Equity Over Exams: Why the AAMC’s Arguments for Devaluing Test Scores Don’t Add Up

The Association of American Medical Colleges (AAMC) has long been a proponent of so-called “holistic review” medical school admissions that devalue test scores and grades to make room for other, less merit-based factors. This approach is often justified on the grounds of pursuing “equity,” and holistic review can be an end-around for race-based admissions.

In its 2024 report on how to interpret MCAT scores, the AAMC argues that admissions officers should take into account students’ “educational opportunities, lived experiences, attributes, and other factors” to demonstrate their commitment to “equity in medical education.”

Buttressing this argument is the following claim:

“Research suggests the differences in MCAT scores for examinees from groups underrepresented in medicine based on race/ethnicity and other background characteristics reflect societal inequalities in income, education, and other factors rather than test bias,” the report reads. 

To support this claim, the AAMC cites a 2013 article co-authored by two AAMC officials and published in the AAMC’s journal, Academic Medicine, that identifies several studies finding socioeconomic disparities between racial groups and linking these disparities to gaps in academic achievement.

There is, of course, a credible element to this statement: that students with higher socioeconomic status may have better MCAT scores due to better access to academic resources (e.g. MCAT tutoring) and the ability to afford the opportunity cost of studying.

But coupled with the AAMC’s recent defense of explicit race-based admissions (and current support of “holistic review” admissions that are often a proxy for considering applicants’ race), the implication is clear: MCAT scores should be weighted differently depending on the applicant’s race.

In fact, elsewhere in the report, the AAMC cites a 2020 article published in Academic Medicine called “The Consequences of Structural Racism on MCAT Scores and Medical School Admissions: The Past Is Prologue.” That article’s authors were Drs. Catherine R. Lucey and Aaron Saguil, who chaired the AAMC’s MCAT Validity Committee and provided recommendations for broadening access to medical education. The article argues that “equitable interpretation of MCAT scores requires consideration of the context in which each applicant earned those scores, rather than assuming that all applicants had equal opportunities.”

There’s a few problems with the AAMC’s approach and its underlying premises.

First, the argument for devaluing MCAT scores relies on the aforementioned claim that racial disparities in MCAT scores can be explained by disparities in socioeconomic status and opportunity.

However, as the AAMC itself notes in a 2024 report, MCAT scores predict students’ performance better than undergraduate GPAs and, when coupled with GPAs, are the best predictor of student success. In particular, there is a strong correlation between MCAT scores and clerkship or “shelf” exams, as well as United States Medical Licensing Examination (USMLE) clinical knowledge exams.

This means that, in general, the better a student’s MCAT scores, the better they will perform in medical school and the more mastery of clinical knowledge they will exhibit. In short, students with better MCAT scores tend to be better medical students. While it’s certainly possible that, because of socioeconomic hardships, a student scores poorly on their MCAT and then goes on to be an excellent student, this is most definitely not the general trend. 

Crucially, this trend cuts against the AAMC’s core argument, and instead indicates that disparities in MCAT scores simply reflect disparities in merit. At a certain point, a student’s academic performance is just reflective of their competence. If the AAMC wants to argue that disparities in competence are due to socioeconomic factors, so be it, but that does not support its argument for devaluing scores.

Second, even if we were to grant the AAMC’s premise, its conclusion and prescription is bizarre. Why should we just consider previous instances of racism when weighting students’ scores? Why not factor in the litany of other historical injustices that may have had cascading effects on the fortunes of today’s prospective medical students? Why not weight scores by parent income, or by whether or not the student grew up in a single-parent household, or whether their community had a public library?

Taking the AAMC’s argument to its logical conclusion reveals how unfeasible and absurd it is. There is no way to properly curve applicants’ scores in an “equitable” manner, and if fairness is the desired outcome, there’s no reason other than racism to make applicants’ race the determinative factor. 

Third, the Supreme Court just ruled that race-conscious admissions are illegal. Considering the context in which a student obtained their scores by considering their race is just race-conscious admissions with added steps. And, as Do No Harm has documented, the use of “holistic review” in admissions is a common end-around employed by medical schools to avoid explicitly acknowledging that they are considering applicants’ race.

Undergirding all of this is the fact that the AAMC fundamentally misunderstands the role of the doctor and, by extension, the role of medical schools. The AAMC believes that medical school admissions should be used to redress past racial discrimination, and aims to accomplish this by devaluing the metrics that best reflect and predict merit and competency. But by lowering standards to permit less qualified people to receive a medical education and become doctors, the AAMC is in turn victimizing all patients who are subjected to a lower standard of medical care. 

No one deserves to become a doctor. And though the echoes of historical racism may be felt by minority groups today, their situation does not justify further injustices that harm all Americans who enjoy our healthcare system.

Rather than pursuing ideological agendas and manipulating medical schools’ racial composition through holistic reviews, the AAMC should instead commit to prioritizing merit. The most talented applicants should be rewarded.

It’s of critical importance that our country’s future healthcare professionals are the best and brightest. There is very little margin for error.