There are several factors that result in fluctuations in ABR initial certification exam pass/fail rates from year to year. Each cohort of residents who take the exam is unique, and some programs have noted the increasing challenges of training in a dynamic academic environment. ABR exams are criterion-referenced, not norm-referenced. They are not graded on a curve and there is no predetermined fail rate. Instead, the passing standard is set months in advance of the administration by a group of volunteers who assess the difficulty level of each question. By following prescribed and consistent processes for our exam development, delivery, and scoring, we make every effort to ensure that the exams and assessments we deliver meet rigorous standards. This methodology does not change significantly from year to year. While our intent is to support the profession by offering a rigorous credential supported by excellent comprehensive training, we do not seek to change the percentage of individuals who pass the test. We do all we can to keep exams and assessments as consistent as possible from year to year. The same test is never administered twice, but the content included is always developed by subject matter experts. ABR question writers are dedicated volunteers from private practice and academia who are committed to writing the best possible questions. The primary determiners of importance and relevance of specific questions are the developers of exam questions and practice analysis surveys. In the case of our initial certification exam materials, these developers are required to be clinically active and to represent a broad range of practice environments. Most important, the question-writing process requires multiple levels of review, including editorial content and analysis by subject matter experts. Once those are completed, each exam form is assembled by a multi-disciplinary committee to ensure that every question is appropriate and meets the exam’s objectives. The goal of these multiple levels of review is to remove or revise questions that might be ambiguous or otherwise potentially mislead the test taker. Once the exam is delivered, the scoring process allows us to evaluate each question individually to ensure that it meets our rigorous performance standards. Any questions that do not meet these standards are evaluated again by subject matter experts and may be eliminated from scoring. This added quality control is the reason it may take up to 10 weeks to compile and distribute the results. We appreciate the feedback we receive related to our exams. Anyone with ideas to improve our processes is invited to contact us at information@theabr.org or (520) 790-2900. One of the best ways to get involved is by being a volunteer on one of our committees, including those that generate exam questions. More information can be found on our website.