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INTRODUCTION The Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions was first convened in 1985 in Ottawa. Since then, what has become known as the Ottawa conference has been held in various locations around the world every 2 years. It has become an important conference for the community of assessment - including researchers, educators, administrators and leaders - to share contemporary knowledge and develop international standards for assessment in medical and health professions education. METHODS The Ottawa 2022 conference was held in Lyon, France, in conjunction with the AMEE 2022 conference. A diverse group of international assessment experts were invited to present a symposium at the AMEE conference to summarise key concepts from the Ottawa conference. This paper was developed from that symposium. RESULTS AND DISCUSSION This paper summarises key themes and issues that emerged from the Ottawa 2022 conference. It highlights the importance of the consensus statements and discusses challenges for assessment such as issues of equity, diversity, and inclusion, shifts in emphasis to systems of assessment, implications of 'big data' and analytics, and challenges to ensure published research and practice are based on contemporary theories and concepts.