduate Bias in the CASPer Situational Judgment Test for Ophthalmology Residency Applicants in 2022–2023. Journal of Academic Ophthalmology, 16(2), 12.

Nguyen, M., Hajduk, A. M., Fancher, T. L., Henderson, M. C., Herrin, J., Henderson, D., et al. (2025). Medical School Admissions After the Supreme Court’s 2023 Affirmative Action Ruling. JAMA Network Open, 8(8), e2527008.

Patterson, F., Zibarras, L., & Ashworth, V. (2016). Situational judgement tests in medical education and training: research, theory and practice: AMEE guide no. 100. Medical Teacher, 38(1), 3–17.

Raghavan, M., Salisbury, S. K., Weisman, J. L., & Stout, L. (2025). The experience of using CASPer at one college of veterinary medicine in the United States. Journal of Veterinary Medical Education. https://doi.org/10.3138/jvme-2024-0136

Robb, C., Banks, P. W., Copeland, H. L., MacIntosh, A., Ivan, R., Moskowitz, J. B., … Sitarenios, G. (2025). Examining the Predictive Validity of an Open-Response Situational Judgment Test with Typed-Response and Video-Response Items. Educational Assessment, 1–11. https://doi.org/10.1080/10627197.2025.2576228.

Rosales, V., Conley, C., & Norris, M. C. (2024). Racial and Ethnic Disparities in Situational Judgment Testing Among Applicants to an Anesthesiology Residency Program. Journal of Graduate Medical Education, 16(2), 140–145.

Royal K. D., Carpentieri, A., Santos, R., Stenuison, D. (2025). Predictors of Academic and Non-Academic Termination From Medical Schools. Cureus 17(12): e98889. doi:10.7759/cureus.98889

Sivahop, Jacqueline EdD, MS, PA-C; Akerman, Amy MPAS, PA-C. (2025) Forecasting the Future: The Relationship Between Pre-matriculant Casper Scores and Student Professionalism Infractions During Physician Assistant School. The Journal of Physician Assistant Education ():10.1097/JPA.0000000000000728.

Disclosure of AI assistance

The literature review was initially conducted with the help of NotebookLM/Google (accessed December 23, 2025) and Elicit.ai basic (December 24, 2025). With the help of Claude/Anthropic, the analysis reports provided the basis for this review. The abstract and first draft were written with the assistance of Gemini (a Chrome extension).

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Abstract: Medical residents routinely delay disability insurance decisions, treating them as problems to solve after training. This article examines why that delay carries specific risks tied to Guaranteed Standard Issue (GSI) eligibility — a time-limited enrollment pathway available only during residency and fellowship. GSI programs allow eligible trainees to obtain individual disability insurance without the full medical underwriting required later in their careers. Because eligibility is tied to training status, residents who wait may lose access to simplified enrollment regardless of their health or financial readiness as attendings. The article outlines common misconceptions that drive delay, including assumptions that higher income, employer coverage or future health will make the decision easier later. It also addresses what happens when the GSI window closes: not necessarily a catastrophic outcome, but added friction, potential coverage exclusions and, in some cases, outright denial that could have been avoided. The intended audience is pre-health and early-career medical trainees who may not yet realize that when they make this decision matters as much as what they decide.

The Pattern Residents Fall Into

Most residents do not make an active decision to ignore disability insurance. It usually just slides down the priority list during training. Residency and fellowship compress years of professional development into a short period filled with long hours, constant evaluation, and a steady focus on the next milestone. That might be finishing intern year, passing boards, matching into fellowship, or signing a first attending contract.

In that environment, decisions that feel like future problems are easy to push off. Disability insurance is often seen as something to deal with later, once income stabilizes or life feels less chaotic. The common assumption is that the decision itself does not really change over time and can be handled when things slow down.

That assumption is understandable, but it misses an important detail. Disability insurance is not just about choosing a product. It is also about timing. For certain types of coverage available to physicians in training, when the decision is made matters just as much as what is chosen. Residents who delay without realizing this often find out later, sometimes years later, that the rules they assumed would still apply have quietly changed.

This applies just as much to early-year residents as it does to those nearing graduation. Even PGY-1s and PGY-2s who are not ready to act benefit from understanding how timing works. Knowing the rules early keeps options open later.

By the time many residents fully focus on the issue, the window that made the decision easier may already be gone.

Why Training Years Are Uniquely Different

Residency and fellowship sit in a narrow and unusual phase of a medical career. Trainees are licensed physicians with defined responsibilities, but they are not yet established in independent practice. That mix of early-career status and future earning potential creates insurance options that simply do not exist at other points in time.

Guaranteed Standard Issue, or GSI, disability insurance programs are built specifically around this training window. At a high level, these programs allow eligible residents and fellows at certain institutions to obtain individual disability insurance without the traditional medical screening that usually applies later in a career. The details vary by insurance carrier and personal situation, but the defining feature is that eligibility is tied to training status and, in some cases, whether a resident has already applied elsewhere and made a mistake they cannot undo.

This is where timing and health history come together in ways many residents underestimate. Medical training is demanding, and it is common for trainees to interact with the healthcare system themselves. Sometimes this is for issues that are temporary, minor, or fully resolved. Those visits may feel insignificant at the time, but they still become part of a permanent medical record.

At the same time, residents are earning roughly $60,000 to $70,000 while training for careers that often exceed $300,000 in annual income. Decisions made during training can shape how that future income is protected.

The point is not that every resident must act immediately or choose the same path. The point is that the training years represent a one-time decision environment. Once training ends, the rules around access to certain coverage options change, regardless of how healthy or financially stable someone may be at that point.

What Happens When the Window is Missed

When residents miss GSI eligibility, the consequences are rarely obvious right away. There is no alert or warning that an option has expired. Instead, the impact shows up later, when a physician revisits the topic assuming it will be easy to take care of then.

At that stage, some physicians discover that coverage requires more review than they expected. Others run into exclusions tied to conditions they never thought would matter. In some cases, the options available look very different from what peers were able to secure during training.

This is not always catastrophic. Many physicians obtain disability insurance after residency without major issues. The risk is not that waiting guarantees a bad outcome. The risk is that waiting adds friction and uncertainty that did not exist before, at the same time professional responsibilities and time pressure increase.

In some cases, the outcome can be far more serious. If a resident applies for a fully medically underwritten policy after training and is declined, that decision can follow them for the rest of their career. What could have been avoided by applying through a GSI offer may result in a physician practicing for decades without any individual income protection at all.

From a planning standpoint, the core issue is having options. Training-specific programs reduce uncertainty by simplifying access at a point when health history is shorter and career risk is still largely theoretical. Once that moment passes, the decision becomes more personal and often more limited.

Common Misconceptions That Drive Delay

Several assumptions commonly lead residents to put this decision off.

One is the belief that qualifying will be easier later, once income rises and life feels more settled. Higher income can help with affordability, but it does not override timing-based eligibility rules or erase changes in health history. Financial clarity does not automatically bring back lost options.

Another common assumption is that employer-provided group coverage will be enough. Group plans can be helpful, but they are designed as broad benefits, not personalized career protection. Many residents assume they can sort out supplemental coverage later without realizing that some individual options are only available during training.

There is also the belief that disability insurance is unnecessary early in a career. Risk feels far away, and the focus is on surviving training. What this overlooks is that the decision is less about immediate risk and more about protecting future flexibility under the most favorable conditions.

Finally, many residents assume they will figure everything out once they are attendings. This treats disability insurance as an information problem that can be solved later with enough research. In reality, the rules around access do not stay the same, and waiting can quietly narrow what is available.

These misconceptions persist in part because disability insurance is rarely discussed in a structured way during training. Financial education usually focuses on debt, budgeting, and contracts. Timing-sensitive insurance decisions tend to stay on the sidelines until a problem forces the issue.

Understanding GSI Without Overcomplicating It

At its core, GSI disability insurance exists because insurers recognize that physicians in training represent a unique profile. They are early in their careers, have high future earning potential, and have not yet accumulated years of occupational exposure. Programs built around that profile are intentionally limited to the training years.

What matters most for residents is not mastering the fine print of how these programs work but understanding that they are not interchangeable with options available later. GSI is not a different policy. It is a different point of entry that exists only during a specific phase of training.

Once that phase ends, physicians move into a more traditional insurance environment where each application is evaluated individually. For some, that transition is smooth. For others, it introduces limitations they did not expect when they chose to wait.

Where to Go Deeper

Residents who want a full explanation of how GSI disability insurance works, including eligibility rules, timing considerations, and coverage structure, can review this comprehensive buyer’s guide. It covers the details this article intentionally leaves out and walks through how GSI programs differ from post-training options.

A Practical Check

For those who simply want to see whether there is a GSI option available at their school, there is a basic eligibility tool. It is meant as a starting point, not a full explanation, and can help residents understand whether a GSI offer may apply to them.

A Closing Reflection

Disability insurance decisions are not the same for every physician, and not every resident will choose to act during training. There is no single correct answer. What matters is recognizing that timing affects the range of choices.

Residents who understand how timing works can make deliberate decisions instead of default ones. Awareness keeps options open, even for those who ultimately decide to wait. The real risk is not choosing wrong. It is realizing too late that the choice itself has already narrowed.

Material discussed is meant for general informational purposes only and is not to be construed as a recommendation or advice. Please note that individual situations can vary therefore, the information should be relied upon only when coordinated with individual professional advice. William is a Registered Representative of Park Avenue Securities LLC (PAS). Securities products offered through PAS, member FINRA, SIPC. Financial Representative of The Guardian Life Insurance Company of America® (Guardian), New York, NY. PAS is a wholly owned subsidiary of Guardian. MDGSI is not an affiliate or subsidiary of PAS or Guardian. CA Insurance License #0D94494, AR Insurance License #3395434. 8755685.1 Exp 2/28

The post Why GSI Disability Insurance Timing Matters More Than Most Residents Realize appeared first on Student Doctor Network.

Abstract: The Kaiser Permanente Bernard J. Tyson School of Medicine (KPSOM) celebrated its third Match Day on Friday, March 20, 2026. The Student Doctor Network wanted to capture the thoughts of these graduating students about their medical school journey, especially since KPSOM opened in 2020, during the COVID-19 pandemic. We share responses from the graduating class of 2026 about their journeys and one administrator’s experience.

Student Perspectives

Dalja Parks (She/Her/Hers)

Original City: Carlsbad, CA.

Education Journey: B.S. in Human Biology and a minor in psychology from UC San Diego. I navigated my undergrad years while managing my own health journey with brain cancer and learning the ropes of higher education as a first-generation student.

PGY1 Destination: Internal Medicine

Anthony Zamary

Biography: I grew up in the Bay Area in Northern California. I stayed in the Bay for undergrad and attended UC Berkeley as part of the Class of 2020. At Berkeley, I majored in Molecular and Cell Biology and minored in Global Poverty and Practice. I was inspired by my father, a pulmonary and critical care physician, and by the service-mindedness of my Coptic Christian diaspora community, originating from Egypt. Throughout my studies, I tried to bridge the microscopic basis of disease with the macroscopic issues challenging the world.

After UC Berkeley, I took two gap years to complete some microbiology research, work as an MCAT Biology teacher, and earn a master’s degree in Radiology and Biomedical Imaging from UCSF in 2022. I was very grateful to attend KPSOM as their third class, starting in 2022, and I just matched into a Diagnostic Radiology residency! 

PGY1 Destination: Diagnostic Radiology

Tell us more about your premed journey, including any challenges that shaped your purpose as a physician. 

Dalja: My journey to medicine was shaped by my experience as a cancer survivor as well as a first-generation student. I realized that being a patient gave me a unique perspective on medicine and the care I can provide as a physician. Going through cancer gave me empathy and compassion that I can share with patients. 

Because KPSOM had not graduated a class when you accepted a seat there, how did they earn your trust that they would help you achieve your goals as a medical student and future resident? 

Dalja: The school provided a lot of mentorship, which I appreciated very much. Whether it was through the longitudinal integrated clerkships (LIC) or providing the funding for my community projects, they gave me the autonomy to build my own clinical identity while providing the resources to make sure I didn’t fall.

How did the school address your concerns (when you started) to build your confidence that you can be successful as a student, a resident, and a physician? 

Dalja: Coming in, one of my fears was whether programs would take a chance on a student from a brand-new school. KPSOM addressed this throughout my four years by bringing in residency PDs [program directors] early on, providing research opportunities, and ensuring our clinical training was strong. 

Anthony: KPSOM was very receptive to student feedback. In fact, I was part of the Student Curricular Board that helped bring students, faculty, and leadership together to continuously improve the student experience….Throughout my experience, it was clear that the school would have the resources, support, and expertise it would need to thrive. Most importantly, having people that genuinely care, students and faculty alike, is what makes the real difference. 

Who was the most supportive student advisor, administrator, or faculty member who helped you through your residency application process? (You can shout-out more than one person.) What did they do?

Dalja: I have to give a massive shout-out to Dr. Razi. She has been a literal inspiration and one of the greatest mentors I could have asked for. When I was navigating the stress of residency applications, she was there every step of the way. Dr. [Rabia Rafi] Razi was one of the greatest facilitators in the class and in the hospital, and is one of my biggest reasons I want to be a cardiologist. She is a great example of [the] amazing physician I aspire to be.

Anthony: This question is too hard. It really takes a village, and KPSOM has a small but quite mighty village. 

Here is a secondary essay prompt you had to answer for admission. Recall what you answered and what you would now add now.

Lifelong learning is an essential process for continued professional development in physicians that includes reflection and being open and responsive to constructive feedback. Tell us about an area of intellectual exploration you are passionate about and have sustained over time. What means have you used to explore this area?

Dalja: I’ve remained passionate about the link between food accessibility and preventive diseases. We often talk about ‘lifestyle modifications’ in the clinic as if they’re easy, but my work with the ParkTree community navigators and the [KPSOM] micro grant community garden showed me the reality of the barriers patients face. I’ve spent the last few years exploring how clinical medicine can partner with urban agriculture to treat the whole patient. It’s a passion I plan to carry into my Internal Medicine residency and eventually into my career as a cardiologist. 

Anthony: One of my interests is how to bring innovative technologies and approaches to under-resourced areas. My service-learning practicum on Skid Row in downtown Los Angeles gave me a glimpse of how I can innovate to improve care in a variety of settings. Moreover, growing up among a lovely Coptic Christian diaspora community, along with my many trips to Egypt, taught me the importance of service. I have seen how helpful my father has been as a physician in the community, and I aspire to do the same. My Coptic community has given me so much over the years, and I have always dreamed of giving back to the community that has given me so much. I also hope to carry the values and inspiration it has instilled in me to serve more broadly beyond my immediate community, and to figure out the best way to do so throughout my career through service, research, education, and innovation with heart.

Faculty/Administrator Perspective: Valinda Lee, Senior Career Advising Program Manager at Kaiser Permanente Bernard J. Tyson School of Medicine (KPSOM)

Briefly tell us your faculty/administrative role. When were you hired at KPSOM?

My name is Valinda Lee, and I’m the Senior Career Advising Program Manager at KPSOM, the staff career advisor for all students. I was hired in April 2021, when our inaugural class was in their first year. 

How has the school supported students (and each other) through personal, regional, or global events or crises?

As a medical school in Pasadena, Altadena’s Eaton Fire took place in our backyard. Many of our faculty and staff, as well as our students, were directly affected by the fires. Our Office of Community Engagement and Government Affairs coordinated clinical volunteer opportunities for our students to engage in with KPSOM faculty at the Pasadena Convention Center for evacuees, and some students had research projects inspired by the fires. Some students volunteered their free time to support victims of the fire with local organizations. 

What aspects/insights of the residency selection process have really improved your ability to provide personalized advice to students, especially given the more recent improvements in the ERAS/Thalamus process (or other processes for military, urology, ophthalmology)?

Each year all students receive two to three required sessions on career selection and planning….In the last year, the Association of American Medical Colleges (AAMC) and partner organizations have increased the information available to schools so that students can make informed choices about where to apply based on their preferences, career interests, and performance in medical school. These resources, combined with other reports, allow us to provide data-driven advising to our students. 

How have you advised students to use preference signaling when it comes to their goals?

It can be challenging for applicants to know how to most strategically use preference signals! Generally, I recommend that: 

1. Students should follow all specialty-wide guidance available via the Organization of Program Directors Association (OPDA) Career Guides. 
2. Students should use all signals available to them in all specialties to which they are applying, including preliminary year applications. 
3. If applying through ERAS, it is helpful for preference signals and geographic signals to align.  
4. Depending on a student’s competitiveness, they may choose to send a higher percentage of their signals to programs that aren’t as likely to receive as many signals overall. 

How have you advised students who had to SOAP – proactively and during the days before the final match?

Conversations regarding risk happen throughout a student’s time in medical school. Some students factor in the competitiveness of a specialty or the number of residency programs in a specific geographic area when deciding which specialty to pursue as early as their first year. 

In year three, students who may have other risk factors, including low Step 2 scores, may decide to apply to more than one specialty to mitigate the chances of being unmatched long before Match Week. Dual applications are labor-intensive and challenging but can spread the work over a longer period and hopefully yield more interviews at more programs that the student would prefer, rather than those they might be able to secure during the four days of SOAP.  

At KPSOM, we use a data-driven approach to conversations regarding risk in the months prior to Match Week. Using the most recent available data from the National Residency Match Program’s Charting Outcomes report for each medical specialty, we meet with students who are at risk of not matching based on the length of their rank order list. These “Emergency Prep” meetings let us discuss contingency plans if they find out on Match Week that they are unmatched. It also gives students time to prepare for SOAP, which may involve asking for new letters of recommendation and writing a new personal statement if the student is planning to apply to a new specialty. If the student plans to apply to a new application system (ResidencyCAS for Emergency Medicine, for example), they will need to create and prepare that new application as well. 

SOAP is challenging for everyone involved. Our aim is to take care of students holistically during this time. In addition to providing appointments and advising with staff and faculty career advisors, students can meet with physician coaches with whom they have worked closely throughout medical school to make decisions regarding their plans and decisions. Our Student Psychological Services team holds therapy appointment times for unmatched students, and we purchase office supplies and snacks to keep students on track. 

Students may opt to SOAP in a reserved office space on campus or work virtually from home; whatever best supports their well-being. 

We thank the KPSOM PR and media relations team for their help with these interviews. Responses were lightly edited for brevity and clarity.

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