Q44: Ethics and the Examination to Test Aspiring Psychologists: Navigating Fairness, Validity, and Responsibility in Psychology Licensure

Graduate School
My first required course as an aspiring psychologist was ethics. l had to learn the Ethical Principles of Psychologists and the Code of Conduct by the American Psychological Association (APA). This was my first doctorate-level class, and I felt a sense of safety in the psychology field due to Principals D and E from the section, General Principals:

Principle D: Justice
Psychologists exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices.

Principle E: Respect for People's Rights and Dignity
Psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status, and consider these factors when working with members of such groups. Psychologists try to eliminate the effect on their work of biases based on those factors, and they do not knowingly participate in or condone the activities of others based upon such prejudices.

Code of Ethics
Recently, I started a literature review about the licensing standards for aspiring psychologists. I found a significant amount of evidence in research that highlights a seemingly disregard for Principles D and E not only in relationship to the development of the Examination for Professional Practice in Psychology (EPPP), but also the high rate of failures for aspirants. Psychologists are required to uphold their ethical principals, (pursuant to the Code of Ethics), and given the research to support significant problems with the EPPP, I fail to understand the lack of ethical accountability to those who create this examination and mistreat aspirants. Therefore, this blog discusses issues in the APA Ethics Code that relate to this examination and how they can been seen violations, particularly for fairness, equity, and bias.

The Introduction and Applicability section states, “The Preamble and General Principles are aspirational goals to guide psychologists toward the highest ideals of psychology." It also reads, "Although the Preamble and General Principals are not themselves enforceable rules, they should be considered by psychologists in arriving at an ethical course of action." Yet, the design, implementation of the Examination for Professional Practice in Psychology (EPPP), and disparity in passing rates may conflict with ethical guidelines and seen as violations of the APA ethics code. If research shows problems with the exam, if the number of White licensed psychologists is significant higher than BIPOC licensed psychologists and if aspirants and licensed psychologists raise ethical concerns about the equity of this exam, my questions are as follows:

• What has APA done to address these issues to, "arrive at an ethical course of action?"
• Has there been investigations by the APA for possible ethical violations against aspiring psychologists by those who create and support this exam?
• We cannot harm the public, but can harm our own aspirants in this field?

How the EPPP May Potentially Violate the APA Code of Ethics
1. Fairness and Justice (Principle D of APA Ethics Code)
Issues:

• The principle of fairness and justice requires that all individuals have equal access to psychological services and opportunities. The EPPP has been criticized for containing culturally biased content that may disadvantage racial and ethnic minority candidates.
• Taking the EPPP can be prohibitively expensive for some candidates, especially when considering retakes, study materials, and preparatory courses. This raises concerns about where the exam creates an economic barrier to entry.

What Can Be Seen as a Violation:

• If the exam disproportionately affects minority groups due to biased questions or scenarios that do not consider cultural differences, it undermines the fairness and inclusiveness mandated by the APA’s ethical standards. This can lead to lower pass rates for minority candidates, limiting their access to licensure and professional opportunities, which violates the ethical principle of justice.
• Financial barriers violate the ethical principle of equity by making it more difficult for individuals from disadvantaged backgrounds to enter the profession, exacerbating inequities within the field of psychology.

2. Nonmaleficence and Beneficence (Principle A)
Issue:

• Psychologists are ethically obligated to do no harm (nonmaleficence) and promote the welfare of individuals (beneficence). The high-stakes nature of the EPPP, combined with repeated failures, can have significant mental health impacts on candidates, including stress, anxiety, depression, and burnout. 

What Can Be Seen as a Violation:

• By placing excessive stress on candidates and potentially delaying or preventing licensure for those who are otherwise competent, the EPPP may inadvertently harm candidates. This could be considered a violation of the duty to protect the well-being of individuals, especially given that the test does not always clearly assess real-world competencies.

3. Competence (Principle B)
Issues:

• Psychologists are expected to ensure that they are competent in their work, and the APA Ethics Code emphasizes the importance of accurately assessing competence. The EPPP has been criticized for focusing too much on theoretical knowledge and not enough on the practical skills required for effective psychological practice.
• There is a lack of transparency in how the EPPP is developed, scored, and validated. Without sufficient transparency, it may be difficult to ensure that the exam is fair and just, potentially violating ethical standards related to responsibility and accountability.

What Can Be Seen as a Violation:

• If the EPPP does not adequately assess the practical competencies necessary for psychologists, then it could be seen as failing to uphold the principle of competence. This could lead to the licensure of individuals who may not be fully prepared for practice while preventing competent individuals who struggle with test-taking from entering the profession.

4. Respect for People's Rights and Dignity (Principle E)
Issues:

• The APA Ethics Code stresses respect for the dignity and worth of all people, including ensuring that psychological practices are free from bias and that diverse populations are treated fairly. Critics argue that the EPPP may not fully consider the experiences of individuals from different cultural, linguistic, and socioeconomic backgrounds.
• Some argue that the EPPP may contain culturally biased questions, disadvantaging test-takers from diverse backgrounds. If the test disproportionally affects minority candidates, it could be seen as inconsistent with the APA’s commitment to avoiding harm and ensuring fairness.

What Can Be Seen as a Violation:

• If the exam's content or structure disproportionately affects minority candidates or those from underrepresented groups, it can be seen as a violation of this principle. Failing to respect and accommodate diverse backgrounds in the testing process infringes on the dignity and rights of these individuals to have equitable access to the profession.

5. Validity and Relevance Issues
Issues:

• Content relevance is an issue since the EPPP may not adequately measure the practical skills necessary for competent psychological practice. If the exam does not align well with the actual competencies needed for practice, it might violate the ethical principle of ensuring that assessments are valid, reliable, and relevant to the purpose they are intended to serve (Standard 9.02).
• Test use and interpretation can be an ethical violation due to concerns with the EPPP’s limitation for accurately predicting who will be a competent psychologist. If the test fails to adequately assess professional competence, it could be seen as violating ethical standards related to the appropriate use of assessments (Standard 9.02).

What Can Be Seen as a Violation:

• If the exam's content or structure disproportionately affects minority candidates or those from underrepresented groups, it can be seen as a violation of this principle. Failing to respect and accommodate diverse backgrounds in the testing process infringes on the dignity and rights of these individuals to have equitable access to the profession.

​Conclusion 
Public evidence to suggest that the APA has conducted formal investigations into potential ethical violations related to the EPPP was not found in my literature review. However, the EPPP has been criticized for potentially violating key principles of the APA Code of Ethics in numerous research studies. Nationally, there is a disparity amongst races in the psychology workforce and only 4% of licensed psychologists are Black (2% are Black psychiatrists), (The Black Mental Health Survey Report, 2022), which should be seen as an ethical violation due to unfairness. Other issues such as justice, competence, nonmaleficence, and respect for diversity all highlight the need for reforms.

Ultimately, "if we are in the profession of identifying inconsistencies and incongruences, identifying pitfalls and areas for growth, and then providing the skills (and moreover the accountability) to our clients to result in effective change, should we not hold ourselves to the same standard," asks Dr. Charles R. Rohr, II, Licensed Clinical Psychologist. The high failure rates impact the profession since there is a shortage of mental health professionals which harms the public, as evidenced by the Health Professional Shortage Areas identified by the Health Resource and Services Administration. The APA can investigate external licensing bodies and the examination and licensing practices for the EPPP to ensure that the exam is both equitable and valid. Addressing these ethical concerns upholds the values of the psychology profession.

Resources:
www.apa.org/ethics/code
abpsi.org/wp-content/uploads/2022/12/The-Black-Mental-Health-Workforce-Survey-Final.pdf;
​data.hrsa.gov/tools/shortage-area/hpsa-find

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