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Area of Science:

  • Health Professions Education
  • Assessment and Evaluation
  • Nursing Education

Background:

  • High-stakes health professions assessments require accurate discrimination between competent and non-competent practitioners.
  • Criterion-referenced standard-setting is preferred for these assessments, but options are limited for resource-intensive Objective Structured Clinical Examinations (OSCEs).
  • The modified borderline group method is feasible for large-scale OSCEs but less defensible for smaller ones.

Purpose of the Study:

  • To compare the decision accuracy and consistency of cut scores from the modified borderline group method (MBGM) with two adaptations for smaller OSCEs.
  • To evaluate the feasibility and defensibility of regression-based and 4-facet Rasch model adaptations of the borderline group method.

Main Methods:

  • Compared three standard-setting methods: modified borderline group method, regression-based borderline group method, and 4-facet Rasch model borderline group method.
  • Utilized data from a 12-station OSCE assessing 112 nurses for entry-to-practice in Canada.
  • Evaluated decision accuracy and consistency of calculated cut scores.

Main Results:

  • All three methods yielded acceptable cut scores (64-65%) for accuracy and consistency.
  • The modified borderline group method was most influenced by lower scores in the borderline group, resulting in the lowest cut score.
  • The regression-based and 4-facet Rasch model adaptations demonstrated potentially greater defensibility for smaller OSCEs.

Conclusions:

  • The modified borderline group method may be less suitable for smaller OSCEs (n < 100-150) due to its sensitivity to borderline group performance.
  • Regression-based and 4-facet Rasch model adaptations offer viable, more defensible alternatives for standard-setting in smaller-scale OSCEs.
  • These findings support the use of adapted borderline group methods to ensure valid and reliable assessments in nursing education.