A common approach to increase test security in higher educational high-stakes testing is the use of different test forms with identical items but different item orders. The effects of such varied item orders are relatively well studied, but findings have generally been mixed. When multiple test forms with different item orders are used, we argue…

The process proposed for the development and use of computer-based testing, including simulation and multiple-choice questions, as part of the National Board of Medical Examiners' certification sequence is outlined. Summary reports of first-phase pilot testing in six medical schools are appended. (MSE)