The American Board of Internal Medicine (ABIM) is implementing new methods for the development of examination content in response to feedback from the internal medicine community and in recognition that there is always room for improvement in the assessment of the skills and knowledge of practicing physicians. First, ABIM is exploring a new cognitive model-based approach to content development in efforts to improve exam relevancy. Second, ABIM has created a new Item-Writing Task Force in an effort to ensure a broad representation of internists from across the country who are engaged in all aspects of clinical practice. Through these mechanisms, the goal is the improved fairness and validity evidence of examinations that are relevant to how medicine is practiced today.