Affirmative Licensing: Step 1 Of Medical Licensing Exam Made Pass-Fail
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When affirmative action was introduced over a half century ago, many assumed that once the under-represented demographics were given a little help getting past the initial gatekeeper, they’d do well at all subsequent levels. Unfortunately, that proved naive. So ever since there have been unending struggles over how far up the ladder to extend affirmative action.

For example, if you have affirmative action in medical school admissions, should you also have affirmative action in doctor licensing?

One obvious but little-discussed problem for the beneficiaries of affirmative action at professional schools is that both law and medicine school lead to professional licensing exams, which can be disastrous if the student can’t pass. In contrast, business school students don’t have to take exams to get a job (outside of a few specialties), so an MBA can be a safer bet for an underrepresented minority. Or at least that’s what logic implies: I’ve never seen this question investigated by academics.

Not surprisingly, black medical students, many of whom are beneficiaries of affirmative action, tend to do worse on the three stage medical licensing exam. Lower scores on the Step 1 of the three part medical licensing exam, a 7 hour exam given to med students in the summer after their second year, make it harder to get desired residencies.

Assuming a standard deviation of 22, compared to white medical students, from 2005 to 2014 black med students score about 0.74 standard deviations worse, Hispanics about 0.51, and Asians about 0.04.

The authorities this week declared that Step 1 will no longer be graded with a 3 digit score. Instead it will be pass-fail.

If the current mean is about 228 and the standard deviation is 21 and the passing score is 194, you only need to score about 1.6 standard deviations below the mean to pass. So unless you are in the bottom 10% of med students in the country, you don’t have too much to worry about now.

This will disadvantage the smarter med students at lower prestige med schools and advantage the dimmer med students at elite med schools, which is, I guess in 2020, considered to be a Good Thing.

This week’s change is pretty similar to what we see with firemen’s hiring and promotion tests, where it is often decided in the name of civil rights and fighting disparate impact discrimination to stop hiring based on rank order of test scores, but instead only require a passing grade on the test, which is set so low that almost all whites pass, and then use more randomized procedures to choose among all those who pass.

Logically, it would seem like a better idea to simply have race quotas and choose in rank order within each race. That would get higher average knowledge firemen than the pass-fail system. But that kind of system is often demeaned as a quota and is seen by beneficiaries as embarrassingly blatant. In contrast, pass-fail systems at least obfuscate the reality of racial preferences, even if a few extra people must burn to death each year.

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