[CME activities of medical journals: quality of multiple-choice questions as evaluation tool. Using the example of the German medical journals Deutsches Arzteblatt, Deutsche Medizinische Wochenschrift, and Der Internist].

BACKGROUND AND PURPOSE: The participation of doctors in Continuing Medical Education (CME) activities provided by medical journals increases. Therefore, their quality and efficacy need to be evaluated.

METHODS: This study evaluated the quality of the multiple-choice questions (MCQs) as evaluation tool of CME activities in three German medical journals (Der Internist, Deutsches Arzteblatt, Deutsche Medizinische Wochenschrift). In total, 390 MCQs were reviewed using evidence-based principles of effective item writing. The content quality of the MCQs was not evaluated in this study.

RESULTS: 264 (67.7%) of 390 MCQs contained flaws with 449 flaws in total. The proportion of flawed items was 60.8% in Deutsches Arzteblatt, 63.3% in Der Internist, and 77.9% in Deutsche Medizinische Wochenschrift. The most frequent flaws were clues (33.8%, Deutsches Arzteblatt), negatively worded stems (29.8%, Der Internist), and unfocused stems (24.7%, Deutsche Medizinische Wochenschrift). SCHLUSSFOLGERUNG: The problem of formal flaws in MCQs has an extensive relevance, as seen by the large number of studies related to this topic. The frequency of flaws (67.7%) was similar to recent studies. The distribution of the flaws suggests that with minor editing the quality of the MCQs could be substantially improved.

PERSPECTIVE: The use of high-quality evaluation tools is essential to invalidate the accusation of the trivialization of CME activities, irrespective of their social context.