Using the Judgments of Physician Examiners in Setting the Standards for a National Multi-center High Stakes OSCE

In 1994 and 1995, the Medical Council of Canada used an innovative approach to set the pass mark on its large scale, multi-center national OSCE which is designed to assess basic clinical and communication skills in physicians in Canada after 15 months of post-graduate medical training. The goal of this article is to describe the new approach and to present the experience with the method during its first two years of operation. The approach utilizes the global judgments of the physician examiners at each station to identify the candidates with borderline performances. The scores of the candidates whose performances are judged to be borderline are summed for each station, yielding an initial passing score for all stations and then the examination as a whole. The latter score is then adjusted upward one standard error of measurement for the final passing score and is used as one of the criteria to pass the examination. Based on the results to date, the new approach has worked well. The advantages, disadvantages and areas of possible refinement for the approach are reviewed.