The ways in which standard-setting procedures are carried out in the medical specialty certification area are described. Three experiments that have been conducted with alternatives to currently used normative standards are examined, and reasons why these experiments have had limited success are suggested in this speech. The defensibility of normative as well as absolute standards is also discussed. The predominant pattern in terms of standard-setting for written examination is to define a norming group, typically of candidates from good training backgrounds, and to fail a proportion of that group. Different Boards use different formulas for this, and the exact details of what was chosen are usually not made public. Thus the most widely used approach is normative. When oral examinations are used, the candidate must first pass the (normative) written examination, then the "absolute" oral, which is a hybrid normative-absolute standard. To the extent that they have been challenged in court, the standard- setting procedures used by the boards have been sustained. (SPG)