In this study, Senior Measurement Scientist Christopher Runyon, PhD, Director of Research Polina Harik, PhD, and their coauthors looked at a new 2-step item format called SHARP (SHort Answer, Rationale Provision).

In collaboration with physician-educators, they integrated short-answer questions into a patient medical record–based item starting in October 2021 and arrived at an innovative item format in December 2021. This format asks test-taker to interpret patient medical record data to make a clinical decision, type in their response, and pinpoint medical record details that justify their answers. In January 2022, a total of 177 fourth-year medical students, representing 20 U.S. medical schools, completed 35 SHARP items in a proof-of-concept study.