title: Setting defensible standards for cardiac auscultation skills in medical students.
abstract: BACKGROUND
  Cardiac auscultation is a critical clinical skill for physicians, but minimum performance standards do not exist.
  
  
  METHODS
  One hundred third-year medical students from three schools completed a case-based computerized examination that assessed their ability to identify 12 major cardiac findings. Cohort performance was reviewed by a panel of expert judges who provided item-based (Angoff method) and group-based (Hofstee method) judgments on two occasions. Judges' ratings were used to calculate a minimum passing standard (MPS) for cardiac auscultation skills. Interrater reliabilities and test-retest reliability (stability) were calculated.
  
  
  RESULTS
  Both methods produced reliable and stable data. Use of the Angoff method yielded a more lenient MPS than the Hofstee method. Two thirds of the students (66%) did not achieve the MPS.
  
  
  CONCLUSIONS
  Use of a defensible standard allows for reliable evaluation of cardiac auscultation skills. Further work is needed to improve the performance of this important clinical skill by medical students.
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Galter 3-150, 251 East Huron Street, Chicago, IL 60611, USA. dwayne@northwestern.edu
authors.forename: Diane B
authors.initials: DB
authors.lastname: Wayne
authors.forename: John
authors.initials: J
authors.lastname: Butter
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Cohen
authors.forename: William C
authors.initials: WC
authors.lastname: McGaghie
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement / Q000379:methods*; D006326:Heart Auscultation / Q000592:standards*; D013337:Students, Medical