Are you ethical enough to be a physician?

The Association of American Medical Colleges has created an optional standardized test to evaluate the “situational judgment” of people applying to medical school.

It asks applicants to evaluate the effectiveness of various responses to a series of hypothetical conundrums, such as how to deal with a classmate who violates patient privacy on social media. The goal is to help medical schools identify such qualities as adaptability, teamwork, ethics, and the ability to interact with others from different cultural backgrounds.

Medical school admissions officers already look for those qualities in applicant interviews and essays, a process they call holistic review. Yet some, including those at Cooper Medical School of Rowan University, also have started using the AAMC’s standardized test.

Another such test, made by Toronto-based Acuity Insights, is called Casper.

The AAMC situational judgment test, called PREview (professional readiness exam), consists of 30 scenarios and 186 related questions.

Here are some sample questions:

You are speaking with a patient who recently immigrated to the United States. The patient is undergoing minor surgery and asks you to contact their family in their home country if anything unexpected occurs. The patient shares the customs that should be followed when someone dies and asks you to ensure that those customs are respected.

Please rate the effectiveness of each response to this situation, using very ineffective, ineffective, effective, or very effective.

1. Tell the patient that, because the surgery is minor, it is not necessary to worry about the customs.

2. Tell the patient that you will respect the customs, but that you cannot guarantee the actions of other hospital staff.

3. Suggest the patient share their request with other hospital staff to ensure the customs are respected by everyone.

4. Tell the patient that you will ask whether the hospital will be able to honor the patient’s requests.

5. Discuss the patient’s request with your supervisor and ask how to proceed.

6. Tell the patient you will try to find a different student who is more familiar with their culture.

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1. Very ineffective. Rationale: The student has failed to demonstrate empathy toward the patient by dismissing their concerns, which could cause the patient stress or anxiety and damage the student’s relationship with the patient. Rather, the student should recognize that the patient is concerned about the procedure and should also make an effort to adhere to their request.

2. Ineffective. Rationale: Although the student acknowledges that they personally will acknowledge the patient’s request, explaining that the hospital staff may not acknowledge the patients request is not helpful as an immediate next step. It could cause the patient stress.

3. Effective. Rationale: This behavior recognizes that the hospital may have a protocol in place for the patient’s customs, but it places the burden of further sharing the request on the patient. It is important for the student to recognize the importance of sharing the patient’s customs with other hospital staff, but the student should take the patient’s request to staff themselves.

4. Very effective. Rationale: The student has demonstrated empathy and listening skills by acknowledging the patient’s request and also taking action to make sure other hospital staff are aware of the request.

5. Very effective. Rationale: While it is critical to acknowledge the patient’s request, the student should also consider that there may be a specific protocol in place when managing similar requests. The student is acting responsibly by bringing this request to their supervisor’s attention and asking for advice on how to proceed.

6. Ineffective. Rationale: Although the student has offered to find another student to help the patient, they have demonstrated a lack of cultural competence by not personally engaging with the patient’s customs. The student should also demonstrate accountability by acknowledging the patient’s concern and taking action to accommodate their request, if possible. Lastly, while another student may be able to help, they may also lack an understanding of the hospital’s protocol for handling the patient’s request.