Standard-setting in written and interactive (oral) specialty certification examinations: issues, models, methods, challenges.

This article addresses standard-setting for written and interactive (oral) examinations in the health professions. The currently used methods are explained and classified, and their strengths and weaknesses are discussed. We argue that standard-setting must be understood as an interactive system involving decision maker(s), subject area, and methods. Thus, standard-setting is a psychological/social psychological process as well as a psychometric one. It rests upon a foundation of judgment. For written examinations, normative and content-referenced (absolute) methods are discussed. In interactive examinations, judges' standards are inherently absolute; design considerations are presented to systematize the context for these judgments.