Module 1: Casper Basics and Ethics Fundamentals

What is the CASPER Exam?

• The CASPER (Computer-based Assessment for Sampling Personal characteristics) exam is a situational judgment test required by many healthcare programs as part of the admissions process. Key facts about the exam:
• Tailored to each specific program, so make sure to take the appropriate version
• Consists of 12-15 sections, each with a video-based or text-based scenario
• 3 questions per section, answered with either typed responses (5 minutes) or video responses (1 minute each)
• Lasts between 60-90 minutes total
• Scored by different raters for each section on a quartile scale, with results sent to schools

Types of Questions on the CASPER Exam

1. Casper scenarios cover a wide range of situations to assess your personal and professional characteristics. Common question types include:

• Personal Experience: Describe a time when you faced a particular situation or challenge. Use the STARR framework to structure compelling answers:
  • Provide relevant context
• Beliefs: Share your perspective on policies, laws, or societal norms. Discuss arguments for and against the issue before explaining your own stance.
• Conflict/Problem-Solving: Place yourself in a scenario involving a disagreement or dilemma. Outline how you would gather information, consider different viewpoints, and reach a resolution.

The Four Ethical Pillars of Medicine

1. Having a solid grasp of medical ethics is crucial for approaching many Casper scenarios. The four core ethical principles are:

• Autonomy: Respect patients' right to make informed decisions about their own care. Prioritize patient perspectives and values.
• Beneficence: Have an ethical obligation to act in the patients' best interest based on your professional knowledge and their personal context.
• Non-Maleficence: Avoid causing harm to patients in your actions and recommendations. Carefully weigh risks and benefits.
• Justice: Treat patients equitably, distributing healthcare resources and access fairly based on need. Consider broader impacts beyond the individual.

When Faced with an Ethical Dilemma on Casper

Identify which principles are in tension. Justify how you would prioritize and balance them to reach a sound decision.

Homework - Personal Reflection

1. To prepare for personal experience questions on the Casper exam, reflect deeply on formative moments from your own journey:

• Recall 3 key experiences that have shaped your personal and professional development. Write a brief 3-4 sentence STARR-format answer for each one.
• Identify your top 3 strengths and weaknesses. Brainstorm concise examples of how you have demonstrated your strengths and are working to improve on your weaknesses.
• Analyze your most significant accomplishments and failures. Extract lessons learned and how you have grown from each one.

Developing this bank of go-to personal stories will enable you to quickly adapt them to address specific Casper prompts.

Module 2: Advanced Casper Strategies and Ethical Reasoning

CanMEDS Roles

Understanding and applying the CanMEDS roles is crucial for success on the Casper test. These roles encompass the abilities physicians need to effectively practice medicine and care for patients:

1. Professional: Demonstrate clinical competence, respect for ethics, continuous development, integrity, honesty, altruism, humility, respect for diversity, and transparency.
2. Communicator: Discuss with patients to understand their symptoms, worries, and context. Explain medical conditions clearly and empathetically.
3. Collaborator: Work effectively with other healthcare professionals, showing trust, respect, and shared decision-making.
4. Leader: Engage in continuous improvement of healthcare delivery and efficient care.
5. Health Advocate: Advocate for patients' access to needed resources and improvements in health determinants.
6. Scholar: Engage in lifelong learning, teaching, and contributing to medical literature.
7. Medical Expert: Integrate all CanMEDS roles to put patients at the center of care.

Demonstrating how you have embodied these roles in past experiences, even in non-clinical settings, can strengthen your Casper responses.

The Do's and Don'ts

Keep these key strategies in mind when approaching Casper scenarios:

Do:

• Explore multiple perspectives: Consider various viewpoints to show unbiased, thoughtful reflection.
• Gather additional information: Ask clarifying questions when details are unclear or missing.
• Take a clear stance: After exploring different angles, articulate your position concisely and justify your reasoning.
• Be concise: Focus on crafting a well-structured, high-quality response rather than a lengthy one.

Don't:

• Make assumptions: Avoid jumping to conclusions based on limited information. Acknowledge uncertainties and seek clarification.
• Be vague: Provide specific examples and explanations to support your points.
• Ramble: Stay focused on directly addressing the question at hand. Reread the prompt to ensure you stay on track.
• Use inflammatory language: Maintain a professional, respectful tone, even when discussing serious issues.

Practicing these do's and don'ts will help you navigate complex Casper scenarios with clarity and professionalism.

Ethics in Medicine

A solid foundation in medical ethics is essential for tackling many Casper scenarios. Key ethical considerations include:

• Physician's role: Uphold the four pillars of medical ethics (autonomy, beneficence, non-maleficence, justice) while embodying CanMEDS roles. Prioritize patient well-being and desires.
• Managing ethical dilemmas: Identify conflicting ethical principles, gather information, explore alternatives, consider all parties involved, and justify your proposed solution.
• Confidentiality: Protect patients' sensitive information. Only breach confidentiality as a last resort when the patient lacks decision-making capacity or there is risk of serious harm.
• Conflicts of interest: Recognize and navigate situations where professional duties may be influenced by personal or financial factors. Prioritize patient well-being and transparency.
• Competency and decision-making: Assess patients' ability to make informed decisions. Involve substitute decision-makers appropriately for incompetent patients.
• Paternalism vs. patient-centered care: Respect patient autonomy by providing information and guidance but ultimately allow competent patients to make their own informed decisions.
• Cultural, religious, and language barriers: Strive to understand and accommodate patients' unique beliefs and needs. Utilize translators and alternative resources to facilitate effective communication and culturally sensitive care.

Applying this ethical framework to Casper scenarios will demonstrate your ability to navigate complex situations with integrity and patient-centered principles.

Homework - Analysis of Current Issues

Select 3 of the following topics and reflect on your personal beliefs, perspectives, and potential solutions:

1. Mandatory masks for COVID-19 and non-compliance
2. Police brutality and defunding
3. Racism in medical schools
4. Sensitive information on social media and censorship
5. Cons of telemedicine and how to address them
6. Access to healthcare for rural communities
7. Physician burnout and/or student mental health

For each topic, write a thoughtful 250-300 word response exploring the issue from multiple angles, articulating your stance, and proposing constructive approaches to address the challenges.

By delving into advanced strategies, ethical reasoning, and current issues, this module equips healthcare students with the tools to analyze and respond to complex Casper scenarios. Developing this critical thinking framework and applying it to real-world challenges will strengthen performance on the Casper test and build essential skills for future medical practice.

Module 3: Mastering Key Ethical Components

Breaking Bad News

Breaking bad news to patients is a challenging but inevitable part of a physician's responsibilities. Using the right approach is crucial:

1. Setting: Ensure a quiet, private place. Ask if the patient wants anyone else present.
2. Perception: Inquire about the patient's understanding of their condition. Clarify misunderstandings.
3. Invitation: Inform the patient you have difficult news. Ask how much they want to know.
4. Knowledge: Share the news clearly and empathetically. Avoid medical jargon.
5. Empathy: Use non-verbal cues to show empathy. Allow silence for processing emotions.
6. Summary: Clarify doubts, offer resources, and discuss next steps.

Mastering this protocol will enable you to navigate these sensitive conversations with compassion and professionalism on the Casper test and beyond.

Medical Errors

Medical errors can stem from human or systemic factors. Key responsibilities when an error occurs:

• Person who made the error: Recognize the mistake, report it to supervisors, inform the patient, and learn from it.
• Witness: Ensure the person who made the error takes necessary steps. Report if they refuse.
• Medical facility: Gather information, implement preventive measures, and maintain transparency.

Demonstrating a systematic, empathetic approach to medical errors on the Casper test will showcase your commitment to patient safety and continuous improvement.

Confidentiality

Protecting patient confidentiality is a core ethical duty, with rare exceptions:

• Patient lacks decision-making capacity
• Risk of serious harm to patient or others
• Legal requirements (e.g., reporting abuse, communicable diseases)

When faced with a scenario involving potential breach of confidentiality on the Casper test, emphasize the importance of obtaining consent, using secure communication channels, and breaching confidentiality only as a last resort.

Conflicts of Interest

Conflicts of interest arise when factors other than patient well-being, available resources, and best practices influence a physician's decisions. Common examples include:

• Gifts or financial incentives from patients or companies
• Treating family members or friends
• Participating in sponsored research

If presented with a conflict of interest scenario on the Casper test, identify the competing interests, discuss the ethical implications, and propose solutions that prioritize patient welfare and transparency.

Competency and Decision-Making

Assessing patient competency is crucial for determining their ability to make informed decisions.

• Adults: Presumed competent until proven otherwise. Assess understanding of risks and benefits.
• Children: Presumed incompetent until proven otherwise. Involve parents/guardians but respect the wishes of mature minors.

When addressing competency issues on the Casper test, avoid stereotyping, consider situational factors, and balance patient autonomy with their best interests.

Paternalism vs. Patient-Centered Approach

Paternalism—making decisions for patients without their consent—opposes the patient-centered approach which prioritizes patient autonomy and values. Physicians should:

• Provide information and guidance
• Reduce power imbalances
• Respect patient choices except in limited circumstances (e.g., illegal requests, incapacity, resource constraints)

Demonstrating a commitment to patient-centered care on the Casper test will highlight your respect for autonomy and shared decision-making.

Language, Cultural, and Religious Barriers

Navigating language, cultural, and religious differences is essential for providing equitable patient-centered care.

• Language barriers: Use professional interpreters when possible. Be cautious with family interpreters. Consider translation software as a last resort.
• Cultural and religious barriers: Educate yourself about patient beliefs. Seek alternatives that respect their values. Engage community leaders if needed.

Approaching these barriers with cultural humility, open communication, and a willingness to find creative solutions will strengthen your Casper test performance.

By mastering these key ethical components—breaking bad news, medical errors, confidentiality conflicts of interest competency paternalism barriers to care—you will be well-equipped to analyze complex scenarios on the Casper test. Demonstrating a strong ethical foundation combined with empathy adaptability will set you apart as future healthcare professional.

Module 4: Casper Test Simulation and Feedback

Homework - Mock Snapshot

Instructions:

Below are 3 mock Snapshot questions that you need to answer. Please follow these steps carefully:

1. Do not scroll down to see the questions until you are ready to record a 2-minute video of yourself as you read and answer each question.
   • When ready (with camera set to record): Scroll to the first question, read it, and reflect on your response for 30 seconds.
   • After 30 seconds, press record and provide a verbal answer to the question in a recording that is 2 minutes or less.
2. Move on to the next question and repeat step 2 until you have three 2-minute videos, one for each of the 3 questions.
   • Upload the 3 videos to your Google Drive, OneDrive, Dropbox, etc. Then, copy and paste a share link for each video in the allocated spot on this document. Ensure proper viewing rights are enabled ("Anyone with the link can view", not "Restricted").
3. Submit your completed document following the submission instructions provided in class.

Question 1: What is one thing you have done that shows initiative? What did you gain from that experience?

Question 2: What does the word "success" mean to you?

Question 3: What is the greatest obstacle you have faced in your life? How did you overcome it?

Feedback Table (For CASPer Prep Program Use Only)

• Overall Comments
• Pros
• Cons
• Red flags

Homework - Mock Exam

Videoath Casper Set I

Purpose of the mock exam:

1. Mimics the actual CASPer examination
2. Helps relieve/reduce anxiety on actual test day
3. Provides feedback to students on their performance

Structure of mock exam:

• The exam has 14 stations
• Part 1: 6 video-response stations
  • Each video-response station has 2 questions
  • You will respond with two 1-minute videos
  • You will NOT see these questions at the same time
  • You will see the prompt, then Q1, respond to Q1 with a 1-minute video, then see Q2, respond to Q2 with a 1-minute video
• Part 2: 8 typed-response stations
  • Each typed-response station has 3 questions
  • You will type your answers within 5 minutes
  • You WILL see these questions at the same time

Breaks:

1. There is an optional 10-minute break between Parts 1 and 2.
2. There is an optional 5-minute break after the first 4 stations of Part 2.

Tips on recording your video responses:

• You must film each question in SEPARATE videos. Recordings may be done by setting up a Zoom link for yourself and recording your response to the cloud or your computer, recording with a phone, a camera, or another software on your computer.
• By the end of the exam, you should have 12 one-minute videos.
• Once you've finished the exam, upload the 12 videos to your Google Drive. Then, copy and paste a share link for each video to the allocated spot on this document. Ensure proper viewing rights are enabled ("Anyone with the link can view", not "Restricted").
• If our medical students cannot open your link because it's restricted, you will NOT get feedback for that question.

By completing this mock Casper exam, you will gain invaluable hands-on experience with the test format, question types, and time constraints. The personalized feedback provided on your video and typed responses will help you identify areas for improvement and refine your approach before the actual test. Embrace this opportunity to practice and learn in a simulated environment, building the skills and confidence needed to excel on the Casper test.

Module 5: Addressing Complex Ethical Challenges

Interdisciplinary Team Issues

In healthcare, professionals from various disciplines must collaborate effectively to provide optimal patient care. However, this interdisciplinary approach can lead to ethical challenges:

• Hierarchy and power dynamics: Junior team members may feel uncomfortable speaking up against senior colleagues, even when patient safety is at risk.
• Conflicting priorities: Different disciplines may prioritize distinct aspects of care, leading to disagreements on the best course of action.
• Communication breakdowns: Ineffective communication can result in misunderstandings, errors, and suboptimal care.

To navigate these challenges on the Casper test, emphasize the importance of open, respectful communication, shared decision-making, and a patient-centered approach. Discuss strategies for addressing concerns, such as escalating issues through appropriate channels and focusing on finding solutions rather than assigning blame.

Pandemics

Pandemics pose unique ethical dilemmas for healthcare professionals:

• Resource allocation: Limited supplies of personal protective equipment, ventilators, and medications may require difficult decisions about who receives treatment.
• Balancing individual and public health: Measures like quarantines and vaccine mandates can infringe on individual autonomy but may be necessary to protect public health.
• Healthcare worker safety: The duty to provide care must be balanced with the need to protect healthcare workers from infection.

When addressing pandemic scenarios on the Casper test, apply ethical principles to guide decision-making. Prioritize the most vulnerable, maximize benefits and minimize harm, and ensure fair and equitable treatment. Discuss the importance of clear communication, transparency, and support for healthcare workers.

Public Health Ethics

Public health ethics involves balancing individual rights with the collective good. Key challenges include:

• Privacy and confidentiality: Public health surveillance and contact tracing can conflict with individual privacy rights.
• Social determinants of health: Addressing upstream factors like poverty, education, and housing is crucial for improving population health but can be politically and logistically challenging.
• Health disparities: Ensuring equitable access to healthcare and addressing the root causes of health disparities requires systemic change.

When tackling public health ethics scenarios on the Casper test, consider the broader social context and long-term consequences of decisions. Emphasize the importance of community engagement, cultural competence, and advocacy for policies that promote health equity.

Student Issues

As future healthcare professionals, students face unique ethical challenges:

• Mistreatment and harassment: Students may experience abuse, discrimination, or sexual harassment from supervisors, colleagues, or patients.
• Impaired colleagues: Students may observe peers or superiors struggling with substance abuse, mental health issues, or incompetence.
• Academic integrity: Pressure to succeed can lead to cheating, plagiarism, or falsifying research data.

When addressing student issues on the Casper test, prioritize student safety and well-being. Discuss the importance of reporting mistreatment through appropriate channels, seeking support from trusted mentors, and upholding standards of professionalism and integrity. Emphasize the role of a supportive and inclusive learning environment in promoting student success.

Maternal / Fetal Conflict

Pregnancy can give rise to complex ethical dilemmas when maternal and fetal interests diverge:

• Refusal of treatment: Pregnant individuals may decline recommended interventions for personal, cultural, or religious reasons, even if it puts the fetus at risk.
• Substance use: Maternal substance use can harm fetal development but punitive approaches may deter individuals from seeking prenatal care.
• Reproductive autonomy: Balancing respect for maternal autonomy with the duty to protect fetal well-being can be challenging particularly in cases of severe fetal anomalies or maternal health risks.

When navigating maternal/fetal conflict scenarios on the Casper test, prioritize open non-judgmental communication to understand the individual's perspective and values. Discuss the importance of informed consent shared decision-making and support for individuals facing difficult choices. Consider broader social systemic factors that may influence maternal health decision-making.

By delving into these complex ethical challenges—interdisciplinary team issues pandemics public health ethics student issues and maternal/fetal conflicts—you will be well-prepared to tackle most difficult scenarios on Casper test. Remember apply ethical principles consider multiple perspectives prioritize patient well-being autonomy Demonstrating ability navigate these challenging situations empathy integrity critical thinking will set apart future healthcare professional.

You're done!