Stakeholders
A high-stakes system may be intended to benefit people other than the test-taker. For professional certification and licensure examinations, the purpose of the test is to protect the general public from incompetent practitioners. The individual stakes of the medical student and the medical school are, hopefully, balanced against the social stakes of possibly allowing an incompetent doctor to practice medicine.
A test may be "high-stakes" based on consequences for others beyond the individual test-taker. For example, an individual medical student who fails a licensing exam will not be able to practice his or her profession. However, if enough students at the same school fail the exam, then the school's reputation and accreditation may be in jeopardy. Similarly, testing under the U.S.'s No Child Left Behind Act has no direct negative consequences for failing students, but potentially serious consequences for their schools, including loss of accreditation, funding, teacher pay, teacher employment, or changes to the school's management. The stakes are therefore high for the school, but low for the individual test-takers.
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