How to Answer CASPer Questions Using the Punnett Square Approach (aka "if then, then that" approach)
We have discussed CASPer a lot in these blog posts: (Top Five Tips For Acing Your CASPer Test & Former CASPer Test Evaluator Reveals Her Top CASPer Prep Tips). We have talked about which kinds of questions you should prepare for and how to think about this weird exam. But we haven’t drilled down into detail how to approach decision making in an ethical conundrum.
On CASPer, you will be asked to explain your thoughts and behaviors around a particular matter of ethics. You will have to share your thought process around situations that reflect a lack of professionalism, crossing professional boundaries and displays of cultural incompetence.
Some of these are really complicated. So how do you make the best decision possible? Sometimes, when you place your hands on the keyboard to start writing as the clock feels like it races to 00:00, you aren’t sure what you should do. It’s not clear what the right answer may be. For CASPer, there are some contexts for which there is no perfect answer but you MUST report to authorities when public safety or vulnerable individuals may be in harm’s way. As long as you report when you know you should, and take the high road (which is usually the safest road), then you won’t fail the question. But, not failing is different than excelling at CASPer.
I want to walk you through an approach that we use for these situations when working with our students on CASPer preparation. I call it the Punnet Square approach because it makes use of mental 2 x 2 tables, but you could also call it the “If this, then that” approach.
For example, consider the following question:
You are a surgeon. You present to the hospital at 7:30am to prepare for the day. As you are changing, a fellow surgeon - a friend of yours - enters the change room and they are acting strangely. You smell a slight scent of alcohol when they come close to you. You know that this surgeon is next in line to run the Department of Surgery at your hospital and will be making important decisions about funding and OR time in the very near future, and you have never seen them act this way before.
What do you do?
The right thing to do here is probably pretty obvious: This surgeon should not be allowed to operate today and their superiors should be notified that he showed up to work intoxicated. But the test isn’t just about whether or not you have the right answer, it’s about sharing how you think, your values and your personality. So the way you break down this problem is as important as doing the ethical thing.
The Punnet Square approach breaks down your approach to thinking about this question into decisions and outcomes.
- Best Outcome Possible
- Worst Outcome Possible
Recommend to your friend that they not operate today and hope they listen. Don’t report the incident.
There are no issues in the OR and the surgery goes as planned.
The patients to be operated on today experience adverse outcomes as a result of an intoxicated surgeon. Some may even die. There is an investigation and my own license to practice is taken away for not fulfilling professional duty to protect patients from harm.
Report the incident to your superior and the professional College that governs physician behavior in your jurisdiction.
The surgeon is not allowed to operate today. They are asked to undergo a review of their recent cases to ensure there is no pattern of unsafe behaviour. The surgeon gets involved with the help they need to deal with whatever led them to drink at work - a clear zone of zero tolerance for alcohol - and they return to work when ready, healthier than ever. No patients are harmed.
The surgeon refuses to speak with me again for reporting the incident. They still somehow get the Department head job and make my life very difficult by limiting access to OR time. I have to change hospitals.
When your CASPer answer includes statements like, “If I talk to my friend to try to urge them to not operate and they don’t listen to me, the best case scenario is…but the worst case scenario is…” then you’re using the Punnet square to logically and clearly break down the most important issues of the question. In doing so, your decision becomes very easy to make. The answer that brings the least harm and the most benefit into the lives of patients is to report the incident. Don’t forget that when you’re done writing through the Punnet square, you actually have to write down the decision you would make so the examiner does in fact know where you stand.
Obviously, when you’re writing CASPer, you can’t actually insert 2 x 2 tables into your answer. But you can think about the scenario like this in your head so you keep clear on where you are with the answer. It will allow you to answer quickly and thoughtfully. The examiner will not be left wondering if you’ve considered the situation from the big picture or not because you clearly have thought through the possible consequences of your actions.
My experience is that this method prevents people from fumbling through their answers, repeating themselves and getting trapped in ethical blind spots. It also allows them to type faster and more cleanly. It also makes them sound professional and accessible.
Try it today in your CASPer practice to see how it improves your responses to questions about ethics.
To your success,
Your friends at BeMo