How Is CASPer Scored? Quartiles, Raters & Tips

How is CASPer Scored: Step-by Step Process

CASPer is scored using a multi-rater system where each scenario is evaluated independently by a different trained assessor. Raters score each of your answers based on whether they exemplify qualities, such as ethical reasoning, empathy, and communication. Your scores are then combined into an overall performance that is reported as a quartile ranking.

Understanding this scoring process is key to maximizing your CASPer performance. Here are the steps of how each response is assessed and assigned a respective score:

1. Independent Evaluation of Responses

Every typed answer you provide on the CASPer receives a separate score, which means that each response directly contributes to your final result.

2. Assessment of Specific Qualities within Response

Raters evaluate your response based on how well you identify key ethical or interpersonal issues while demonstrating empathy and professionalism. Responses that consider multiple perspectives using clear reasoning tend to be scored higher by raters as well.

3. Assigned a Score to Response

Based on standardized criteria, the rater assigns a score reflecting the overall strength of your answer.

4. Response Scores are Aggregated

Your individual scores across all CASPer questions are combined to form your overall performance.

5. Performance Ranked into a Quartile

Your total score is compared to other test-takers and converted into a quartile ranking.

Because each response is scored independently, consistent performance across all questions is essential to achieving a high CASPer score. This consistency has become even more important following recent updates to the CASPer scoring model, which now place greater emphasis on how each individual response is evaluated.

How the CASPer Format Affects Scoring

Each response on the CASPer test is evaluated independently, meaning your performance is assessed across multiple scenarios rather than as a single overall impression.

According to Acuity Insights, the current format includes:

• Fewer scenarios
• Fewer associated questions
• Less time per response

This format affects how CASPer is scored. With fewer opportunities to demonstrate your judgment, each response carries more weight, making consistent performance across scenarios essential.

Reduced time per question also increases pressure, requiring efficient decision-making. As a result, scoring reflects how reliably you apply your judgment under time constraints.

In previous versions of CASPer, more scenarios allowed for greater variability in performance. The current format places greater emphasis on steady performance across individual responses.

Who Scores CASPer and How are Responses Evaluated? 

To understand how CASPer scoring is applied in practice, it is important to look at who evaluates your responses and how the process is designed to ensure fair scoring. CASPer responses are reviewed by multiple independent raters using standardized evaluation guidelines instead of being graded by a single rater.

Who Are CASPer Raters?

CASPer raters come from a diverse pool of trained individuals. This diversity in background is intentional because it allows responses to be evaluated from multiple perspectives as opposed to through the lens of a single professional viewpoint.

How are CASPer Raters Trained?

All CASPer raters complete a structured training process, which consists of an online orientation and training session. This training session focuses on the logistical aspects of marking CASPer tests and how to apply standardized scoring criteria to each response when grading it.

Focusing on these aspects of the test helps minimize subjective judgment, improving the consistency in how responses are objectively evaluated. Tests with written answers marked by humans, even ones who are experts in this field, will never be 100% objective.

Why Multiple Raters Improve Fairness

Because each response is reviewed independently, each applicant’s CASPer test will be seen by several raters, which increases the inter-observer reliability of the test.

While raters are given general information about the concepts important to each scenario and major ideas that should be discussed they do not have access to your identity or your other answers. This minimizes bias and ensures that each response is judged on its own merits.

Together, this structure ensures that your overall performance is not determined by a single opinion, providing a more reliable assessment of your responses.

How Raters Analyze CASPer Responses in Practice

When reviewing a response, raters apply marking criteria to each answer to gauge how you approach the situation and communicate your reasoning. Familiarizing yourself with this criteria through effective CASPer test prep with professionals and knowing how long it takes to prepare for CASPer is key to improving your performance.

Application of the criteria will vary from question to question, as you may be given a CASPer scenario centered around informed consent, but then be asked a question on patient autonomy.

 For example, imagine the following scenario station: such as the following example:

Scenario X

“You are a surgical resident in an outpatient clinic seeing a patient who has been diagnosed with ovarian cancer that requires surgical intervention. You are discussing the details of the surgery and explain that both open and laparoscopic oophorectomy are possibilities in her case. After your discussion, the patient expresses that she does not wish to undergo surgery, stating that she would like to give chemotherapy a chance first."

Question 1: How would you ensure any consent this patient provides for surgery is informed?

Question 2: How would you respond to this decision?

This example scenario encompasses numerous areas and deals with several ethical concepts. While the first question specifically asks about informed consent, the second then adds a dimension of patient autonomy, which could even be argued to branch into evidence-based medicine.

It is important to note advanced technical knowledge of “open and laparoscopic oophorectomy” is irrelevant and if you see a technical term in CASPer it is just meant to shake you up a bit and stress you. From a rater’s point of view, the more dimensions of the question you can demonstrate that you have recognized and considered, the better the score you will receive.

A rate may view a strong response to this example scenario as:

1. Starts by identifying the consequences of doing nothing and its impact.

2. Specifies what information should be gathered, either through private conversations or consulting policies, to clarify important aspects of the patient encounter that contribute to informed consent, such as proposed procedure, risks and complications, and possible alternatives.

3. Balances these aspects with the understanding that, provided the patient has the capacity to make their own decisions about their healthcare, making the decision to decline surgery, although potentially inadvisable within the context of their illness, is a patient’s inalienable right as part of their autonomy.

Raters evaluate responses using a 9-point Likert scale, where 1 indicates an unsatisfactory response and 9 indicates a superior one. Because scoring focuses on the quality of the judgement than a single “correct” answer different responses can receive similar scores if they demonstrate effective reasoning, even when the approaches vary.

What Happens if You Miss or Skip a CASPer Question? 

Under the current CASPer format, each typed response is scored individually, not as part of one combined station. If you skip a question or fail to provide an answer, that response receives no evaluation.

Skipping or missing a CASPer question can lower your overall performance or quartile because there is no opportunity for stronger answers to offset it. This is especially the case given the reduced number of scenarios and questions, increasing the relative impact of each response.

To maximize your results, aim to provide a brief and thoughtful response to both prompts as opposed to leaving them blank. Providing a partial response allows you to show some level of reasoning and judgement, which gives the rater some basis for evaluation.

What Triggers a Red Flag in CASPer?

Another crucial part of understanding how CASPer is scored is recognizing what constitutes a red flag, such as unethical or unprofessional responses, as these answers can drastically affect your score.

A rater will flag a typed or a video answer for the following reason:

"The response given indicates a dangerous, unethical, unprofessional, or potentially harmful approach to the scenario that displays a clear deficiency in the candidate’s ability to appreciate the complex ethical issues raised."

-Former CASPer Rater

This perspective helps demonstrate an important aspect of how responses are evaluated in practice. Examples of responses that may trigger a red flag for raters may include:

• Unethical or harmful suggestions, such as recommending dishonest, unsafe, or inappropriate actions without acknowledging consequences.
• Failure to recognize key issues by ignoring central concerns such as consent, fairness, or responsibility.
• Dismissive or judgmental tone by responding in a way that lacks empathy or respect for others involved.
• Overly rigid or one-sided reasoning that involves providing an absolute answer without considering alternative perspectives.

In practice, red flags tend to emerge from a few recognizable response patterns.

How Red Flags Are Handled

When a response is flagged, the rater is then obligated to comment on why they flagged the answer and provide justification for flagging it.

This mechanic acts as a fail-safe for a candidate’s application process. The flagged response and the rater’s comments are reviewed by an admissions officer or committee. If it is felt that the rater was excessively harsh in their judgment of the response and provided that the remainder of the candidate’s responses are scored well, this red flag can be overlooked within the context of that candidate’s overall application. Multiple red flag responses on your CASPer test, however, are likely to result in rejection of your application.

You may be asking yourself, “What happens if my test is marked by a rater with excessively high standards?” This occurrence is unlikely because each scenario is marked by a different rater. It would also be unlikely that you end up with multiple raters who were all difficult graders. The training CASPer raters receive and the scoring system both account for the possibility that some raters have more critical approaches than others.

When scoring CASPer, a rater will usually be given a series of candidates’ responses to the same scenario and questions.

The advantage in doing this is two-fold:

1. The rater can apply the same criteria to multiple applicants’ responses rather than having to shift focus between subject matters every time.

2. You have a different assessor marking each question rather than one continually harsh (or lenient) assessor for your whole test.

This is deemed fairer and gives a more accurate representation of your interpersonal skills and ability to respond to the challenging scenarios CASPer presents.

Here's what you need to AVOID when taking CASPer!

How to Get a High CASPer Score

Strong CASPer performance is about consistently demonstrating clear, thoughtful judgment across a range of scenarios. For this reason, high-scoring responses tend to follow a few key patterns that make them easier for raters to evaluate and more effective overall in terms of structure and content.

Example of a Strong CASPer Response

Scenario:

A colleague is consistently arriving late, affecting team workflow.

Response:

I would first try to understand if there are underlying reasons for their behavior, as there may be circumstances I am not aware of. At the same time, I would recognize the impact this is having on the team and the importance of maintaining professionalism. I would approach the colleague privately to discuss the situation, express my concerns respectfully, and offer support if needed. If the issue continues, I will consider escalating it through appropriate channels while maintaining a fair and constructive approach.

Why This Response Works

The above example response is effective because it demonstrates the following:

• Identifies the core issues, such as the colleague's mental well-being, impact on the team, and professionalism.
• Considers multiple perspectives, such as possible underlying reasons for the colleague’s lateness and job performance.
• Maintains a professional tone by using concise sentences, active voice, and neutral language.
• Provides a clear and actionable approach for all stakeholders.
• Balances empathy with accountability.

CASPer Test-Taking Tips

These elements form the foundation of strong CASPer responses and can be applied across a wide range of scenarios.

To consistently produce your own strong responses:

• Start by identifying the main issue before proposing a solution
• Acknowledge relevant perspectives, even briefly
• Keep your answer structured and easy to follow
• Focus on practical next steps, not abstract ideas
• Manage your time so every question receives a complete response

Over time, applying these techniques will improve the clarity and effectiveness of your CASPer responses.

What Do CASPer Quartile Ranking Mean?

Another common question among applicants is what CASPer quartile rankings mean, especially for admissions committees.

When you take the CASPer test, your response scores are used to generate a quartile based on evaluating how you compare to your peers who took the same test type on the same test date and time as you. The quartile ranking you receive is therefore relative to the performance of everyone else, which is what your ranking demonstrates rather than the percentage of questions you got “wrong” or “right.”

Every student’s scores are sorted into one of the following quartiles:

• 1st Quartile: applicants who ranked in the 0-24^th percentile, compared to their peers. 
• 2nd Quartile: applicants who ranked in the 25-49^th percentile, compared to their peers.
• 3rd Quartile: applicants who ranked in the 50-74^th percentile, compared to their peers. 
• 4th Quartile: applicants who ranked in 75-100^th percentile, compared to their peers. 

If you ranked in the 4th quartile, it means that you scored higher than at least 75% of your peers who took the test at the same time as you. If you ranked in the 3^rd quartile, for the sake of comparison, you scored higher than at least 50% of your peers. Ranking in the 2^nd quartile means you scored higher than at least 25% of your peers, whereas ranking in the 1^st quartile means you scored lower than 75% of your peers.

Applicants receive their quartile ranking one month after completing their CASPer test. How medical schools and other professional programs use the CASPer ranking in the admissions process for a variety of reasons, ranging from interview screening to creating a comprehensive profile of candidates that they cannot decipher from GPA and MCAT alone. You simply do not know, so apply to schools where your academic achievements and background fit the school’s profile, regardless of what quartile score you get!

How CASPer Scores Are Reported to Schools 

While applicants receive a percentile based on their quartile ranking, schools are provided with a z- score. Like quartiles, standardized scores allow admissions committees to evaluate your performance in the context of other applicants, but in further detail.

A z-score is how many “points” you are away from the mean score and indicates where you are in the distribution of scores across all candidates.

If your z-score is 0, for example, it means that your score is the same as the mean. A z-score of +1 means that you scored higher than the mean by one standard deviation, whereas a z-score of -1 means that you scored lower than the mean by one standard deviation.

Both quartiles and z-scores are measures of relative standing, but they use different approaches. Z-scores can offer a more precise understanding of where you stand statistically in comparison to other test-takers.

Your z-score is released directly to the programs you indicated in your CASPer profile 2-3 weeks after you complete the test. Each school has its own way of using your score in the admissions process. Some programs may post this information on their official websites, so make sure to check them out. 

Final Thoughts on CASPer Scoring

Understanding how CASPer is scored is only one part of performing well on the test. What matters is how effectively you can apply that understanding when responding under time constraints. Developing that ability takes practice, structure, and clear feedback. If you want to improve your performance, focused preparation can make a meaningful difference.

FAQs

To your success,

Your friends at BeMo

BeMo Academic Consulting

Disclaimer: CASPer is a claimed trademark of McMaster & Altus. BeMo does not recommend, endorse nor affiliate with CASPer, Altus or McMaster and vice versa.

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