The MPRE is developed by a six-member drafting committee comprising recognized experts in the area of professional responsibility. Before a test item is selected for inclusion in the MPRE, it undergoes a multistage review process that occurs over the course of several years. Besides undergoing intensive reviews by the drafting committee and testing specialists, each test item is reviewed by other national and state experts.

All test items must successfully pass all reviews before they are included in the MPRE. After an MPRE examination is administered, the statistical performance of each test item is reviewed and evaluated by content and testing experts before the items are included in the computation of examinees' scores. This final statistical review is conducted to ensure that each test item is accurate and psychometrically sound.