Standard Setting in Medical Education: Standards, Methods, and Psychometrics

Fixed pass rate is a sensitive issue in the current practice of assessmentAssessment in medical education and is often used as a preset number randomly decided by the institution'sInstitution policymakers. The most important criteriaCriteria to practice a particular method of standards setting primarily takes into account the intent of the test selected by the expert judges making an informed decision based on an agreeableAgreable definition of borderline examineesExaminees, the credibilityCredibility of the standard, evidence from research and being transparent, and feasible to practice. Once the criteriaCriteria have been decided, it should be acceptable to all those concerned and evaluated for its reliability and validity to produce a sensible pass rate comparable with evidence from the literature. Literature provides substantial empirical evidence on standard settingStandardSetting in students’ assessmentAssessment globally practiced in medical education. A 50% passing score has been under scrutiny with regards to the balance between type I and type II errors decided based on being false +ive and false −ive passing of students respectively. ExamineesExaminees who passed the examExams but actually should fail and vice-versa is unfair and not acceptable. However, it is important to follow standards, which are defensible, credible, and based on best practices of medical education besides, being feasible and acceptable to all stakeholders including students. Another important factor before setting the standard of exam questions judges should have reached a consensusConsensus on the competencyCompetency of borderline students of a specific intake. The use of item-judgment methods, specifically practiced with modified AngoffAngoff method in written test of knowledge, offers a significant improvement compared to adopting to fixed pass rate decided randomly. With all reservations and opinions, modified AngoffAngoff method creates a fairer and credible testing process. Setting up of standard using the borderline regression methodBorderline regression method (BRM) (BRM) is an acceptable and feasible process that can be defended to determine the cut scoreCut scores to gauge the performance-based test of OSCEObjective structured clinical examinations (OSCEs) that has patient and examiner encounter and two types of scores, such as the global scores the checklist score have been compiled. A set standard in assessmentAssessment yields cut-off number as the expression of professional values in a particular contextContexts, which must have been obtained through a value-added process and consensusConsensus of experts to make logical decision.