Minorities, Women Lag on Medical Exams : Research: Study says gaps are linked to students’ education, not race or sex.

Although ethnic minorities and women do worse than white males on the so-called medical boards--standardized national exams taken by second-year medical students--the results are related more to undergraduate educational achievement than to race or sex, researchers report today.

In the first look at the achievement of such groups on the medical boards, researchers found Asian Americans scored 15 to 20 points lower than white males, Latinos scored 60 points lower and African Americans scored 100 to 120 points lower, while women scored an average of 30 points lower than males of the same ethnic group. The mean score is 500.

Those results are being published today in the Journal of the American Medical Assn. by a team from the National Board of Medical Examiners, which administers the test, and Southern Illinois University.

Pass rates on the test were 88% for whites, 84% for Asian Americans, 66% for Latinos and 49% for African Americans.

Achievement on the test could, in general, be predicted from the students’ grade-point averages as undergraduates, the number of science courses they took and their scores on the Medical College Admission Test, independently of race. The two exceptions were Asian Americans and women, both of whom scored lower on the boards than would have been predicted from undergraduate data, said biostatistician Beth Dawson of Southern Illinois University, the paper’s primary author.

Many of those who do poorly on the test do not graduate from medical school or become practicing physicians. The exam is given two years before graduation to determine placement in residencies and whether the student should remain in medical school.

Furthermore, Dawson added, “We really do not know at this point how well these exams are related to performance as physicians.”

Dr. Lonnie E. Fuller, dean of the historically black Morehouse School of Medicine in Atlanta, noted that most of the minorities do much better the second or third time they take the boards, “substantially closing the gap” between them and whites.

“What concerns educators is that objective types of measures (such as the boards) may sometimes not reflect nonobjective measurements . . . that we think measure competence and the ability to get things done,” Fuller said. “The skills that you need to be competent are often data gathering and assessment skills” that are not measured by multiple-choice questions, he added.

“The most important thing is that those who pass the exam have a substantial knowledge base and turn out to be good doctors, regardless of which (ethnic group) they come from,” said Dr. Tom Bowles, president of the National Board of Medical Examiners.

Although some critics had suspected that ethnic disparities exist, the issue had never been studied before because neither the application forms for the boards nor the tests themselves included ethnic information. Dawson and her colleagues were able to circumvent that difficulty by comparing data from the boards with that from the Medical College Admission Test (MCAT), which does collect such information. The team studied all students who took the board exam, formally known as the National Board of Medical Examiners Part I examination, for the first time in June of 1986, 1987 and 1988, a total of about 48,000 students. That test has subsequently been revised and is now called the U.S. Medical Licensing Examination, but Bowles believes that the findings apply to it as well, “although we don’t have enough data to publish yet.”

Fuller said the results were not particularly surprising. He said educators have long known that while high MCAT scores are predictive of success in medical school, low scores are less useful. A low score is very predictive of failure among whites, he said, but is less significant among blacks. That is, blacks with a low MCAT score are more likely to succeed than whites with a similar score.

“The bottom line is that ethnic minorities are doing as well as anyone could expect them to do based on their preparation when they came in,” Dawson said.

Examining the Exams

Minorities and women generally do worse than white males on “medical boards,” exams taken after the second year of medical school, a new three-year study finds. But educational achievement as an undergraduate is a bigger factor than the medical student’s race or sex, the study concludes. Here are the mean scores and percentages in each group who passed.

WOMEN MEAN SCORE PASSING % * Overall women 455 79.4% * White 467 84.1% * Latina 386 55.8% * Black 369 44.0% * Asian/Pacific Islander 458 78.9%

MEN MEAN SCORE PASSING % * Overall men 492 87.2% * White 499 89.5% * Latino 447 71.6% * Black 392 53.9% * Asian/Pacific Islander 485 86.6% TOTAL 480 84.5%

SOURCE: JAMA