High-Stakes Assessment in Anesthesiology: The Design, Evidence, and Governance of American Board of Anesthesiology Certification.

The American Board of Anesthesiology's (ABA) assessment program has evolved from the written and oral examinations first administered in 1938 into the multimodal staged examination system that includes computer-based examinations, a standardized oral examination and an objective structured clinical examination. The psychometric practices that ensure the validity, fairness, and legal defensibility of the ABA's staged examination system are discussed and evidence from implementation and outcomes research are presented. The article also situates the ABA assessments within competency-based medical education and explores how emerging technologies, including AI, could enhance development, analytics, and feedback if governed with rigor and transparency.