How to Improve Your CASPer Test Score for Canada: Tips for IMGs!

How To Improve Your CASPer Test Score For Canada: Tips For IMGs!

How to improve your CASPer test score for Canada with tips for IMGs to quickly and effectively score in the top quartile.

Another test? I know. I am sorry this is happening to you. BUT…YOU HAVE TO GET OUT OF THAT HEADSPACE! The following tips will help you approach situational judgement questions quickly, with clear and concise language. Learn how to HIGHLIGHT your professional competence (AND AWESOMENESS) for the CASPer test and (more importantly) practicing medicine in Canada.

Disclaimer: mariA. think outside the box MED.ucation does not endorse and is not affiliated with Altus Assessments Inc. or the CASPer® test. CASPer® is a registered trademark of Altus Assessments Inc. The tips provided in this blog are for general education and informational purposes only and are not intended to provide specific professional, medical, legal or academic advice. mariA. think outside the box MED.ucation does not guarantee test scores. You understand that test results vary from person to person. Please read the terms and conditions for further details. 

Is this your first CASPer TEST experience?

Many IMGs struggle with situational judgement tests (SJTs) like the CASPer test because they have not had much experience with them. This does not mean IMGs don’t have the skills. It just means the opportunities to learn and practice these skills in formal training were not available. Just like starting a new exercise routine, it can feel uncomfortable or unnatural at first. However, with more practice and understanding, it becomes a smooth, streamlined process like riding a bicycle or driving a car. 

I get it, though. It’s frustrating explaining your every move, especially after you have been working for several years. Moreover, if you were recruited to come to Canada…(well, I won’t go into that issue here). I’ve been driving for over 30 years. If I had to explain what I was going to do and why I was doing it every time I drove my car, I’d take the bus! Fortunately for me, I’m not passionate about driving, so no big whoop. 

YOU however, ARE PASSIONATE ABOUT MEDICINE, so it’s worth the effort! 

In this blog, I will give a brief description of the CASPer test, followed by TIPS that are based on the most common problems I have observed and researched by working with IMGs on the path to medical licensure in Canada. Please go to the official CASPer test website for a thorough description of test details and updates. If you are already familiar with the test, I have added links (below) so you can skip to the sections that apply to your interests. 


Before you scroll to the TIPS, remember to reframe any negative thoughts about the CaRMS process, specifically the requirement of the CASPer test itself. As an educator, I think consistently battering medical professionals with tests produces a “test-taker” mentality and hurts society. A “test-taker” mindset does not prepare doctors to see patients as humans, leading to poor patient care and physician burnout. But, learning and practicing the CanMEDS competencies IS critical for dismantling racism and discrimination in Canadian health-care systems and can save lives. I hope by the end of this blog, you will feel empowered and moved to make a difference. 

I wrote about the benefits of positive reframing here. I mention positive reframing because negative thinking can negatively affect your PERFORMANCE ON TESTS, whereas constructive thinking and positive attitude can improve your performance. My intention is to help you achieve your HIGHEST POTENTIAL AS A PHYSICIAN, rather than simply achieve a high test score. You are worth more than a “percentile”. Let’s do this! 

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What is the CASPer test?

This acronym stands for Computer Based Assessment for Sampling Personal Characteristics. Situational judgement tests (SJTs), such as the CASPer and MMIs (multiple mini interviews), measure your intellectual quotient (IQ) such as logic and reasoning; emotional intelligence (EI) such as psychological stability or adaptability; and interpersonal communication skills such as working with or involving others, by the way you respond to complicated (often emotionally triggering) situations. For the CASPer test, human raters examine your responses to 12 different non-academic scenarios composed of 3 questions each. To add more pressure, you have 5 minutes per scenario to type your responses on a computer. CASPer is required by most Canadian medical schools.  

Why is the CASPer test used?

By examining both your intellectual strengths and personal attributes before medical residency, SJTs can reliably predict future performance in the field. Since spots are so limited for residency in Canada, selection committees want to determine which candidates are the most likely to succeed. The selection process is designed to evaluate your readiness to withstand or overcome adversity during training so you can complete the residency program, as well as have a long, fulfilling personal and professional life in practice. The competencies assessed on the CASPer are evidence-based practices that facilitate optimal patient-centred care and the maintenance of professional standards. Try to focus your energy on mastering the competencies for the CASPer rather than getting a high test score. If you accomplish the former, you will have a better chance at achieving the latter. 

In the F.A.Q. section of the CASPer test website it is stated that their situational judgement test is a better predictor of candidate performance than traditional screening tools, such as MCAT or NAC OSCE. It is also stated that the CASPer test scores aid program committees in selecting candidates who have a higher likelihood of program completion by providing a more reliable and meaningful snapshot of behavioural/personal skills. Since personal attributes are not measured on other exams, data from the CASPer test lend greater insight about candidates to ensure a diverse group of candidates have the opportunity to get interviewed. They want to know if you are academically AND psychologically ready (i.e. resilient) for the very challenging lifestyle that is required for successful medical practice in the Canadian health-care system. 

What is assessed?

According to the official CASPer test website, the specific behavioural competencies that are measured include: Collaboration, Communication, Empathy, Equity, Ethics, Motivation, Problem Solving, Professionalism, Resilience, and Self-Awareness. All of the CASPer competencies correspond to the CanMEDS Physician Competencies Framework, which was developed in Canada to enhance physician training and improve patient care.

What is the connection between the CASPer Test and the CanMEDS Framework?

CanMEDS has become the most widely accepted and applied physician competency framework in the world. The CanMEDS framework is used for medical education and consists of seven roles which include: Medical Expert (central role), Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional. Physicians who master these competencies are better at meeting the needs of their patients. One way to pre-screen thousands of applicants for these skills is to administer the CASPer test. You are NOT EXPECTED TO BE PERFECT. DO NOT think you need to write an essay, like all the expert answers online. You don’t have time. You DO need to be able to show you have analytical and critical thinking skills, as well as demonstrate self-control, compassion and integrity. 

CASPer Inspiration: CanMEDS Skills in Action!

To show you what a Medical Expert under the lens of the CanMEDS Framework does, here is a Canadian example. Dr. Samir Shaheen-Hussain, a Montreal pediatric emergency room physician, has written about medical colonialism and fought against a Quebec policy that forbade parents from accompanying sick kids on emergency air evacuations. Watch this video of Dr. Shaheen-Hussain. To learn more about Dr. Shaheen-Hussain’s work and book go here. (this is NOT an affiliate link) 

When you watch the video, think about the CanMEDS Competencies. How many can you count while Dr. Shaheen-Hussain tells his story? This is also a good example of how you can answer personal reflection questions on the CASPer. If you have a good story to tell, it is effortless. 

Source:  Fighting for a Hand to Hold, January 6, 2021.

Description: Micro-documentary trailer by Katsi’tsakwas Ellen Gabriel. Art by Kent Monkman. Interview with Samir Shaheen-Hussain filmed in November 2020.  Dr. Samir Shaheen-Hussain discusses his advocacy work around the Canadian medical establishment’s role in the displacement, colonization, and genocide of Indigenous Peoples. Dr. Shaheen-Hussain explains systemic racism as the racism that exists in a system, in an institution, in the structures of society; racism embedded in the laws and policies allow racism to continue to exist. 



Your score on the CASPer is a percentile which depends on how you rank in the group of applicants writing with you (cohort). The first quartile is the group with the weakest responses compared to the same cohort. It does not mean the responses are wrong. The fourth quartile is the group with the strongest responses. To get into the fourth quartile, you will have to IDENTIFY the main issues, EXPLORE a couple of options and EXPLAIN the reasons for your final decision using the ethical and professional standards expected in Canadian health-care settings. 

Most of your cohort will be CMGs (Canadian Medical Graduates) who have been trained in Canadian ethics, professionalism and CanMEDS since the first day of medical school. They are well versed in the language and response structure that clearly demonstrate competencies on tests like CASPer. Your ability to COMMUNICATE and DEFEND your choices ethically and professionally are the MAIN purpose of the CASPer. You’ve got this! 


TIP #1 Understand Appropriate Skills and Attitudes in Canadian Medical Culture

For IMGs this is where professional experience and formal medical education could contradict the expectations of Canadian medical culture, causing confusion. Your ideas and communication skills may be misinterpreted and not received as intended. In order to be understood, you need to use language and the communicative approach that is used in Canadian medical culture. 

IMGs are HIGHLY EXPERIENCED professionals. If you are an IMG, your goal is to make sure you know how to make that expertise SUPER OBVIOUS by using the language, communication and counselling skills expected in Canadian health-care. The BEST way to do that, is to read and understand the Canadian Medical Association (CMA) Code of Ethics and Professionalism. You can get excellent eLearning and FREE practice tests on the Canadian Medical Protective Association (CMPA) website. You can also watch sample scenario videos and get an updated summary of professionalism and ethics from the CMPA Guide on Professionalism and Ethics. FREE training is also available on the website. Pay close attention to the MCC role objectives in the lessons to understand the language and approach that will help you formulate the CASPer test responses. These resources will not only be useful to form your MINDSET for the CASPer, but also for NAC OSCE, MMIs and personal interviews. Did I mention that they are FREE? 

Formulating your responses based on CMA expectations will help you IDENTIFY THE TYPES OF ISSUES you need to address in the CASPer, as well as how to approach each scenario. By reading the code of ethics and professionalism you will learn how to identify the critical issues in the scenarios and become familiar with the language that can DEMONSTRATE YOUR COMPETENCIES THROUGH TEXT. To illustrate what I mean, see the infographic below. 

TIP #2 Choose Words That You Already Use and Can Easily Type + Infographic

Since the points given on the CASPer test are based on your typed words, it is important that you use words and ideas that demonstrate the competencies. Building a collection of sample words can be a practical, personal resource that helps you prepare for the test. Creating your own word bank may aid in memory recall so you can express your thoughts clearly and concisely on the day of the test. Basically, your brain will associate specific words with the competencies. 

In the following infographic you will see all 10 competencies that are assessed on the CASPer with corresponding words or phrases that can help test raters identify your ability to critically analyze the main issues and appropriately apply the competencies. This is not an exhaustive list. 

Also, remember that words and ideas can overlap into more than one competency. For example, self-care and resilience or ethics and professionalism. To deepen associations for memory, draw lines from one competency circle to another. The associations should be based on your experience, knowledge and understanding of the competencies. This will help you link meanings to words or ideas and make a visual image in your mind. Once you download the infographic, you should add your own words or notes based on what you have learned from the links I shared in TIP #1 or from CASPer test practice questions. 

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TIP #3 Actively Read Sample Questions and Responses

There are several websites that offer free sample scenarios with questions. A basic search on the internet will bring you to the most popular sources. As you read the CASPer sample prompts, questions and expert responses, pay attention to the words that may serve as clues to the type of scenario you have, the main issues, and which competencies should be demonstrated in your responses. Underline them and add them to your list. 

 Remember, you DON’T have to DEMONSTRATE ALL THE COMPETENCIES IN EACH QUESTION. Becoming familiar with the scenarios and competencies will help you understand which competencies you should demonstrate per question. 

Let’s reflect: 

  1. If you were a test rater, how would you know the writer has the competencies? 
  2. What would you look for? 
  3. Make notes in your infographic. 
  4. Recognize that your responses on the test won’t be so detailed. You don’t have time. 

TIP #4 Identify the Types of Scenarios and List Them

Below is a list of common themes you may come across. The more you are familiar with practice scenarios, the more you will start to identify typical situations and feel prepared. 

Here are some common themes in scenarios: gossipping, working with a team, rules and regulations, justice and fairness, equality, equity, strategies, opinions on a cause or issue, giving advice, diffusing a conflict or crisis, dealing with relationships, conflict of interest, the right thing to do, for the greater good of society, seeking higher authority, managing a complex problem that involves others or yourself, morality, being a support or confident, ethical dilemma, lack of resources, a quote. Add your own ideas to the list.  

20 Ideas and Techniques of How To Approach CASPer Test Questions

  1. Non-emotional (be objective)
  2. Honestly
  3. Respond to and normalize a person’s concerns if they are in an emotional crisis (empathy)
  4. State that you will listen to the concerns of others and adjust your plans accordingly
  5. Demonstrate shared decision-making or finding common ground (equity and communication)
  6. Acknowledge limits of your own knowledge or experience (humility)
  7. Maintain ethics and act professionally (uphold laws)
  8. Describe how you could advocate for others or yourself
  9. Define or describe boundaries/appropriate behaviour while also providing support
  10. Protect confidential information or privacy of others (ethics)
  11. Consider any policies and include them in your analysis (professional)
  12. Personal skills such as consistency, organization, management skills 
  13. Compare and contrast (if/then) (critical thinking and analysis)
  14. Give strategies or steps of how to do something (management)
  15. Provide a personal opinion based on ethics, integrity, giving examples or obtaining more information (critical thinking and analysis)
  16. Describe a personal experience and your transformation (organization and insight)
  17. Prevention (leadership and medical expert)
  18. Intervention (leadership and advocate)
  19. Communicate, collaborate and state different perspectives (perspective taking)
  20. Take initiative but don’t overstep the limits of your role (leadership and collaboration)

TIP #5 Identify the Main Issues in the Scenarios

The main issues in the test questions are most likely linked to issues that would typically occur during residency or medical practice, including work-life balance. The skills and strategies you have developed in your life when faced with challenges are universal and can be transferred to any situation. It is these skills that have gotten you to where you are today and can carry you forward by serving as a foundation for growth. 

Don’t try to think of these examples while you are writing the CASPer. It will be difficult because of time constraints. However, if you think about them now, they will be in your recent memory and will come to mind faster during the test. Think of the types of challenges that arise either personally or professionally during your daily life where you use skills you’ve learned from past experience. It can be anything such as time management, planning events, moving, traveling, delays or setbacks, preparing for a job or exams, overcoming illness, helping others, marriage, becoming a parent, taking public transportation in the winter, living with power outages, water shortage, living through a pandemic, employment strikes, or working as a physician in your native country.  

Describe your management skills in steps or strategies. Type them into a document. Your personal stories should describe overcoming something or how you solve problems. See my blog on The 3 Best Resilience Strategies for IMGs in Canada  to help you build a personal resource kit of accomplishments (Cookie Jar Method), positive reframing examples and mindfulness self-care strategies (S.T.O.P. Technique). 

25 Common Issues to Help You Think of Specific Personal Experiences for CASPer

  1. Confronting conflict
  2. Loss or grief
  3. Disappointment
  4. Autonomy (personal or others)
  5. Rejection
  6. Proud moment
  7. Negative feedback
  8. Giving advice
  9. Giving or receiving bad news
  10. Negative thinking
  11. Reporting a colleague or friend
  12. Cheating
  13. Unethical/illegal acts (substance use when in a position of care, stealing, crossing boundaries)
  14. Accident or mistake
  15. New situation or dealing with unfamiliar places or people
  16. Crisis
  17. Relationship issues (personal/professional)
  18. Overcoming barriers
  19. Courage
  20. Self-regulation and self-care
  21. Justice, fairness and rights
  22. Abuse
  23. Power struggles
  24. Privacy
  25. Add your own ideas to the list! 

TIP #6 Write a Script + Free Infographic

This is a sample. Use your own words so it is easier to retrieve from memory. 

This is just the expected flow of your thought process. It is ONLY AN EXAMPLE. The purpose is to help you understand how to ORGANIZE your ideas and EXPLAIN your decision based on the competencies being assessed. You have 5 minutes per scenario, and each scenario has 3 questions. Read all 3 questions before you formulate your answers. Some of these cues below can be broken up to address each of the 3 questions, depending on what is being asked. It may seem overwhelming now, but with practice your ability to recognize the issues and how to respond, will get faster. Say it: I can do this!  

Sample Script Outline

Sample Scenario: Your coworker Bob and his wife are preparing to be new parents. Bob has told you that he and his wife decided early on that he would take paternity leave so he could stay home to help his wife and bond with their baby. However, your boss just offered Bob a new position for more money. Bob will need to spend more hours at work. Bob tells you he could use the money, but he also wants to be with his family and doesn’t want to disappoint his wife. Bob confides in you that he does not know what to do and asks what you think.  

What would you tell Bob to do? 

State the main concern/issue and who/what is involvedThis helps you focus on the problems and people to create a baseline or anchor for your thought process. It also let’s the rater know what you have understood from the information presented in the scenario. There is a different rater for each scenario, so don’t worry about using the same script repetitively. 

The anchor or summary sentence can be a critical thinking statement. 

My coworker appears to be struggling with a decision to either take paternity leave or take a promotion to support his family financially. Bob asked for my advice.” 

You have identified the key person, the problem and your role. You have also demonstrated empathy and emotional intelligence because you use the words “appears to be struggling”, which were not in the prompt. With these words you have shown that you understand it “may” be a difficult decision for Bob, but you don’t want to assume anything. 

Critical Thinking and Analysis Sequence     

If Bob asked for my advice on a private family matter, he seems to trust my judgement. I would like to help Bob make an informed choice by getting more information.” 

You have demonstrated that you understand this is a confidential issue and that Bob has a trusting relationship with you. You demonstrate your desire to support Bob but you want to ensure you help him get factual information before making a decision. 

“First, I would suggest we check the work policy on paternity leave to see if it is flexible or time sensitive.” 

Together, you are checking the rules at work to see if Bob has alternative options.

Then, I would encourage Bob to discuss the choices with his wife, so they can prioritize their personal needs.”

You are encouraging Bob to communicate with his wife before making a decision that affects both their lives and their baby’s life. You are promoting shared-decision making and have clarified that it is a personal matter.

I would also encourage Bob to talk to our boss about the new responsibilities and if he can work remotely some days to be closer to his family.”

You are encouraging Bob to talk to a higher authority to check if there are other options. This is a private family matter, so it is not in your role to talk to Bob’s wife or your boss. You are promoting communication and collaboration to elicit more factual information

Other common responses about giving advice or options could be:

State that your response depends on more information and you cannot take the situation at face value.  

“First, I must remain non-judgmental and gather more information.” 

“I must not jump to conclusions about (a, b, c) or place blame on anyone/thing.” 

State what you know and what you don’t know, based on the information given

These statements are OK, but it is much better to “show” rather than “tell” the reader you are non-judgemental, for example.

Ask others directly (or indirectly like in Bob’s situation). Involve perspectives other than your own. This depends on the situation, the people involved and privacy/confidentiality issues. Remember not to share or discuss personal or embarrassing information in front of other people in the situation. If you are in a role where there is a manager or higher authority, always remember to consult with them before you make a final decision. 

Check with any rules, regulations, policies that you must follow. You need to demonstrate that you can uphold the policies and integrity of the profession, while providing support

Communicate the new information to other people involved and demonstrate an effort to come to a shared decision or demonstrate your duty to inform or report  regarding your decision (if applicable). 

State the options and possible consequences based on evidence. This includes information learned from asking others and checking resources. How are the people involved affected, including you? 

To help you with ideas to explain your reasoning, think of consequences or options as: if/then statements, pro and con, benefits and risks/costs, positive and negative, helpful or harmful, proactive or reactive and so on. Think opposites.  

State your final decision. Describe the sequence or steps you would take to make an informed choice and why. On what evidence are you basing your final decision? You must have support for your choice

If Bob and his wife agree that financial security is more important at this time than Bob taking paternity leave, I would support Bob’s decision to take the job promotion over staying home. Bob mentioned that family time is important to him. If Bob is not permitted to do his work remotely, I would also offer to work extra hours some days to relieve Bob from his duties so he could get home earlier to spend time with his family.”

Creating alternative solutions to support a colleague in need demonstrates professionalism, respect and compassion.   

End your responses with a follow-up

Follow-up solutions could include plans to prevent future conflicts, how to improve a process, show gratitude,  demonstrate how you are open to change, flexible, or willing to answer future questions. 

At the next meeting, I would suggest a flexible schedule or role rotations. This could help all employees achieve a work/life balance with shared responsibilities while promoting collective/group accountability. We could also have bi-annual meetings to check-in on professional progress and personal well-being.” 

Suggesting a positive work culture like rewarding staff for supporting colleagues and participating in collaborative teamwork are examples that demonstrate how you would respond to colleagues in need. These suggestions show that you understand the benefits of a just work culture and the importance of psychological safety in the workplace (i.e. CanMEDS role of Professional based on CMA Code of Ethics and Professionalism).

Possible Follow-up Question:

Would you change your answer if Bob were in a same-sex relationship? Explain.

“I would not change my answer. The gender of Bob’s spouse or Bob’s sexual orientation does not change the fact that as a person living in Canada, Bob has the right to be a parent and take paternity leave. Also, “paternity” and “maternity” are outdated terms in policy and have been replaced with “parental” leave to include all persons regardless of gender, sexual orientation, or other discriminations. Research shows that the healthy development of a child depends on love, nurturing and safety. Gender or sexual orientation of a parent do not have negative effects on child development, according to science.” 

Your answer remains the same and you support it with reference to Canadian labour and human rights laws, in addition to policy terms and conditions. You add that there is science to support these laws regarding child development and safety

Using specific terms such as the updated term “parental” demonstrates you are informed of Canadian laws related to discrimination in the workplace and human rights. Your personal morality or beliefs are not included in the statement. All the support for your response is related to laws and science, in addition to the professional and ethical responsibilities of doctors in Canada

In this response, you have demonstrated professionalism, ethics, scholar and critical analysis based on objective evidence. What is being assessed is the manner in which you defend your claims using objective information, not personal subjective feelings. 

Keep in mind that the CASPer is not an essay or research paper. You don’t have time to cite or present empirical information. But, stating that you rely on science or that you are informed of laws and policies outside of the medical field (i.e. the social determinants of health), demonstrates you are a responsible, caring and prudent critical thinker. 


How to Improve Your CASPer Score: Ideas for a Script with Canada’s Public Health Ethics Framework 

This is another FREE resource! The 5 Steps Ethical Framework was created for Canadian public health professionals and policy makers as a guide to systemic analysis of ethical issues to support decision-making in the context of COVID-19. It’s a perfect sequence for CASPer questions!  

Tips for IMGs to improve their CASPer test results in Canada to quickly and effectively score in the top quartile.
Dos and Don'ts infographic to help you prepare for the CASPer Test!

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TIP #7 Test Your Script with Sample Questions and Responses

Your script should simply guide your responses so that you can demonstrate a few of the competencies. The explanations in TIP #6, are meant to FACILITATE your understanding of how to APPLY CanMEDS competencies and the CASPer Test competencies to the problems. Follow the sample sequence in TIP #6 and use the two  FREE COOL TOOLS INFOGRAPHICS as guides to create a script, strategy or flow that works for you. Remember that you will not have time to demonstrate each competency in each question. You are NOT EXPECTED TO.  However, if you have a basic FLOW to your response that shows you can IDENTIFY and ADDRESS a few key issues in an ORGANIZED SEQUENCE, you should perform well. But, let’s not ASSUME anything.

  1. Create a script draft
  2. Use it with practice questions
  3. Self-assess your responses to see how well  you are responding
  4. Ask a colleague or study group partner to check your responses (i.e. someone who understands CanMEDs)
  5. Make revisions to your script after reflecting on feedback (if applicable)
  6. Practice using the script under timed test conditions

If you are still having trouble, leave a comment or questions below.

TIP #8 Test Your Typing Speed and Simplify Responses

There are several websites where you can test your typing speed. Simply do a search online to find one that you like. Once you are comfortable with the scenarios, try using the typing speed website to respond to questions. This will give you a more accurate idea of your typing skills under the conditions of the CASPer test.

To practice now, here is the response to Bob’s scenario discussed in TIP #6. The explanations given in the sample response are for you to understand how to use the CMA Code of Ethics and Professionalism when answering questions. 

However, it is unrealistic that you would be able to think and type all of that information in five minutes. The full scenario is 450 words long! Just typing this in 5 minutes would be difficult for average typers. You would also have NO TIME to read the prompts and think of a response. Therefore, I have summarized it in very simple language for you. On the actual test, grammar and spelling are not penalized (as per Suite FAQ). So, if using capital letters, commas or hyphens slows down your typing, don’t use them. The main points are still evident as are the competencies. It’s NO MASTERPIECE, and that is OK! Don’t get stuck on perfection!

Question 1: “Bob appears to be struggling with a moral decision and wants my help. It is a private family matter. I would tell Bob to talk to his wife first so they can decide together. I would also tell him to talk to our boss to see what other options he has. We can check the work policy to see if there are other options to take a leave.  If he takes the job but still wants to be with his family, I would work overtime some days so he can go home early. In a work meeting I would suggest group work and alternating shifts so everyone has a chance to balance work and home life.” 

Question 2: “No. Changing my answer based on gender or sexual orientation is discriminatory and against the law in Canada. Everyone has the right to parental leave. It doesn’t matter who as long as they provide safety and nurturing. There is no science that supports gender or sexual orientation is bad for child development or safety.” 

This type of summary can be difficult if you are not familiar with Canadian labour laws, the code of ethics and professionalism, or your use of English is limited. The best way to improve your range of vocabulary  is to read the Canadian news, understand the social determinants of health terms (in English) and the CMA Code of Ethics and Professionalism. Then, learn to simplify complex ideas by trying to explain the concepts to a child, someone who is not an expert in the medical field, or has limited English skills.  

TIP #9 What to Include in Your Personal Reflection Questions

What I am about to tell you is probably not going to BLOW YOUR MIND. List experiences that demonstrate CanMEDs competencies. Wash, rinse, repeat! GENIUS!

Competencies can overlap in a story, so choose stories where competencies are obvious and easy to explain. If you followed TIPS #4 and #5, you already have specific stories ready. Work smarter, not harder. Use the same stories! 


35 Additional Topics to Help You Tell an Amazing Personal Story 

  1. Altruism (selflessness)
  2. Generosity
  3. Independence
  4. Mastering a skill
  5. Feeling or providing a sense of belonging
  6. Teamwork
  7. Overcoming adversity/challenges
  8. A celebration
  9. Working with diverse cultures
  10. Rural environment experience
  11. Historically underrepresented communities and advocacy
  12. Meaningful experiences
  13. Patient autonomy and surrendering control 
  14. Providing options
  15. Explaining more than one perspective (perspective taking)
  16. Explaining at the level of a person’s understanding
  17. Privacy/confidentiality controversy
  18. Not blaming and being humbled by it
  19. Critical thinking (questioning the obvious) and discovering new truths
  20. Seeking help
  21. How you create options for others
  22. How you modified something and the outcome that ensued
  23. How you are flexible
  24. Presenting research
  25. How you confronted discrimination in the workplace
  26. Advocating for an individual-group-yourself
  27. Overcoming weaknesses
  28. How you developed strengths
  29. Explain self-care practices you use
  30. Describe how you have fun or things that give you joy
  31. Give strategies of how you deal with stress
  32. Describe a time when you lacked resources
  33. Talk about your social support system
  34. Give examples of  how to identify personal biases
  35. Discuss interesting experiences and how you stay curious in your world 

These stories don’t have to be related to medical practice. The skills are the same, and can be transferred into any situation. For example, having integrity is a reflection of your character not a situation. Experiencing failure can be broad such as in sport, a test, a relationship, at an important meeting, arriving late. The important factors to get across are how you dealt with it, what you learned, and if it resulted in some sort of personal transformation. The outcome (or personal transformation) demonstrates your character. Everyone has flaws. Don’t forget you are human after all.

TIP #10 How to Organize Your Responses: FACTS & FLOW

You can use the STAR method (SITUATION-TASK-ACTION-RESULT), but let’s avoid acronyms and KISS (KEEP-IT-SIMPLE-SILLY…That was a joke about our North American obsession with abbreviations IMHO…in my humble opinion LOL…OMG…OK I’ll stop now). 

You need to tell a story with a beginning, middle and end. To organize your story in a cohesive, easy to remember structure, think about the relevant past, present, and future parts of your story and tell them in that sequence


Sample Question: Tell me about a time when…


Story Set-Up


  1. What happened (event)?
  2. Who was involved?
  3. What were the options?
  4. Your decision and why
  5. The consequences or outcome



  1. How did it change you or influence who you are today?
  2. What do you know now because of that experience?
  3. What did you learn that you didn’t expect? (aha moment, wow, growth)
  4. What conflicted or corresponded with what you were taught? (change your perspective/strengthen a belief)
  5. How do you feel/think/act now as a result of this situation? (ACT:your choices, how you respond, daily routines, how you work; THINK: outlook, frustrated but determined; FEEL: proud, compassion, disappointed but hopeful)


FUTURE (Pick one)

  1. What would you do next time? 
  2. What did you take away that you will use in the future? 
  3. If… then, …
  4. I would do something differently next time because….
  5. I would do it again…because
  6. I will advocate for/collaborate with/communicate with…




8 More Personal Reflection Types that Could Show Up on the CASPer 

  1. Tell me about your …
  2. What is the best way to…
  3. How do you set goals?
  4. If you were a ______ which/what would you be and why? 
  5. What are your experiences with a lack of resources, technological challenges, financial constraints,______?
  6. How have you managed your work/study requirements (role, responsibility, productivity metrics) when you don’t have resources or support?  
  7. What are some examples when you/When do you know it is time to ask for help? 
  8. How do you set boundaries? (personal/professional)

Improving Your CASPer Test Score: Putting it All Together for IMG Newcomers


Joyce Echaquan was a 37 year old mother, partner, and daughter of the Atikamekw Nation from Manawan north of Joliette, Quebec. Joyce went to the hospital because of stomach pain and complained of being overmedicated. Rather than listen to her concerns, Joyce was taunted with derogatory racist comments by healthcare workers and tied to her hospital bed. Joyce Echaquan live streamed her treatment on Facebook. She died moments later on September 28, 2020.  Echaquan’s death is a recent example of systemic racism in the health-care system

The medical ethics and professionalism of healthcare workers in Canada have been questioned because of the maltreatment of patients across the country, especially to Indigenous Peoples. Failure to uphold the CMA Code of Ethics and Professionalism and apply CanMEDS competencies in practice has resulted in physical and emotional harm including patient death. Lack of competence and systemic racism affect the lives of patients, loved ones, health-care professionals, the medical profession, society at large, and often involves litigation.  

The Real Reason for Mastering the CASPer Competencies: EVOLUTION

Joyce Echaquan and her family expected her to come home after that medical appointment. Had she not recorded the incident, no one would actually know what happened. The four main principles of clinical ethics in health-care include beneficence, nonmaleficence, autonomy, AND JUSTICE. A year after Joyce’s death, justice is still absent in this case. 

But, being angry will not remedy the problem. Canadian health-care needs to evolve. The most profound statement and call for justice was made by Joyce’s husband. As reported by APTN News Joyce’s husband stated he wants “EVOLUTION NOT REVOLUTION”, and for SOCIETY to REMEMBER JOYCE and what happened to her SO IT DOESN’T HAPPEN AGAIN. Download Joyce’s Principle to learn how you can CONTRIBUTE to health-care reform.   

The Canadian Medical Association (2018) acknowledges the physician’s responsibility to address systemic issues in health-care, specifically to Indigenous Patients and Communities.  The professional responsibilities between PHYSICIANS AND SOCIETY include: 

  1. CONTRIBUTE, individually and in collaboration with others, to improving health care services and delivery to ADDRESS SYSTEMIC ISSUES that affect the health of the patient and of populations, with particular attention to disadvantaged, vulnerable, or underserved communities (CMA, 2018, p.7).

Acknowledging and addressing systemic racism in Canadian health-care is the first step in achieving non-discrimination, equality and justice for all. 

Which TIPS do you think are the most helpful?

Which CanMEDS competencies do you think are the most difficult to apply in practice?

Tips for IMGs to improve their CASPer test results in Canada to quickly and effectively score in the top quartile.
Ahmed, Ahmed M. MSc The Real Core Competencies in Premed Culture, Academic Medicine: May 2019 - Volume 94 - Issue 5 - p 611