This chapter addresses content development practices for credentialing examinations, presenting best practices and recognized industry standards. The content development process is an important component in the collection of evidence to support the validity of the credentialing decisions made through certification and licensure examinations. The multiple-choice item format is useful across an expansive range of content areas, in both educational and professional testing. It is an efficient item type that can usefully contribute to representative sampling of the content domain. Multiple-choice is still overwhelmingly the most prevalent item format on credentialing examinations. Nevertheless, in part due to computer-based testing (CBT), the number of item formats available is increasing. Licensure and certification programs may use a range of item formats, including performance testing or the computerized simulations. Performance assessments "are often complex in nature and generally require the test takers to demonstrate their abilities or skills in settings that closely resemble real-life situations".