Since the currently increasing proportion of problem-solving test items in both National Board of Medical Licensure and Specialty Board Examinations, valid measurement of the examinee s professional c ompetence becomes the utmost concern in various quallification examinations in medical community. However, appropriate guideline with regard to its construction techniques has not been referred in the literature. This article identified the existing misconcept in test item construction among facullty members and described methods to upgrade the knowledge level of individual items. The author developed the baseline skills accompanied with examples for construction of test items in each determined level of knowledge, and introduced the conversion technique of recall-type items to problem-solving ones. Construction of more practical test items instead of theoretical items was emphasized with/without providing raw data or pictorials. Replacement of simpe, recall-type of test items with problem-solving ones in written examinations should be encouraged not only in the National Licesure and Specialty Board Examinations but also during every MD-programs. It is also stressed that the examination should reflect the situation much close to the real clinical setting by application of raw data/pictorials identical in practical clinical and laboratory situations which encourage the examinees to reinforce their learning habit form theory-based learning to problem-based ones.