In 1972, faculty from a number of anesthesiology residency programs began working together to develop a formal knowledge assessment tool to support resident education. This group became the Inter-Hospital Study Group for Anesthesia Education (IHSGAE), which was incorporated as a not-for-profit organization in 1986. IHSGAE is a volunteer organization whose members are anesthesiology physician-educators from accredited anesthesiology residency programs in the United States.

Following a several year period of development and pilot testing, a formative examination designed to assess learning during the first month of anesthesiology residency became available to residency programs. Initially named The First Month Resident Examination in Anesthesiology and Cardiopulmonary Resuscitation, this examination was re-named the Anesthesia Knowledge Test-1 (AKT-1) in 1977.  The AKT-1 is a set of paired examinations designed to be given at the beginning and end of the first month of clinical anesthesiology residency.  Administered as a pre-test and post-test, the examinations assess baseline knowledge of anesthesiology and the growth of knowledge during the first 4-6 weeks of clinical training.

In 1986, the Anesthesia Knowledge Test-6 (AKT-6), was introduced to assess knowledge after 6 months of clinical anesthesia training.  An examination to test knowledge in 7 subspecialty areas of anesthesiology was developed in 2001, with the first round of testing occurring during the 2001-2002 academic year. This examination was initially designed to be administered after 18 months of clinical anesthesia training and was named the Anesthesia Knowledge Test-18 (AKT-18).  In 2009, the timing of the examination was moved to 24 months of clinical anesthesia training and the name was changed to the AKT-24.  This change allowed all candidates taking the examination to have completed rotations in all the subspecialty areas by the time they were tested.

From the introduction of the AKT series until 2017, Metrics Associates, Inc provided psychometric and technical support for the examinations.  In June 2017, internet-based testing began for the AKT examinations.  Since June 2017, PSI/AMP has provided the psychometric and technical support for the examinations.  The AKT examinations are available for use by residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the Royal College of Physicians and Surgeons of Canada.