Do We Know Who the Person With the Borderline Score is, in Standard-Setting and Decision-Making

When assessing clinical competence, health professional educators use assessments of knowledge attainment, skills acquisition, and professional development, which impact on decision-making for student’s training progression. Given the impact of progression-failure, it is critical that the expected standard of performance is derived accurately, fairly, and transparently, and that the rating of student performance is performed within the highest standards achievable. There is ongoing disagreement as to the most appropriate methods to address both standard setting and decision-making. The borderline candidate has been debated extensively in the academic and educational setting, with ongoing disagreement surrounding the concept. In this paper, we discuss further perspectives on the use of the borderline candidate, as part of the process for standard-setting, to give insights into how we can reframe the concept more accurately and apply it more appropriately. Drawing parallels to Kane’s validity framework, we consider the concept of the borderline candidate from four different perspectives: ‘what is’-what are the linguistics and implications behind the phrase ‘borderline candidate’; ‘who is’-who is the borderline candidate; decided ‘by whom’-who is the person making the judgement; and ‘under what circumstances’-the context of the assessment. Finally, we translate the theoretical discussion into pragmatic and practical solutions in standard-setting practice