AAMC PREview Professional Competencies: The Foundation of the Exam
Understanding the Eight-Domain Framework
The PREview competency framework is structured around eight distinct areas of professional behavior: Service Orientation, Social Skills, Cultural Competence, Teamwork, Ethical Responsibility to Self and Others, Reliability and Dependability, Resilience and Adaptability, and Capacity for Improvement. These domains are not arbitrary; they reflect the specific qualities that the Association of American Medical Colleges (AAMC) has identified as essential for a successful transition from student to clinician. In the context of the exam, these domains function as the blueprint for every scenario and response option. When a test-taker encounters a prompt, the underlying task is to identify which domain is being tested and which response most closely aligns with the professional standards of that domain. For instance, a question regarding a missed deadline primarily tests Reliability and Dependability, while a disagreement over a group project targets Teamwork and Social Skills.
Why Competencies Matter for Medical School Admissions
Admissions committees utilize PREview scores to gain a holistic view of an applicant beyond their GPA and MCAT scores. This medical school situational judgment test content provides a psychometrically sound method to predict how a student will behave in clinical rotations and small-group learning environments. The scoring system rewards responses that demonstrate high-level professional reasoning, as determined by a panel of medical school experts. A high score indicates that an applicant possesses the maturity to handle the "hidden curriculum" of medicine—the unwritten social and ethical rules that govern professional interactions. Because medical schools are increasingly moving toward competency-based education, demonstrating proficiency in these areas during the application phase signals that a candidate is prepared for the collaborative and patient-centered nature of modern healthcare.
How Competencies Are Translated into Test Scenarios
To understand PREview exam domains explained in practice, one must look at the scenario construction. Each item begins with a prompt—a short narrative involving a challenge—followed by a series of potential actions. The candidate must rate each action on a four-point scale: Very Ineffective, Ineffective, Effective, or Very Effective. This format differs from traditional multiple-choice questions because there isn't always a single "right" answer; instead, there is a spectrum of professional appropriateness. The AAMC uses a consensus-based scoring model where your rating is compared to the ratings of medical school faculty. To score well, you must move beyond personal opinion and apply the specific definitions of the PREview eight core competencies to determine if an action solves the problem without creating new issues or violating ethical boundaries.
Deconstructing the Service Orientation Domain
Defining Patient-Centered Advocacy and Care
Service Orientation is defined as a desire to help others and a sensitivity to the needs and feelings of patients and colleagues. In the AAMC PREview, this goes beyond simple kindness. It involves Patient-Centered Advocacy, which requires the individual to prioritize the well-being of the patient above their own convenience or administrative ease. In a clinical scenario, this might mean taking extra time to explain a procedure to a frightened patient or advocating for a patient’s wishes when they conflict with a standard hospital protocol. The core mechanism here is the recognition of the patient as a vulnerable individual whose interests must be protected. Effective responses in this domain consistently demonstrate a proactive approach to addressing the needs of others while maintaining a professional demeanor.
Scenarios Involving Patient Needs and Advocacy
When AAMC PREview what is tested includes service orientation, the scenarios often place the examinee in a position of limited power, such as a volunteer or a junior student. You might be asked how to respond if you notice a patient is being ignored by the nursing staff or if a peer is speaking dismissively about a patient’s concerns. The key to scoring "Very Effective" in these instances is to take direct, respectful action that addresses the patient's immediate need. For example, if a patient asks for water but is on a restricted diet, the most effective response isn't just to say "no," but to explain why and offer to find a nurse who can provide more information. This demonstrates a balance of following medical rules (safety) while validating the patient's experience (service).
Differentiating Effective Help from Assumptions
A common pitfall in the Service Orientation domain is making assumptions about what someone needs without asking them. The AAMC looks for "active listening" and "needs assessment" as components of effective service. If a scenario involves a peer struggling with a workload, a "Very Effective" response usually involves asking the peer how you can best support them rather than simply taking over their tasks. Taking over without consent can be seen as "Ineffective" because it may undermine the peer’s autonomy or fail to address the actual root of the problem. True service orientation requires a collaborative approach where the helper seeks to empower the person being helped rather than merely performing a task to feel useful.
Navigating Social Skills and Interpersonal Dynamics
Assessing Communication in Stressful Situations
The Social Skills domain focuses on the ability to communicate effectively and maintain rapport, even when under pressure. In the PREview exam, this is often tested through scenarios involving high-stakes environments, such as an emergency department or a heated group study session. The exam assesses your ability to use Non-Verbal Communication cues and verbal clarity to de-escalate tension. When a character in a scenario is angry or frustrated, the most effective responses are those that acknowledge the emotion without becoming defensive. This is often referred to as the "empathy-first" approach. By validating the other person's feelings before moving toward a solution, a student demonstrates the social maturity required to navigate the high-stress interactions common in medical practice.
Managing Conflict Between Peers or with Supervisors
Conflict management is a frequent theme in the PREview. Scenarios may involve a teammate who is not contributing to a project or a supervisor who provides harsh, public criticism. The exam evaluates your adherence to the Chain of Command and your ability to engage in "Direct Professional Communication." Generally, the most effective way to handle peer conflict is to address the individual privately and directly before involving a higher authority. In contrast, if the conflict involves a supervisor, the effective response usually involves seeking a private moment to ask for clarification or feedback, rather than arguing in front of others. These scenarios test whether you can resolve interpersonal friction without damaging professional relationships or disrupting the team's workflow.
Demonstrating Empathy and Professional Boundaries
While empathy is a cornerstone of social skills, the AAMC PREview also tests the maintenance of Professional Boundaries. An "Effective" response shows concern for a colleague's personal struggles but does not allow those struggles to compromise professional responsibilities or patient safety. For instance, if a peer is going through a divorce and asks you to cover their clinical shift, a "Very Effective" response might involve expressing sympathy and helping them find a formal way to request time off, rather than simply doing their work in secret. This distinction is crucial; the exam rewards those who can be supportive while still upholding the standards and requirements of the medical profession.
Applying Cultural Competence in Healthcare Settings
Recognizing Bias and Stereotypes in Scenarios
Cultural Competence involves an awareness of one’s own biases and the ability to interact respectfully with people from diverse backgrounds. In the PREview, this often manifests as identifying Implicit Bias in oneself or others. Scenarios may present a situation where a colleague makes a stereotypical comment about a patient's background or lifestyle. The exam evaluates how you respond to this unprofessional behavior. An "Effective" response involves recognizing the harm in the comment and addressing it in a way that educates rather than simply punishes. The goal is to ensure that the bias does not affect the quality of care provided to the patient, reflecting the core principle that every patient deserves equitable treatment regardless of their identity.
Responding to Diverse Patient Beliefs and Practices
Medical students must be prepared to work with patients whose health beliefs may differ from Western medical tradition. The PREview assesses this through scenarios involving Cultural Humility. You might encounter a patient who wishes to use a traditional remedy alongside prescribed medication. A "Very Effective" response would involve showing respect for the patient's beliefs, inquiring about the remedy to ensure there are no dangerous drug interactions, and consulting with the medical team. "Ineffective" responses are those that dismiss the patient’s beliefs out of hand or treat them as ignorant. The exam looks for candidates who can bridge the gap between different worldviews to maintain the therapeutic alliance.
Ensuring Equitable Treatment and Respect
The ultimate goal of Cultural Competence is to promote Health Equity. This means recognizing that different patients may require different types of support to achieve the same health outcomes. On the exam, this might involve a scenario where a patient has limited English proficiency. A "Very Effective" response would be to pause the interaction and wait for a certified medical interpreter rather than relying on a family member or trying to "get by" with basic gestures. This ensures that the patient has full access to information and can provide informed consent. By prioritizing the patient's right to clear communication, the student demonstrates a commitment to the ethical standard of justice in healthcare.
Teamwork, Ethics, and Professional Integrity
Collaborating Effectively in Team-Based Scenarios
Medicine is a team sport, and the Teamwork domain assesses your ability to work toward a common goal. This involves Shared Decision Making and the willingness to contribute your fair share. Scenarios often involve "Problem-Based Learning" (PBL) groups where one member is dominating the conversation or another is disengaged. The exam rewards responses that encourage participation from all members and help the group stay on task. A "Very Effective" action in these cases is often a "facilitative" one—asking the quiet student for their opinion or suggesting a structured way to divide the workload so that everyone is involved. This demonstrates that you value the collective intelligence of the team over individual performance.
Identifying and Addressing Ethical Dilemmas
The Ethical Responsibility domain is perhaps the most critical for patient safety. It involves the application of Bioethical Principles, such as autonomy, beneficence, non-maleficence, and justice. In the PREview, ethical dilemmas are rarely black and white. You might be asked what to do if you see a resident physician performing a procedure without the proper equipment or if you notice a fellow student cheating on an exam. The "Very Effective" response is almost always the one that prioritizes the integrity of the profession and the safety of the patient. This often requires "Moral Courage"—the willingness to speak up or report a violation even when it is uncomfortable or socially risky.
Balancing Team Harmony with Patient Safety
A common challenge in SJTs is the tension between being a "good teammate" and being an ethical professional. The AAMC PREview specifically tests this balance. If a teammate makes a clinical error, "Teamwork" might suggest you should cover for them to maintain harmony, but "Ethics" and "Professional Integrity" demand that the error be reported and corrected. In these scenarios, the Standard of Care always takes precedence over social cohesion. A response that suggests "talking to the teammate privately and then reporting the error to a supervisor if they refuse to do so" is typically rated as "Effective" or "Very Effective" because it balances interpersonal respect with the non-negotiable requirement of patient safety.
Demonstrating Reliability, Dependability, and Adaptability
Prioritizing Tasks and Managing Commitments
Reliability and Dependability are about "Professional Accountability." In the context of the PREview, this is often tested through scenarios involving time management and competing priorities. You may be given a situation where you have a looming deadline for a research project but are also asked to help a friend with a personal crisis. The exam assesses your ability to fulfill your primary obligations while still being a supportive colleague. The most effective responses involve Time-Task Triaging—identifying what must be done immediately and communicating clearly about what must be delayed. Simply ignoring a deadline or a friend is "Ineffective"; the professional approach is to manage expectations through clear, proactive communication.
Responding Constructively to Setbacks or Change
The Resilience and Adaptability domain measures how you handle stress, feedback, and unexpected changes in your environment. Medical training is characterized by long hours and frequent shifts in responsibilities. Scenarios might involve receiving a poor grade on an OSCE (Objective Structured Clinical Examination) or having your clinical rotation schedule changed at the last minute. The AAMC looks for a Growth Mindset. A "Very Effective" response to a setback involves reflecting on what went wrong, seeking constructive feedback, and creating a plan for improvement. "Ineffective" responses include complaining, blaming others, or becoming discouraged to the point of inaction. The goal is to show that you can remain functional and professional even when things do not go as planned.
Showing Accountability for Mistakes
One of the most important aspects of professional readiness is the ability to own up to one’s errors. In the PREview, scenarios involving a mistake you made—such as forgetting to check a patient’s vitals or missing a mandatory meeting—test your Integrity. The "Very Effective" response is to admit the mistake immediately to the relevant parties, apologize, and take steps to ensure it does not happen again. Attempting to hide a mistake or shift the blame to a colleague is consistently rated as "Very Ineffective." This is because, in medicine, transparency is essential for patient safety and for maintaining the trust of the public and your colleagues.
Developing an Effective Study Strategy for Competency-Based Questions
Analyzing Official AAMC Practice Scenarios
Preparation for the PREview should center on the official AAMC practice materials. Because the exam is scored based on the consensus of experts, your goal is to align your "Internal Compass" with the AAMC Professionalism Standards. When reviewing practice questions, do not just look at the correct rating; read the rationales provided by the AAMC. These rationales explain why a certain action is "Effective" or "Ineffective" based on the core competencies. For example, you might learn that an action is "Ineffective" not because it was wrong, but because it was "Incomplete"—it solved the immediate problem but failed to address the underlying cause or follow proper protocol.
Building a Mental Model for Each Competency
To succeed, you must develop a mental model for how each competency should be applied. For the Capacity for Improvement domain, your mental model should prioritize self-reflection and the pursuit of excellence. When faced with a scenario where you are criticized, your "Professional Reflex" should be to listen, ask for specific examples of how to improve, and thank the person for the feedback. By categorizing potential responses into "Reflexive Behaviors" associated with each of the eight domains, you can more quickly evaluate the effectiveness of options during the actual timed exam. This structured approach reduces cognitive load and improves the consistency of your ratings across different scenarios.
Common Pitfalls in Interpreting SJT Scenarios
A frequent mistake made by advanced candidates is "Overthinking the Scenario." Examinees often imagine "what if" details that are not in the prompt, leading them to choose an overly complex or inappropriate rating. Another pitfall is the "Hero Complex"—the tendency to choose the most extreme or dramatic action. In the PREview, the Most Professional Action is often the most moderate and collaborative one. For example, instead of reporting a peer to the Dean immediately for a minor infraction (extreme), the better response is usually to talk to the peer first (moderate). Understanding these nuances—the difference between being "decisive" and being "impulsive"—is key to moving your score into the highest percentiles.