Examination programs are facing increased scrutiny over differing pass rates and concerns about fairness. While maintaining test integrity has always been central to assessment design, today’s environment calls for renewed attention to quality, consistency, and transparency. This session explores how exam developers can build on established best practices to strengthen fairness and defensibility. We’ll discuss how personal perspective can shape item writing, review real-world examples of training that improved item development, and analyze sample questions to identify common issues. By emphasizing clarity, rigor, and professional responsibility at every stage of exam development, testing programs can enhance trust and demonstrate accountability to regulators and stakeholders.