Standard setting for clinical competence at graduation from medical school: a comparison of passing scores across five medical schools.

While Objective Structured Clinical Examinations (OSCEs) have become widely used to assess clinical competence at the end of undergraduate medical courses, the method of setting the passing score varies greatly, and there is no agreed best methodology. While there is an assumption that the passing standard at graduation is the same at all medical schools, there is very little quantitative evidence in the field. In the United Kingdom, there is no national licensing examination; each medical school sets its own graduating assessment and successful completion by candidates leads to the licensed right to practice by the General Medical Council. Academics at five UK medical school were asked to set passing scores for six OSCE stations using the Angoff method, following a briefing session on this technique. The results were collated and analysed. The passing scores set for the each of the stations varied widely across the five medical schools. The implication for individual students at the different medical schools is that a student with the same level of competency may pass at one medical school but would fail at another even when the test is identical. Postulated reasons for this difference include different conceptions of the minimal level of competence acceptable for graduating students and the possible unsuitability of the Angoff method for performance based clinical tests.