Procedures for establishing defensible absolute passing scores on performance examinations in health professions education

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. Summary: 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.