Assessing Performance When the Stakes are High.

This paper is concerned with measuring achievement levels of medical students. Precise tools are needed to assess the readiness of an individual to practice. The basic question then becomes, what can this candidate do, at a given time, under given circumstances. Given the definition of the circumstances, and the candidate's performance, the necessary evaluation of competence can be made. The University of Illinois College of Medicine has developed the "Minimum Passing Level" (MPL), which is a score point which reflects the minimum level of performance a student must achieve to progress at the normal rate or to be certified as eligible for the degree Doctor of Medicine. Both multiple choice examinations and simulated problems in patient management are used. A performance level must be established by examiners for each item seperately. The options are weighted on each item and given a weight from high negative to high positive. After the essential positive options and the not allowable negative options have been identified, the option scores are summed to determine the minimum required passing level. Disadvantages include: (1) subjective judgements, and (2) confusion regarding results and methods. (author/KJ)