Description and impact of using a standard-setting method for determining pass/fail scores in a surgery clerkship

Background: Research on performance evaluation highlights the importance of using multiple measures to develop an accurate profile of students, yet we found no literature describing the use of a standard-setting method for determining a pass/fail cutoff for a clerkship based on multiple assessment methods. Method: Steps in setting an absolute standard for a pass/fail grade are described. The new cut-off score was used to compare what decisions would have been made had it been applied in previous clerkships. Results: We successfully applied the Hofstee method to ascertain a new standard pass/fail cutoff for our total surgery clerkship score. Had this absolute score been used in 4 prior clerkships, 150 instead of 152 would have passed the clerkship, and 10 instead of 8 would have failed the clerkship. Conclusions: A standard-setting method can be applied to a final clinical clerkship grade even when multiple performance measures are used.