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PaperclipPerfector  1yr ago (text post)   31726 thread views

Culture War Roundup for the week of July 24, 2023

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I have great idea then! Let's let everybody into the best residency program, without any tests, or regard how well they do there. We'll have a whole society full of great doctors!

I don’t think OP implies that at all.

The point is not that exam scores can be disregarded. It’s that they don’t matter conditional on the good residency. Whatever combination of test scores and AA and resume-padding gets you into that residency—that’s still important.

The question becomes how much AA is practiced in getting into residencies. If there is AA practiced at medical school but much less at residency, then it may be that residencies themselves aren’t that skill building but are separating the wheat from the chaff.

Right.

No idea what the demographics look like among these residencies, though.

I'm not really sure what your "gotcha" is. You only get into a residency program after you've passed the USMLE and per the paper:

We found no evidence for a major selection effect in residency program output. If programs differ substantially in the quality of physicians they graduate, much of that difference might be attributable to the initial quality of the trainees they attract, but we found little difference in effects after adjustment for individual physicians' standardized medical licensure examination Z scores. This suggests either that these scores do not capture medical students' clinical ability or that skills developed during residency training are more important for producing good maternal outcomes than skills developed during medical school, and residency programs differ in skill development.

If we could feasibly let everybody who passed their exams into the best residency programs - we would. It would probably lead to better patient outcomes.

It's magical thinking, refuted by Goodhart's Law.

The first problem is that the idea that the residency programs themselves act as filters doesn't even occur them. It shows how much these people are stuck in a bubble.

The second problem is this:

If we could feasibly let everybody who passed their exams into the best residency programs - we would

If passing the exam is a pre-filter that residency programs rely on, and you'll give people of a particular race a boost that let them pass an exam they otherwise wouldn't, that's going to mess the pre-filter.

It would probably lead to better patient outcomes.

A hypothesis that is very easy to check - find some of the worst doctors that managed to hang on to a licence, send them to the best residency programs, and see what happens. I have no patience for people who fish for correlations (or lack therefor) anymore.

The first problem is that the idea that the residency programs themselves act as filters doesn't even occur them. It shows how much these people are stuck in a bubble.

I’m not sure I understand what you mean by filter here. They pretty explicitly call this out as a possibility - which is why they account for exam scores.

A hypothesis that is very easy to check - find some of the worst doctors that managed to hang on to a licence, send them to the best residency programs, and see what happens.

Why bother with testing the residency program at all in this scenario? You should see doctors from the best medical schools performing considerably better than those from lower ranked ones - but that isn’t really true either.

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