The training, evaluation and certification of medical personnel is an important area in which the use of technology to produce realistic simulations of work activity is burgeoning. The Patient Management Problem (PMP) format, despite recognized limitations, has continued to be used by prestigious credentialing bodies such as the National Board of Medical Examiners (NBME) and ETS. Its face validity also has appeal in non-medical areas, particularly in the context of the current recognition that problem-solving is an important performance dimension that is not being tapped by traditional measurement formats. This paper summarizes the psychometric literature associated with PMPs, discusses recent developments in clinical problem-solving and outlines an approach for integrating these developments with those occurring in psychometrics, most notably, Item Response Theory (IRT). The results of preliminary investigations conducted to gain additional insights are presented together with recommendations for next steps to be pursued.