Writers are provided details on the best practices in question development. Each draft question is reviewed by at least one other writer before entry into the database. Questions are then reviewed during an on-line international workshop for form, consistency, accuracy and appropriateness to domain, and modified as needed. Questions accepted by the workshop panel are then beta-tested alongside scored questions during an actual exam. The questions that perform well (according to psychometric best practice evaluation) can then be used in future exams. The selection of specific questions for each exam is done by Exam Form Reviewers.