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About
Setting standards and leading innovation for the practice of anesthesiology since 1938
Assessing anesthesiologists against a gold standard is a tremendous responsibility that the American Board of Anesthesiology (ABA) does not take lightly. Anesthesiologists make critical decisions every day, and certification must reflect the high level of judgment and readiness those decisions demand.
While examinations are the most obvious representation of our mission, they signify only a portion of the work required to assess an entire specialty at a national scale. Behind every candidate is a year-round system built around rigorous standards and professional expertise. Together, these elements underpin trust in ABA certification, ensuring it earns its distinction.
The Anatomy of ABA Assessments
The ABA’s initial assessments include In-Training Exams (ITE), initial certification exams and subspecialty exams. These assessments evaluate candidates’ readiness to advance at each stage of professional development.
Encompassing initial and subspecialty certification, the ABA assesses approximately 16,000 physicians per year in exams spanning multiple formats. The written exams, which are computer-based and multiple choice, begin with voluntary, formative ITEs in each year of residency to evaluate residents’ learning over time. Initial certification encompasses two written exams, the BASIC and ADVANCED, followed by our in-person APPLIED Exam, which consists of the Standard Oral Examination (SOE) and Objective Structured Clinical Exam (OSCE). Additionally, the ABA administers four subspecialty written exams: Adult Cardiac Anesthesiology, Critical Care Medicine, Pain Medicine and Pediatric Anesthesiology.
Building the Exams: Physicians at the Center
These exams are meticulously designed with a focus on reliability, validity and expert oversight. ABA staff and board-certified anesthesiologist volunteers develop and refine more than 2,200 new exam questions annually before they ever appear on an exam, as well as dozens of new standardized oral and simulation scenarios for the APPLIED Exam. Altogether, staff and volunteers review about 4,000 written exam items per year and revise about 1,200. By regularly reviewing and revising items, we ensure our assessments remain current on the latest advancements and developments in the specialty.
ABA assessments reach thousands of candidates and hundreds of programs nationwide, carrying implications for future patient care far beyond the exam. Accordingly, we embrace intentionality and attention to detail at every step of development and delivery.
This process is collaborative, requiring careful coordination between volunteers and staff. The ABA brings together more than 700 board-certified anesthesiologist volunteers, most of whom serve as item writers, editors and APPLIED examiners. While much of the item development work is accomplished remotely in an online item banking system, the ABA also hosts assessment development volunteers in person to cultivate the deep discussion and mentorship that helps resolve complex questions and maintain consistency in exam development.
Volunteer authors and editors collaborate to draft, edit and refine exam content. We encourage expert judgment as a cornerstone quality control measure. Our volunteers develop content to assess the knowledge and skills that matter most for optimal patient care. They ensure questions and case-based scenarios reflect clinical practice, reevaluating exam items across every review cycle and each time they appear on an exam. Committee members debate topics and cite references to reach consensus.
A subset of question authors progresses to become editors and committee members over time, which helps sustain continuity even as assessments evolve. Exam editors on ABA staff provide an additional level of proofreading oversight, making sure ideas are communicated clearly.
Comprehensive Review, Informed by Research and Results
The review process doesn’t end when an item appears on an exam. After candidates complete their assessments, the ABA’s psychometricians analyze item-level performance data. They then flag questions that fall outside acceptable ranges for difficulty or discrimination, meaning items that nearly everyone got right or wrong, or that failed to distinguish higher-performing candidates from lower-performing ones. Flagged items are brought to key validation webinars, where panels of board-certified anesthesiologists review the statistical evidence and re-validate the medical evidence and references before deciding whether to remove the question before scoring. This ongoing cycle ensures that the exam continues to reflect the realities of current clinical practice.
“What makes this process meaningful is that the statistics alone don’t make the call,” said Chief Assessment Officer Ann Harman, PhD. “The psychometric data tells us which items deserve a second look, but it’s the board-certified anesthesiologists in the room who bring the clinical context and expertise to explain why an item likely behaved the way it did. That marriage of statistical evidence and clinical judgment is what gives us confidence in the decisions we make.”
ABA staff constructs written exams according to established blueprints, after which committees review and align on content. Staff finalizes the written exams for delivery through copy editing, formatting and extensive quality control prior to publication.
Staff also assembles oral and simulation-based exams for the APPLIED Exam with standardized cases, prompts and criteria, cross-referencing exam content with assessment intent and test development principles. Our teams administer the APPLIED Exam to approximately 2,500 candidates per year and coordinate assignments for more than 460 examiners. For the OSCE portion of the exam, introduced in 2018 to evaluate communication, judgment and technical skills, ABA staff recruits, selects, trains and coordinates scheduling for standardized patient actors, as well as examiners and candidates.
Administering Exams Across Varying Circumstances
Successful assessment delivery relies on dependable processes and steady administration. ABA staff manages complex logistics year‑round, responding to individual circumstances and resolving issues as they emerge.
Our team manages item banking systems, registration platforms and delivery tools to facilitate assessments, often balancing individual circumstances with fixed constraints. We collaborate with a nationwide network of testing centers to administer written exams and advocate on candidates’ behalf when needed. As the final step in initial certification, candidates take the oral APPLIED Exam at the AIME Center, where staff manages schedules and logistics for six scheduled exam weeks per year.
The ABA makes accommodations to establish some flexibility without compromising rigor, in alignment with ADA requirements and with consideration of individual circumstances. In some cases, candidates may not be able to make scheduled exam days. If they provide documentation for military, medical or religious conflicts, the ABA can provide alternative scheduling options as needed. For instance, we might need to reschedule a candidate’s exam to accommodate the Jewish Sabbath or coordinate international written exams for military candidates stationed overseas.
Despite the best laid plans, issues can still arise that can hinder candidates’ ability to take their exams, such as a weather-related closure at one of our partner testing centers. ABA staff is well-versed in our policies and triages between key stakeholders to clear these obstacles. In some cases, our team intervenes directly with testing vendors or center administrators to negotiate alternative appointments, extend testing windows or problem-solve in real time. When it’s most successful, this work remains largely invisible, but it plays a pivotal role in upholding fairness and trust in our assessments.
To learn more about how ABA assessments ensure excellence in anesthesiology, click here.
The Future State of Assessments
The ABA’s vision is to transform certification to shape the future of anesthesiology. To achieve that, the Board of Directors has identified seven strategies and more than 30 initiatives that make up our Strategic Plan. As we look to the future, the ABA is on its way to developing an innovative, digital-first assessment ecosystem to support training, initial and subspecialty certification and continuing certification. “Digital-first” refers to an approach where the entire assessment process, from development and delivery to scoring and feedback, leverages digital technologies.
Evaluating a specialty requires sustained investment in the people and systems that work together year-round to make it possible. Every assessment decision carries heavy weight, with certification influencing patient safety and professional standing throughout an anesthesiologist’s career. As the certifying board for anesthesiology, with a mission to advance the highest standards of practice, the ABA assesses candidates with the utmost respect and care, at every step of the way.
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About the American Board of Anesthesiology
The American Board of Anesthesiology (ABA) has served as the certifying body for anesthesiologists since 1938, partnering with physicians to elevate the specialty. Our mission is to advance the highest standards of the practice of anesthesiology. We administer initial and subspecialty certification exams and the MOCA continuing certification program, which facilitates lifelong learning with a focus on quality and safety.
The ABA’s work extends far beyond assessment. We prioritize innovation, research, technology and programming that promote exceptional patient care and clinical outcomes. Our dedicated staff collaborates with more than 700 board-certified anesthesiologist volunteers who develop exam and MOCA content, inform policy, serve as examiners and provide critical feedback. Their contributions across numerous committees and task forces drive the ABA’s strategic progress and help shape the future of the specialty.
Based in Raleigh, NC, we are a nonprofit organization and a Member Board of the American Board of Medical Specialties (ABMS).
