Although standardized patients have been employed for formative assessment for over 40 years, their use in high-stakes medical licensure examinations has been a relatively recent phenomenon. As part of the medical licensure process in the United States and Canada, the clinical skills of medical students, medical school graduates, and residents are evaluated in a simulated clinical environment. All of the evaluations attempt to provide the public with some assurance that the person who achieves a passing score has the knowledge and/or requisite skills to provide safe and effective medical services. Although the various standardized patient-based licensure examinations differ somewhat in terms of purpose, content, and scope, they share many commonalities. More important, given the extensive research that was conducted to support these testing initiatives, combined with their success in promoting educational activities and in identifying individuals with clinical skills deficiencies, they provide a framework for validating new simulation modalities and extending simulation-based assessment into other areas.

Although the Angoff procedure is among the most widely used standard setting procedures for tests comprising multiple‐choice items, research has shown that subject matter experts have considerable difficulty accurately making the required judgments in the absence of examinee performance data. Some authors have viewed the need to provide performance data as a fatal flaw for the procedure; others have considered it appropriate for experts to integrate performance data into their judgments but have been concerned that experts may rely too heavily on the data. There have, however, been relatively few studies examining how experts use the data. This article reports on two studies that examine how experts modify their judgments after reviewing data. In both studies, data for some items were accurate and data for other items had been manipulated. Judges in both studies substantially modified their judgments whether the data were accurate or not.

USMLE Step 2 CK scores provide useful information about the odds a physician will receive an official sanction for problematic practice behavior. These results provide validity evidence supporting current interpretation and use of Step 2 CK scores.