Moral Decision-Making in Medical Education: A Survey of Medical Student Perceptions on Admission Tests Evaluating Ethical Judgment Skills

David Beyda, MD – Chair and Professor, Department of Bioethics and Medical Humanism, University of Arizona College of Medicine Phoenix

Abstract: As medical school admissions become increasingly competitive, institutions in the U.S. and abroad have incorporated Situational Judgment Tests (SJTs), such as CASPer and AAMC Preview, to assess applicants’ ethical reasoning, empathy, and collaboration skills. These tests, lasting 90–110 minutes, present scenarios that are scored by trained evaluators. While research suggests SJT performance correlates with success in medical training, little attention has been given to the ethics of using a timed, standardized measure to quantify inherently subjective qualities. Furthermore, there is limited understanding of how these assessments shape the future medical workforce and whether students perceive them as fair or accurate reflections of their abilities. This study surveyed medical students at a single institution to evaluate their perceptions of SJTs in assessing ethics, professionalism, problem-solving, and social intelligence. Among 65 students who took CASPer, 43% felt it did not accurately measure their ethical judgment. Of 25 students who took AAMC Preview, 36% found it an inaccurate assessment. Additionally, nearly half of respondents believed their typing speed affected their scores. These findings raise concerns about whether SJTs truly measure ethical competence or simply reward test-taking skills. Efforts to quantify ethical reasoning in medical school admissions may unintentionally standardize moral decision-making, prioritizing conformity over diverse ethical perspectives. If ethical judgment is reduced to a score, are we selecting future physicians for their ability to reason through moral dilemmas—or for their ability to answer them in a way that aligns with a predetermined framework?

Keywords: Medical School Admissions, Medical Education, Admission Tests