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RESEARCH METHODOLOGY Procedures for Establishing Defensible Absolute Passing Scores on Performance Examinations in Health Professions Education Steven M. Downing Ara Tekian Rachel Yudkowsky Department of Medical Education University of Illinois at Chicago Chicago, Illinois, USA

Standard Setting Procedures

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Procedures for Establishing Defensible Absolute Passing Scores on Performance Examinations in Health Professions EducationSteven M. Downing Ara Tekian Rachel Yudkowsky Department of Medical Education University of Illinois at Chicago Chicago, Illinois, USA

Learning Objectives By the end of IP we should able to Describe standard setting methods Differentiate b/w their types Norm based Criterion based Relative Absolute

Know Passing Score Describe selection of Judges (examiners) Identify Borderline Examinee Understand each method

What do experts say?"We have come to realize that there is no objectively correct way to set standards. But we have also come to realize that there is nothing wrong with using judgments appropriately." (Zieky, 1995, p.5) "Determination of a minimum acceptable performance always involves some rather arbitrary and not wholly satisfactory decisions." (Ebel, 1972, p.492)

Why we need standard setting methods? To determine the standards of performance To separates the Non-competent from the Competent To provide an educational tool to decide CUT OFF POINT on the score scale (Reference AMEE Guide No. 18: Standard setting in student assessment)

essentials 1. choice of content expert 5-6 or 11- 12 2. identification of borderline examine 3. cut score

Choice of content expertJudges should be to Judge examinee performance Unbiased Follow the Instructions Understand their task Judges should be subject experts Belong from variable culture, ethics, religion and both genders ( male and female judges) 5 -12 judges panel is better.

Borderline examinee One who has 50 50 probability of passing or failing the test. Sometimes passes the exam and sometimes fails Or Judges will decide the characteristics of borderline examinee

Cut Score There is no gold standard for pass scores. Passing score is what ever the judges decide. Different panel of judges may decide different passing score for the same exam. It depends upon how much is enough to pass, the subject experts will decide by devising a check list / predetermined key or left it open on judges judgment.

Problem with judges Judges expect even more from borderline examinee They set unrealistically high standards which fails a reasonably high proportion of examinee e.g in viva (Examiners expectations are so high ) It happens when judges decide cut off without knowing the actual performance data.

How can we overcome this problem Celebration of judges by Providing student record showing their overall performance.

Student record

TestJan Feb Mar April May June Aug Sept Send up

TopicsThanatology Autopsy and exhumation Asphyxia PI and traumatology

MCQsFail Pass Pass Above Above

SAQsFail Fail Pass Above pass

OSPEbelow Pass Pass Excellent Very good

VIVAFail Fail Borderline Pass Good

Passing Rate0 Not done 1 poor 2 3 Below expectation 4 17 4 borderline 5 6 Meet expectation 35 7 7 Above expectation 3





no of passed students x 100 total no of students appeared 64/100x100 = 64%

Standards setting MethodsRelative Absolute relative absolute compromise method

Item based

Criterion based


Performance based

Norm based


Item based


Modified Angoff


Original Angoff

Judgments of the judges are combined to determine passing score

Angoff Method5 .80 .75 .65 .65 .70 .65 .70 .65 .43 .65 6 .95 .85 .60 .70 .85 .85 .90 .80 .55 .70

Item 1 2 3 4 5 6 7 8 9 10

7 M .85 0.86 .75 0.78 .60 0.59 .70 0.69 .80 0.78 .80 0.73 .60 0.63 .70 0.73 .45 0.48 .70 0.66 Sum 6.93 Pass Score is 69.30% Raw Passing Score = Sum of item means = 6.93. Percent Passing Score = 100% (sum of item means/number of items) = 100% (6.93/10) = 69.30%.

1 .80 .70 .50 .70 .75 .60 .50 .70 .45 .60

2 .87 .75 .63 .68 .70 .65 .58 .78 .50 .69

Rater 3 4 .85 .90 .80 .85 .55 .60 .70 .70 .80 .85 .80 .75 .55 .60 .75 .75 .50 .45 .65 .65

Angoff Passing Score

Angoffs method - 2 Read the first item Estimate the proportion of the borderline group that would respond correctly Record ratings, discuss, and change Repeat this for each item Calculate the passing score by adding rating score of each item separately (modified angoffs) e.g FCPS examinee has to satisfy all judges Adding performance of all stations (original angoff) OSCE

Ebels Method Judges define the check list and rating scale Categorize items like essential, important, acceptable Rate item like easy medium hard judges define the borderline performance to pass (0 100 %)

Ebels methodEasy Medium Hard




Ebels Method Judges make judgments about the percentages of items in each category that borderline test-takers would have answered correctly Calculate passing score

Ebels method%(borderline perform correctly)








Important Acceptable







Items Relevance

Easy Item # % correct

Medium Item # % correct

Hard Item # % correct

Weighted Mean


4 , 5






2(.93)+.81+.63= 3.30.89+.76+.59= 2.24








acceptable N/A




6 , 8


.62+2(.42)= 1.46

T. Mean

3.30 + 2.24 + 1.46 =


Passing rate = Total mean x 100 / no of items = 7 x 100 / 10 = 70% % correct is the mean judgment of all the judges , borderline examinee did correct.

AbsoluteCriterion based Norm based

Criterion referenced methods : Based on how much the examinees know Candidates pass or fail depending on whether they meet specified criteria In Criterion-referenced tests (or CRTs) performance of each examinee is compared to a pre-defined set of criteria or a standard. The goal with these tests is to determine whether or not the candidate has the demonstrated mastery of a certain skill or set of skills. E.g . A national board medical exam is an example of a CRT. Either the examinee has the skills to practice the profession, in which case he or she is licensed, or does not. e.g. examinees must correctly answer 70% of the questions REF : NORM-REFERENCED VS. CRITERION-REFERENCED TESTING May 22nd, 2008 by Danielle, Director of Sales and Marketing, Language Testing

Criterion referenced standardTest score distribution (average group)Test score distribution (poor group) Test score distribution (good group)

50 %

criterion based Based upon already set criteria e.g 33% passing score in FA,BA exams 50% passing score in MBBS exams 60% passing score at post graduation level 80% passing score in skilled exams.

Criterion based



Contrasting Groups Performance is judged by check list or rating scale. Students are divided into expert and nonexpert groups based on rating scale Graphical presentation . Passing score is set at the insertion of two distributions false positive and false negative.

Compromise Methods Advantages Easy to implement Educators are comfortable with the decisions

Disadvantages The cut score may not be in the area defined by the judges estimates The method is not the first choice in a high stakes testing situation

Borderline Group Examinee centered. Performance of the examine is judge overall. Faculty directly observe the performance E.g OSCE Each judge observe multiple examinee on same station. Judges use global rating scale 1= fail, 2= borderline, 3= pass The mean checklist score of borderline examinee becomes the passing score.

Types of Standards Norm referenced methods (NTR ) : Based on a comparison among the performances of examinees Or Compare examinee performance to that of other examinees. Standardized examinations such as the SAT are norm-referenced tests. The goal is to rank the set of examinees so that decisions about their opportunity for success (e.g. college entrance) can be made. e.g Normal distribution bells curve. A set proportion of candidates fails regardless of how well they perform e.g. the top 84% pass

Norm based: Cut off score is not pre defined Identify a group of passing and failing examinee by comparing their performance In OSCE there are 10 stations total Score 100, No of examinee is 05examinee 1score 100 50





Mean = 320/5x = 64 64 is cut off b/w pass and fail (REF: Medical Knowledge Using Progress Tests A.M.M. Muijtjens, R.J.I. Hoogenboom, G.M. Verwijnen, C.P.M. van der Vleuten)

Norm-referenced standardTest score distribution

30 %50 % 80 %

Hofstee Method (relative absolute compromise method) Judges are ask to define minimum and maximum passing score and failure rate .e.g 81 -100 % outstanding 71 80 % above expectation 61 70 % (max pass score) meet expectation 56 60 % top borderline 51 55 % (min pass score) bottom borderline 40 50 % below expectation 20 39 % perform incorrect 0 - 19 % dont know

Hofstee Method Graphical presentation Judges predefined Fail rate e.g min 6, max 20 students to fail. Acceptable Lowest pass score % Highest pass score % Min/max J 1 J- 2 J- 3 pass score Min 62 57 51 max 72 67 73

J -4 55 65

J -5 52 60

J -6 59 71

mean 56 68

Hofstee GraphMin Max pass %

56 %Cumulative %

68%Actual score

Max fail rate 20 %


Min fail rate 06 %


Compensatory Vs Non compensatoryCompensatory Poor performance on one station can be compensated by good performance on other stations. Overall score will be the avg of performance on all the station. E.g SAQs, MMI, OSCE Non compensatory Student should reach the minimum level of competence on each station. Student has to meet a predefined criteria on each station to pass. E.g OSATS, DOPS, Mini CEX

comparisonJudgment focused on Judgment require performance data No Direct observation Timing of judgememt


Test items / Performance


Before exam

EbelHofstee Border line Contrast

Test itemsWhole test Examinee performance Examinee performance

YesYes No No

NoNo Yes Yes

After examAfter exam During exam During exam

Summary :1. All standard-setting is judgmental 2. Standard-setting leads to errors of classification

3. Standard-setting is and will remain controversial4. There is no purely absolute standard.

5. There is no one right method6. Choosing judges is more important than choosing methods 7.

Summery . If the expert use rating scale or check list for assessment then you can choose borderline or contrasting method. If you dont have expert rating the exam then you can choose Angoff, eble or Hofstee method

Critique This article describes only the standard settings for performance based exam ie OSCE, OSATS, DOPS Classification of standards is some what confusing. Standards are overlapping no clear demarcation These methods can be applied with some modifications. Dose not discuss percentile method.

References AMEE guide No. 18 Berk, R.A. (1986). A consumer's guide to setting performance standards on criterion-referenced tests. Review of Educational Research, 56, 137-172. Cizek, G. J. (2001). Setting Performance Standards: Concepts, Methods, and Perspectives. Mahwah, NJ: Lawrence Erlbaum Associates. Jaeger, R.M. (1989). Certification of student competence. In R.L. Linn (Ed.), Educational Measurement. New York: American Council on Education and Macmillan Publishing Company. Kane, M. (1994). Validating the performance standards associated with passing scores. Review of Educational Research, 64, 425-461. Livingston, S.A. and Zeiky, M.J. (1982). Passing scores: A manual for setting standards of performance on educational and occupational tests. Princeton, NJ: Educational Testing Service.

References Norcini, J.J. and Guille, R.A. (2002). Combining tests and setting standards. In Norman, G., van der Vleuten, C., and Newble, D. (Eds.): International Handbook of Research in Medical Education (pp. 811-834). Dordrecht: Kluwer Press. Norcini, J. J. (2003). Setting standards on educational tests. Medical Education, 37, 464-469.

Norcini, J. J. & Shea, J. A. (1997). The credibility and comparability of standards. Applied Measurement in Education, 10, 39-59.Zeiky, M. J. (2001). So much has changed. How the setting of cutscores has evolved since the 1980s. In G.J.Cizek (Ed.), Setting Performance Standards: Concepts, Methods, and Perspectives (pp. 19-52). Mahwah, NJ: Lawrence Erlbaum Associates.