Raising the Bar: Reassessing Standards for Procedural Competence

Background: How often passing standards for clinical skills examinations should be reexamined is unknown. Purpose: The goal is to determine if improved resident performance affects the passing standard imposed by expert judges. Method: In 2006, we set a passing standard for a central venous catheter insertion clinical skills examination using an expert panel. From 2007 to 2010, trainee scores improved steadily. In 2010, a new expert panel provided judgments for the examination using 4 consecutive years of resident performance data. Interrater reliabilities and test-retest reliability (stability) were calculated. Passing standards from 2006 and 2010 were compared. Results: Judgments provided were reliable and stable. The new passing standard was 88% for internal jugular and 87% for subclavian central venous catheter insertion compared to 79% for both sites in 2006. Conclusions: Cumulative performance data influenced experts to set a more stringent minimum passing standard. Standards should be regularly reviewed to ensure they are fair and appropriately rigorous.