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The educationalists’ standard stranglehold

BMJ 2009; 338 doi: (Published 18 February 2009) Cite this as: BMJ 2009;338:b690
  1. Andy Levy, professor of endocrinology, Bristol University
  1. a.levy{at}

    In a norm referenced assessment a candidate’s success or failure depends on the performance of the other examinees. Theoretically, identical scores attained by candidates in sequential high and low achieving year groups might fail one year but pass the next. By contrast, in a criterion referenced exam, a candidate’s achievement is assessed independently of the performance of others by using clearly stated standards related to predetermined learning outcomes. All you need to do is to define with absolute clarity that fine and unwavering line across each skill, every element of knowledge and nuance of attitude that once rated and ordered, differentiates “a doctor” from “not a doctor.” Current dogma is that if you cannot make criterion referencing work you are not trying hard enough.

    In a 10 minute data interpretation station our 2008 MB ChB final exam candidates were asked to write a concise discharge summary from a complete set of clinical notes. The assessor—a senior, experienced, and earnest examiner, himself charged with leading a unit in the fourth year of the programme—marked a proportion of …

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