A competency-based approach to pass/fail decisions in an objective structured clinical examination: An observational study
BackgroundAny high-stakes assessment that leads to an important decision requires careful consideration in determining whether a student passes or fails. This observational study conducted in Erbil, Iraq, in June 2018 proposes a defensible pass/fail decision based on the number of failed competencies.MethodsResults were obtained for 150 medical students on their final objective structured clinical examination. Cutoff scores and pass/fail decisions were calculated using the modified Angoff, borderline, borderline-regression and holistic methods. The results were compared with each other and with a new competency method using Cohen’s kappa. Rasch analysis was used to compare the consistency of competency data with Rasch model estimates.ResultsThe competency method resulted in 40 (26.7%) students failing, compared with 76 (50.6%), 37 (24.6%), 35 (23.3%) and 13 (8%) for the modified Angoff, borderline, borderline regression and holistic methods, respectively. The competency method demonstrated a sufficient degree of fit to the Rasch model (mean outfit and infit statistics of 0.961 and 0.960, respectively).Conclusionsthe competency method was more stringent in determining pass/fail, compared with other standard-setting methods, except for the modified Angoff method. The fit of competency data to the Rasch model provides evidence for the validity and reliability of pass/fail decisions.