Stage A Histopathology Examination

The Stage A Histopathology Examination is for Histopathology trainees in ST1/Stage A of an approved training programme. The examination is designed to test a candidate’s applied knowledge and skills relevant to the Stage A Histopathology curriculum.

The examination will take the format of an OSPE examination with 15 stations, which are made up of 13 question stations and two rest stations. Candidates will move around each station. After the completion of each station, candidates must post their answer sheet(s) into the ballot-style box or envelope provided. Candidates will not be allowed to access examination material during the rest stations. The examination will last for approximately three hours. There will be internal and external examiners present for the duration of the examination.

The questions will be fixed to the stations. Digital images are included. Slides and/or macroscopic or microscopic photographs will be provided at some stations, where candidates may be asked to write brief comments or make verbal comments in response to specific questions or a particular topic. Candidates may be asked to discuss at least one slide over a double-headed microscope with the assessor/examiner, who will test the ability to discuss a clinical problem. The communication stations could include histology and/or diagnostic cytology. Unless otherwise notified, it is the responsibility of the examiner to ensure all necessary materials and equipment are available at the candidate’s disposal.

Each question will give an indication of what materials are required (if any) and whether an examiner will be present for the candidate to enter into discussions with. An indication of the maximum amount of marks achievable will be given for each section of a question.

Standard setting the Histopathology Stage A Examination


For the Histopathology Stage A Examination, the standard will be set using the Borderline Group Method (BGM).


The examiners who will derive the standard are knowledgeable in the content area. All the regional and deputy members of the Histopathology Stage A Examination Panel are practitioners in the relevant field – familiar with the Stage A Histopathology curriculum and are involved in the educational process of ST1 histopathology trainees.


a. What is the BGM?

The BGM is a credible and defensible method of standard setting and is well suited to an OSPE examination. It is a robust system as the assessors decide what the minimum acceptable standards are whilst they are assessing the candidates.

The BGM utilises the expert judgement of the assessors to make a ‘global’ judgement as to whether a candidate has passed, failed or has reached a borderline standard in the particular station or question that each assessor is marking. These judgements are then used as a means of determining the pass mark. This method is based on the idea that the passing score is the borderline between an acceptable and an unacceptable level of competence.

Borderline candidates are those who, in the opinion of the examiners, would ‘just barely’ meet the performance criteria. In addition, a borderline candidate can be described as demonstrating variable understanding of a case, lacking insight and intuition, applying information inconsistently or without justification and presenting discrepancies in management plans.

Most examiners feel comfortable about identifying performance that is a good pass and that which is unacceptable, a clear fail. Borderline candidates are those who fall in between these categories, whom the examiner finds difficulty in placing in either category.


The main advantages of the BGM are that:

  • it is simple to use and to explain
  • a large number of examiners set a collective standard while observing the candidates – it is not just an academic exercise
  • those candidates on the borderline are usually a small percentage of all those who take the examination
  • it is reliable – the cut-off score is based on large sample of judgments
  • it is credible and defensible – it is based on expert judgment in direct observation.


The main disadvantages are that:

  • the success of the method depends on the accuracy of the examiners in identifying borderline performance on questions
  • it depends on the absence of significant differences among the different examiners
  • passing scores are not known in advance
  • it is difficult to keep judgments about pass or fail independent of checklist scoring
  • it requires expert processing of marks immediately after the examination


The examination paper will consist of a mixture of previously validated and new questions confirmed by the Histopathology Stage A Examination Panel.

The data collected from each candidate will enable a pass mark to be calculated using the borderline group method (BGM) after the examination. The BGM scores and the grading for each question for each candidate will be collated by the College after the examination. Organisers at each centre will provide these to the College within an agreed timeframe. The College will implement the BGM and determine the overall provisional pass mark which is ‘the mean of the performance scores of candidates who have been identified by the examiners as 'borderline’ for each question. The overall provisional pass mark is the aggregated score of the pass marks for each question.


There are two criteria required to pass the examination. Trainees must pass a minimum number of stations and also achieve a score on or above the pass mark. The minimum number of stations required and the global pass mark will be determined by the Histopathology Stage A Examination Panel during the standard setting process.

For each station, the individual pass mark, derived from the BGM method will be considered and the station pass mark adjusted accordingly following specialist and expert advice.


1. Norcini, JJ. Setting standards on educational tests. Med Educ 2003;37(5):464–469.