This paper discusses the development and use of "item shells" in constructing multiple-choice tests. An item shell is a "hollow" item that contains the syntactic structure and context of an item without specific content. Item shells are empirically developed from successfully used items selected from an existing item pool. Use of item shells in item writing is a compromise between conventional methods, with considerable freedom in developing items, and the newer approaches, with little or no freedom in developing items. This paper evaluates the item shell technique from the standpoint of training item writers in health care professions. The following criteria were applied in the evaluation: difficulty, productivity, quality, helpfulness, satisfaction, editorial quality, and item performance. Most writers indicated that the quality of their items would remain the same using either method (conventional or item shells). Item shells were found useful for generating items in specific areas of need within a test item pool. Comments about ease of use were positive, though some suggested that the shells be used only in specific situations. The majority of item writers indicated that they could generate more items with item shells. Because the item shells were developed from previously edited items, items that adhered to the shells were editorially sound. The study concludes that further evaluation is needed. (JAZ)