Extended‐matching items: A practical alternative to free‐response questions

This article describes an item format, termed extended matching, that is currently used for the United States Medical Licensing Examination (USMLE). Extended‐matching items are organized in sets that include several items with a single option list. In one common form of extended‐matching items, each item in a set describes a patient with the same chief complaint and requires the examinee to select the most likely diagnosis from a list of diagnoses associated with that chief complaint. This article outlines procedures for writing and reviewing these items, discusses the test development and psychometric advantages of the format, and reviews practical issues that arise in test administration and scoring. If items provide fairly detailed descriptions of patient situations and require examinees to make a diagnosis or specify the next step in patient care, the extended‐matching format can be used to challenge important clinical decision‐making skills. With its long option list, the format provides a good compromise between free‐response questions and traditional five‐option multiple‐choice items.