title: Procedures for establishing defensible absolute passing scores on performance examinations in health professions education.
abstract: BACKGROUND
  Establishing credible, defensible, and acceptable passing scores for performance-type examinations in real-world settings is a challenge for health professions educators. Our purpose in this article is to provide step-by-step instructions with worked examples for 5 absolute standard-setting methods that can be used to establish acceptable passing scores for performance examinations such as Objective Structured Clinical Examinations or standardized patient encounters.
  
  
  CONCLUSIONS
  All standards reflect the subjective opinions of experts. In this "how-to" article, we demonstrate procedures for systematically capturing these expert opinions using 5 research-based methods (Angoff, Ebel, Hofstee, Borderline Group, and Contrasting Groups). We discuss issues relating to selection of judges, use of performance data, and decision-making processes.
  
  
  CONCLUSIONS
  Different standard-setting methods produce different passing scores; there is no "gold standard." The key to defensible standards lies in the choice of credible judges and in the use of a systematic approach to collecting their judgments. Ultimately, all standards are policy decisions.
authors.affiliation: Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois 60612-7309, USA. sdowning@uic.edu
authors.forename: Steven M
authors.initials: SM
authors.lastname: Downing
authors.forename: Ara
authors.initials: A
authors.lastname: Tekian
authors.forename: Rachel
authors.initials: R
authors.lastname: Yudkowsky
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004501:Education, Medical / Q000592:standards*; D004521:Educational Measurement / Q000379:methods* / Q000592:standards; D006281:Health Occupations / Q000193:education*; D006801:Humans; D007600:Judgment; D016730:Program Development; D013663:Teaching / Q000592:standards*