Adoption of the Altus Suite and Its Impact on Residency Applications


Connor Devoe, MS
ACP Council of Student Members

University of New England, College of Osteopathic Medicine


As exciting as the shift to Pass/Fail scoring on USMLE Step 1 and COMLEX Level 1 examinations was, it further clouded the view into residency committee decision making surrounding prospective applicants. Not to be misunderstood, I believe the shift was a necessary and beneficial one; however, residency application committees have been forthcoming in the past about the weight of step 1/level 1 scores in the process. Therefore, we are left to wonder what factors will ultimately carry that weight if the same emphasis is not placed on a passing score on these exams. This has prompted a search into a relatively new assessment that is in the early stages of adoption by several Accreditation Council for Graduate Medical Education (ACGME) programs: the Altus Suite.

Background on Altus Suite

Although USMLE and COMLEX aim to assess a medical student's cognitive skills, Altus Suite is a multipart assessment primarily used to understand noncognitive skills such as compassion, collaboration, and ethics. The Suite consists of three examinations: CASPer, Snapshot, and Duet (1).

  • CASPer is a situational judgment test that presents 15 scenarios in 100 to 120 minutes. The test provides two forms of response, written and video, and is meant to prompt immediate and honest input given the significant pressure of the waning timer. Some scenarios are presented in text format and others via a short video.
  • Snapshot is a one-way video interview meant to evaluate “communication skills, self-reflection, and the motivation for the profession.”
  • Duet offers the candidate the opportunity to explain their values and priorities and match their responses with those from programs to match applicants based on an appropriate fit.

Altus Suite in Medical School Applications

Originally developed in 2010 by McMaster University School of Medicine, the CASPer test has been in use for many years in Canada and the United States as a part of the medical school admissions process. The benefit admissions committees receive is an opportunity to review noncognitive skills in addition to cognitive skill assessments, such as the MCAT or GPA, before selecting candidates to interview. According to, in 2021 a total of 46 U.S. allopathic and 13 U.S. osteopathic medical schools had adopted the CASPer test as a component of their application (2).

Altus Suite in the Residency Match

For the 2022 to 2023 match cycle, the ophthalmology residency match will be piloting implementation of the Altus Suite. At the time of this article, they are the only specialty that has announced widespread adoption. However, many individual programs are piloting implementation of the Altus Suite during the 2022 to 2023 match. Most of these programs belong to obstetrics/gynecology and anesthesia, although a few general surgery and urology programs have announced their pilot. More information can be found on the Altus Suite website (2).

Only one internal medicine residency program, St. Mary Mercy Hospital, is requiring the Altus Suite for its 2022 to 2023 residency applicants. University of Connecticut Internal Medicine Residency Program, which piloted the program in 2021 to 2022, has listed the Altus Suite as recommended but not required for its 2022 to 2023 applicants.


As stated earlier in the post, the primary benefit of the Altus Suite application is that it provides another metric to be used by residency application committees, specifically one that assesses noncognitive skills before, and in addition to, the interview. Additionally, the Altus Suite pilot, which has been conducted over the past application cycle, revealed general positive reviews from respondents after the testing process. Applicants ranked the CASPer test 7 out of 10 for overall testing experience. Of 98% of applicants who completed the exit survey for Snapshot, 78% rated their experience fair or good. And for Duet, 76% rated the system “easy to use” and 97% of respondents felt the “order of priorities for each category generated by Duet matched or somewhat matched what they were expecting” (3). Altus Suite has said they will continue to assess this input from examinees, which will undoubtedly improve the experience for future test takers.


The most obvious downside to residency programs electing to utilize the Altus Suite is the time, anxiety, and preparation required by prospective applicants to sit for another exam. Although CASPer, Snapshot, and Duet are made to assess attributes that are “noncognitive,” being anxious about this assessment is understandable, particularly the CASPer test. Remembering back to my time applying to medical school, I thought the CASPer test would be relatively straightforward and approached it with an optimistic (and blind) confidence. The one takeaway I can share 4 years later is that the timing component added an additional level of stress that I could have prepared better for. This assessment prompts you to digest, contemplate, and articulate your thoughts surrounding ethically and personally challenging scenarios, with a timer ticking down in the background. I did run out of time typing several responses and would want to spend more time practicing if I was to take CASPer again.

A second detractor from the use of Altus Suite is the cost. Minimal as it may seem, paying yet another examination registration fee can be prohibitive for some. Fortunately, for the 2022 to 2023 cycle, Altus Suite has waived the registration fees for prospective GME students. This is likely to change as adoption increases and the pilot programs morph into permanent application requirements for GME programs. For context, applicants using Altus Suite for medical school applications are charged $85 for registration and distribution to 8 programs, as well as an additional $15 per program for additional distribution. Qualifying students can and should take advantage of the Fee Assistance Program (FAP) assuming Altus Suite will add GME as a qualifying U.S.-based FAP program.


The Altus Suite is unlikely to replace the emphasis step 1/level 1 scores previously held but may serve to provide ACGME application committees with another metric with which to assess prospective residents. Programs currently using Altus Suite as a component of their application are in the early adoption stage and more information is likely forthcoming after the 2022 to 2023 cycle. This year's ophthalmology match will be particularly interesting to monitor given the widespread pilot. However, it appears we are still a few years away from that kind of adoption in the internal medicine match.

Perhaps this goes without saying, but I would be remiss if I did not add one final comment. The Altus Suite provides unique insight into characteristics that are unquestionably important for residency applicants to possess such as ethical decision making, collaborative and considerate teamwork skills, and values and missions in line with those of their program. Yes, the Altus Suite's virtual and one-sided platform lacks a certain humanity that would be present in an in-person setting, but surely it is better than no evaluation at all. Should we not strive to evaluate all prospective applicants on these fundamentals?


  1. Acuity Insights. Altus Suite. Accessed at on 1 December 2022.
  2. Katta R. What is the Casper test: important background. 28 February 2022. Accessed at on 1 December 2022.
  3. Bell B. How Altus Suite supports your residency application. 26 July 2022. Accessed at on 1 December 2022.

Back to the December 2022 issue of ACP IMpact