Setting defensible standards for cardiac auscultation skills in medical students.

Background: Cardiac auscultation is a critical clinical skill for physicians, but minimum performance standards do not exist.

Methods: One hundred third-year medical students from three schools completed a case-based computerized examination that assessed their ability to identify 12 major cardiac findings. Cohort performance was reviewed by a panel of expert judges who provided item-based (Angoff method) and group-based (Hofstee method) judgments on two occasions. Judges' ratings were used to calculate a minimum passing standard (MPS) for cardiac auscultation skills. Interrater reliabilities and test-retest reliability (stability) were calculated.

Results: Both methods produced reliable and stable data. Use of the Angoff method yielded a more lenient MPS than the Hofstee method. Two thirds of the students (66%) did not achieve the MPS.

Conclusions: Use of a defensible standard allows for reliable evaluation of cardiac auscultation skills. Further work is needed to improve the performance of this important clinical skill by medical students.