Journal of Educational Evaluation for Health Professions

Research articles

Comparing the cut score for the borderline group method and borderline regression method with norm-referenced standard setting in an objective structured clinical examination in medical school in Korea: Song Yi Park, Sang-Hwa Lee, Min-Jeong Kim, Ki-Hwan Ji, Ji Ho Ryu; J Educ Eval Health Prof. 2021;18:25. Published online September 27, 2021; DOI: https://doi.org/10.3352/jeehp.2021.18.25

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Purpose
Setting standards is critical in health professions. However, appropriate standard setting methods do not always apply to the set cut score in performance assessment. The aim of this study was to compare the cut score when the standard setting is changed from the norm-referenced method to the borderline group method (BGM) and borderline regression method (BRM) in an objective structured clinical examination (OSCE) in medical school.
Methods
This was an explorative study to model the implementation of the BGM and BRM. A total of 107 fourth-year medical students attended the OSCE at 7 stations for encountering standardized patients (SPs) and at 1 station for performing skills on a manikin on July 15th, 2021. Thirty-two physician examiners evaluated the performance by completing a checklist and global rating scales.
Results
The cut score of the norm-referenced method was lower than that of the BGM (P<0.01) and BRM (P<0.02). There was no significant difference in the cut score between the BGM and BRM (P=0.40). The station with the highest standard deviation and the highest proportion of the borderline group showed the largest cut score difference in standard setting methods.
Conclusion
Prefixed cut scores by the norm-referenced method without considering station contents or examinee performance can vary due to station difficulty and content, affecting the appropriateness of standard setting decisions. If there is an adequate consensus on the criteria for the borderline group, standard setting with the BRM could be applied as a practical and defensible method to determine the cut score for OSCE.

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Refining competency benchmarks: a scoping review of Angoff standard-setting in dental education
Galvin Sim Siang Lin, Abdul Rauf Badrul Hisham, Muhammad Nazmi Abdul Majid, Chan Choong Foong, Ting Khee Ho, Lara T. Friedlander
BMC Oral Health.2026;[Epub] CrossRef
Standard setting methods in objective structured clinical examination (OSCE): A comparative study of five methods
Reshma Ansari, Norhafizah Ab Manan, Nur Ain Mahat, Norfaizatul Shalida Omar, Atikah Abdul Latiff, Sara Idris, Azli Shahril Othman
Journal of Medical Education Development.2024; 17(56): 87. CrossRef
Analyzing the Quality of Objective Structured Clinical Examination in Alborz University of Medical Sciences
Suleiman Ahmadi, Amin Habibi, Mitra Rahimzadeh, Shahla Bahrami
Alborz University Medical Journal.2023; 12(4): 485. CrossRef
Possibility of using the yes/no Angoff method as a substitute for the percent Angoff method for estimating the cutoff score of the Korean Medical Licensing Examination: a simulation study
Janghee Park
Journal of Educational Evaluation for Health Professions.2022; 19: 23. CrossRef
Newly appointed medical faculty members’ self-evaluation of their educational roles at the Catholic University of Korea College of Medicine in 2020 and 2021: a cross-sectional survey-based study
Sun Kim, A Ra Cho, Chul Woon Chung
Journal of Educational Evaluation for Health Professions.2021; 18: 28. CrossRef

Similarity of the cut score in test sets with different item amounts using the modified Angoff, modified Ebel, and Hofstee standard-setting methods for the Korean Medical Licensing Examination: Janghee Park, Mi Kyoung Yim, Na Jin Kim, Duck Sun Ahn, Young-Min Kim; J Educ Eval Health Prof. 2020;17:28. Published online October 5, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.28

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Abstract PDF Supplementary Material

Purpose
The Korea Medical Licensing Exam (KMLE) typically contains a large number of items. The purpose of this study was to investigate whether there is a difference in the cut score between evaluating all items of the exam and evaluating only some items when conducting standard-setting.
Methods
We divided the item sets that appeared on 3 recent KMLEs for the past 3 years into 4 subsets of each year of 25% each based on their item content categories, discrimination index, and difficulty index. The entire panel of 15 members assessed all the items (360 items, 100%) of the year 2017. In split-half set 1, each item set contained 184 (51%) items of year 2018 and each set from split-half set 2 contained 182 (51%) items of the year 2019 using the same method. We used the modified Angoff, modified Ebel, and Hofstee methods in the standard-setting process.
Results
Less than a 1% cut score difference was observed when the same method was used to stratify item subsets containing 25%, 51%, or 100% of the entire set. When rating fewer items, higher rater reliability was observed.
Conclusion
When the entire item set was divided into equivalent subsets, assessing the exam using a portion of the item set (90 out of 360 items) yielded similar cut scores to those derived using the entire item set. There was a higher correlation between panelists’ individual assessments and the overall assessments.

Citations

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Standard setting for dental knowledge tests: reproducibility of the modified Angoff and Ebel method across judges
Ting Khee Ho, Noor Lide Abu Kassim, Lucy O’Malley, Reza Vahid Roudsari
BMC Medical Education.2025;[Epub] CrossRef
Angoff methods in standard setting in health professional education: a systematic review and meta-analysis
Kannan Sridharan, Gowri Sivaramakrishnan
BMC Medical Education.2025;[Epub] CrossRef
Application of computer-based testing in the Korean Medical Licensing Examination, the emergence of the metaverse in medical education, journal metrics and statistics, and appreciation to reviewers and volunteers
Sun Huh
Journal of Educational Evaluation for Health Professions.2022; 19: 2. CrossRef
Possibility of using the yes/no Angoff method as a substitute for the percent Angoff method for estimating the cutoff score of the Korean Medical Licensing Examination: a simulation study
Janghee Park
Journal of Educational Evaluation for Health Professions.2022; 19: 23. CrossRef
Equal Z standard-setting method to estimate the minimum number of panelists for a medical school’s objective structured clinical examination in Taiwan: a simulation study
Ying-Ying Yang, Pin-Hsiang Huang, Ling-Yu Yang, Chia-Chang Huang, Chih-Wei Liu, Shiau-Shian Huang, Chen-Huan Chen, Fa-Yauh Lee, Shou-Yen Kao, Boaz Shulruf
Journal of Educational Evaluation for Health Professions.2022; 19: 27. CrossRef
Possibility of independent use of the yes/no Angoff and Hofstee methods for the standard setting of the Korean Medical Licensing Examination written test: a descriptive study
Do-Hwan Kim, Ye Ji Kang, Hoon-Ki Park
Journal of Educational Evaluation for Health Professions.2022; 19: 33. CrossRef
Presidential address: Quarantine guidelines to protect examinees from coronavirus disease 2019, clinical skills examination for dental licensing, and computer-based testing for medical, dental, and oriental medicine licensing
Yoon-Seong Lee
Journal of Educational Evaluation for Health Professions.2021; 18: 1. CrossRef
Comparing the cut score for the borderline group method and borderline regression method with norm-referenced standard setting in an objective structured clinical examination in medical school in Korea
Song Yi Park, Sang-Hwa Lee, Min-Jeong Kim, Ki-Hwan Ji, Ji Ho Ryu
Journal of Educational Evaluation for Health Professions.2021; 18: 25. CrossRef

Using the Angoff method to set a standard on mock exams for the Korean Nursing Licensing Examination: Mi Kyoung Yim, Sujin Shin; J Educ Eval Health Prof. 2020;17:14. Published online April 22, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.14

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225 Download
15 Web of Science
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Abstract PDF Supplementary Material

Purpose
This study explored the possibility of using the Angoff method, in which panel experts determine the cut score of an exam, for the Korean Nursing Licensing Examination (KNLE). Two mock exams for the KNLE were analyzed. The Angoff standard setting procedure was conducted and the results were analyzed. We also aimed to examine the procedural validity of applying the Angoff method in this context.
Methods
For both mock exams, we set a pass-fail cut score using the Angoff method. The standard setting panel consisted of 16 nursing professors. After the Angoff procedure, the procedural validity of establishing the standard was evaluated by investigating the responses of the standard setters.
Results
The descriptions of the minimally competent person for the KNLE were presented at the levels of general and subject performance. The cut scores of first and second mock exams were 74.4 and 76.8, respectively. These were higher than the traditional cut score (60% of the total score of the KNLE). The panel survey showed very positive responses, with scores higher than 4 out of 5 points on a Likert scale.
Conclusion
The scores calculated for both mock tests were similar, and were much higher than the existing cut scores. In the second simulation, the standard deviation of the Angoff rating was lower than in the first simulation. According to the survey results, procedural validity was acceptable, as shown by a high level of confidence. The results show that determining cut scores by an expert panel is an applicable method.

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The Nursing Student Licensure Examination: A Scoping Review
Flavia Pantaleo, Alessandro Stievano, Chiara Mastroianni, Giorgia Petrucci, Natascia Mazzitelli, Michela Piredda, Maria Grazia De Marinis, Anna Marchetti
Nursing Reports.2025; 15(8): 299. CrossRef
Optimal cutoff score for the Malay version of parenting and child tooth brushing assessment (M-PACTA)
Yu Jie Chin, Jennifer Geraldine Doss, Sabri Musa, Danaee Mahmoud, Shani Ann Mani
BMC Oral Health.2025;[Epub] CrossRef
Angoff methods in standard setting in health professional education: a systematic review and meta-analysis
Kannan Sridharan, Gowri Sivaramakrishnan
BMC Medical Education.2025;[Epub] CrossRef
Comparing the passing rates of nursing students participating in the objective structured clinical examination using fixed score, Angoff, yes/no Angoff, and 3-level Angoff methods†
Fatemeh Maghsoodi, Mohammadreza Yazdankhahfard, Shahnaz Pouladi, Kamran Mirzaei, Amin Beigzadeh
Frontiers of Nursing.2025; 12(4): 511. CrossRef
Experts’ prediction of item difficulty of multiple-choice questions in the Ethiopian Undergraduate Medicine Licensure Examination
Shewatatek Gedamu Wonde, Tefera Tadesse, Belay Moges, Stefan K. Schauber
BMC Medical Education.2024;[Epub] CrossRef
Standard setting methods in objective structured clinical examination (OSCE): A comparative study of five methods
Reshma Ansari, Norhafizah Ab Manan, Nur Ain Mahat, Norfaizatul Shalida Omar, Atikah Abdul Latiff, Sara Idris, Azli Shahril Othman
Journal of Medical Education Development.2024; 17(56): 87. CrossRef
Comparing Estimated and Real Item Difficulty Using Multi-Facet Rasch Analysis
Ayfer SAYIN, Sebahat GÖREN
Eğitimde ve Psikolojide Ölçme ve Değerlendirme Dergisi.2023; 14(4): 440. CrossRef
Application of computer-based testing in the Korean Medical Licensing Examination, the emergence of the metaverse in medical education, journal metrics and statistics, and appreciation to reviewers and volunteers
Sun Huh
Journal of Educational Evaluation for Health Professions.2022; 19: 2. CrossRef
Possibility of using the yes/no Angoff method as a substitute for the percent Angoff method for estimating the cutoff score of the Korean Medical Licensing Examination: a simulation study
Janghee Park
Journal of Educational Evaluation for Health Professions.2022; 19: 23. CrossRef
Development of examination objectives based on nursing competency for the Korean Nursing Licensing Examination: a validity study
Sujin Shin, Gwang Suk Kim, Jun-Ah Song, Inyoung Lee
Journal of Educational Evaluation for Health Professions.2022; 19: 19. CrossRef
Possibility of independent use of the yes/no Angoff and Hofstee methods for the standard setting of the Korean Medical Licensing Examination written test: a descriptive study
Do-Hwan Kim, Ye Ji Kang, Hoon-Ki Park
Journal of Educational Evaluation for Health Professions.2022; 19: 33. CrossRef
Comparing the cut score for the borderline group method and borderline regression method with norm-referenced standard setting in an objective structured clinical examination in medical school in Korea
Song Yi Park, Sang-Hwa Lee, Min-Jeong Kim, Ki-Hwan Ji, Ji Ho Ryu
Journal of Educational Evaluation for Health Professions.2021; 18: 25. CrossRef

Comparison of standard-setting methods for the Korean Radiological Technologist Licensing Examination: Angoff, Ebel, bookmark, and Hofstee: Janghee Park, Duck-Sun Ahn, Mi Kyoung Yim, Jaehyoung Lee; J Educ Eval Health Prof. 2018;15:32. Published online December 26, 2018; DOI: https://doi.org/10.3352/jeehp.2018.15.32

22,231 View
274 Download
16 Web of Science
11 Crossref

Abstract PDF Supplementary Material

Purpose
This study aimed to compare the possible standard-setting methods for the Korean Radiological Technologist Licensing Examination, which has a fixed cut score, and to suggest the most appropriate method.
Methods
Six radiological technology professors set standards for 250 items on the Korean Radiological Technologist Licensing Examination administered in December 2016 using the Angoff, Ebel, bookmark, and Hofstee methods.
Results
With a maximum percentile score of 100, the cut score for the examination was 71.27 using the Angoff method, 62.2 using the Ebel method, 64.49 using the bookmark method, and 62 using the Hofstee method. Based on the Hofstee method, an acceptable cut score for the examination would be between 52.83 and 70, but the cut score was 71.27 using the Angoff method.
Conclusion
The above results suggest that the best standard-setting method to determine the cut score would be a panel discussion with the modified Angoff or Ebel method, with verification of the rated results by the Hofstee method. Since no standard-setting method has yet been adopted for the Korean Radiological Technologist Licensing Examination, this study will be able to provide practical guidance for introducing a standard-setting process.

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Third-Year Veterinary Student Academic Encumbrances and Tenacity: Navigating Clinical Skills Curricula and Assessment
Saundra H. Sample, Elpida Artemiou, Darlene J. Donszelmann, Cindy Adams
Journal of Veterinary Medical Education.2025; 52(3): 398. CrossRef
Standard setting for dental knowledge tests: reproducibility of the modified Angoff and Ebel method across judges
Ting Khee Ho, Noor Lide Abu Kassim, Lucy O’Malley, Reza Vahid Roudsari
BMC Medical Education.2025;[Epub] CrossRef
Angoff methods in standard setting in health professional education: a systematic review and meta-analysis
Kannan Sridharan, Gowri Sivaramakrishnan
BMC Medical Education.2025;[Epub] CrossRef
Setting standards for a diagnostic test of aviation English for student pilots
Maria Treadaway, John Read
Language Testing.2024; 41(3): 557. CrossRef
The challenges inherent with anchor-based approaches to the interpretation of important change in clinical outcome assessments
Kathleen W. Wyrwich, Geoffrey R. Norman
Quality of Life Research.2023; 32(5): 1239. CrossRef
Possibility of independent use of the yes/no Angoff and Hofstee methods for the standard setting of the Korean Medical Licensing Examination written test: a descriptive study
Do-Hwan Kim, Ye Ji Kang, Hoon-Ki Park
Journal of Educational Evaluation for Health Professions.2022; 19: 33. CrossRef
Comparison of the validity of bookmark and Angoff standard setting methods in medical performance tests
Majid Yousefi Afrashteh
BMC Medical Education.2021;[Epub] CrossRef
Comparing the cut score for the borderline group method and borderline regression method with norm-referenced standard setting in an objective structured clinical examination in medical school in Korea
Song Yi Park, Sang-Hwa Lee, Min-Jeong Kim, Ki-Hwan Ji, Ji Ho Ryu
Journal of Educational Evaluation for Health Professions.2021; 18: 25. CrossRef
Using the Angoff method to set a standard on mock exams for the Korean Nursing Licensing Examination
Mi Kyoung Yim, Sujin Shin
Journal of Educational Evaluation for Health Professions.2020; 17: 14. CrossRef
Performance of the Ebel standard-setting method for the spring 2019 Royal College of Physicians and Surgeons of Canada internal medicine certification examination consisting of multiple-choice questions
Jimmy Bourque, Haley Skinner, Jonathan Dupré, Maria Bacchus, Martha Ainslie, Irene W. Y. Ma, Gary Cole
Journal of Educational Evaluation for Health Professions.2020; 17: 12. CrossRef
Similarity of the cut score in test sets with different item amounts using the modified Angoff, modified Ebel, and Hofstee standard-setting methods for the Korean Medical Licensing Examination
Janghee Park, Mi Kyoung Yim, Na Jin Kim, Duck Sun Ahn, Young-Min Kim
Journal of Educational Evaluation for Health Professions.2020; 17: 28. CrossRef

Review Articles

Reconsidering the Cut Score of Korean National Medical Licensing Examination: Duck Sun Ahn, Sowon Ahn; J Educ Eval Health Prof. 2007;4:1. Published online April 28, 2007; DOI: https://doi.org/10.3352/jeehp.2007.4.1

44,694 View
181 Download
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Abstract PDF

After briefly reviewing theories of standard setting we analyzed the problems of the current cut scores. Then, we reported the results of need assessment on the standard setting among medical educators and psychometricians. Analyses of the standard setting methods of developed countries were reported as well. Based on these findings, we suggested the Bookmark and the modified Angoff methods as alternative methods for setting standard. Possible problems and challenges were discussed when these methods were applied to the National Medical Licensing Examination.

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Licentiate Examinations in English Speaking Developed Countries USA, UK as Against Proposed National Exit Test (NExT) as a Licentiate Examination in India – A Narrative Review
Neelam Mishra, Shubhada Gade, Vedprakash Mishra, Gaurav Mishra
Journal of Datta Meghe Institute of Medical Sciences University.2025; 20(3): 470. CrossRef
Predicting medical graduates’ clinical performance using national competency examination results in Indonesia
Prattama Santoso Utomo, Amandha Boy Timor Randita, Rilani Riskiyana, Felicia Kurniawan, Irwin Aras, Cholis Abrori, Gandes Retno Rahayu
BMC Medical Education.2022;[Epub] CrossRef
Possibility of independent use of the yes/no Angoff and Hofstee methods for the standard setting of the Korean Medical Licensing Examination written test: a descriptive study
Do-Hwan Kim, Ye Ji Kang, Hoon-Ki Park
Journal of Educational Evaluation for Health Professions.2022; 19: 33. CrossRef
Applying the Bookmark method to medical education: Standard setting for an aseptic technique station
Monica L. Lypson, Steven M. Downing, Larry D. Gruppen, Rachel Yudkowsky
Medical Teacher.2013; 35(7): 581. CrossRef
Standard Setting in Student Assessment: Is a Defensible Method Yet to Come?
A Barman
Annals of the Academy of Medicine, Singapore.2008; 37(11): 957. CrossRef

A Pychometric Approach to Setting a Passing Score on Korean National Medical Licensing Examination: Guemin Lee; J Educ Eval Health Prof. 2004;1(1):5-14. Published online January 31, 2004; DOI: https://doi.org/10.3352/jeehp.2004.1.1.5

32,264 View
152 Download
5 Crossref

Abstract PDF

National Health Personnel Licensing Examination Board (hereafter NHPLEB) has used 60% correct responses of overall tests and 40% correct responses of each subject area test as a criterion to give physician licenses to satisfactory candidates. The 60%-40% criterion seems reasonable to laypersons without pychometric or measurement knowledge, but it may causes several severe problems on pychometrician's perspective. This paper pointed out several problematic cases that can be encountered by using the 60%-40% criterion, and provided several pychometric alternatives that could overcome these problems. A fairly new approach, named Bookmark standard setting method, was introduced and explained in detail as an example. This paper concluded with five considerations when the NHPLEB decides to adopt a pychometric standard setting approach to set a cutscore for a licensure test like medical licensing examination.

Citations

Citations to this article as recorded by

Analysis on Validity and Academic Competency of Mock Test for Korean Medicine National Licensing Examination Using Item Response Theory
Han Chae, Eunbyul Cho, SeonKyoung Kim, DaHye Choi, Seul Lee
Keimyung Medical Journal.2023; 42(1): 7. CrossRef
Using the Angoff method to set a standard on mock exams for the Korean Nursing Licensing Examination
Mi Kyoung Yim, Sujin Shin
Journal of Educational Evaluation for Health Professions.2020; 17: 14. CrossRef
Comparison of results between modified-Angoff and bookmark methods for estimating cut score of the Korean medical licensing examination
Mikyoung Yim
Korean Journal of Medical Education.2018; 30(4): 347. CrossRef
Presidential address: launching the Korea Health Personnel Licensing Examination Institute, a government-supported special foundation from December 23, 2015
Chang Hwi Kim
Journal of Educational Evaluation for Health Professions.2016; 13: 20. CrossRef
Reconsidering the Cut Score of Korean National Medical Licensing Examination
Duck Sun Ahn, Sowon Ahn
Journal of Educational Evaluation for Health Professions.2007; 4: 1. CrossRef

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