Multiple choice questions: their value as an assessment tool

Multiple choice questions are a well-established, reliable method of assessing knowledge and are used widely in postgraduate examinations in anaesthesiology. Like other methods of assessment they have their strengths and weaknesses. With the drive for revalidation and changes in undergraduate medical education much work has been done on devising valid, reliable and feasible methods of assessment of clinical practice including the need for the use of several different methods. Different multiple choice question formats have been devised and the importance of well-written multiple choice questions with clear assessment objectives recognized. There is controversy about the use of number-right as opposed to negative marking but, provided that the candidates know which marking system is being used, either method is satisfactory. The pass standard should be determined using criterion-based rather than norm-based referencing. Multiple choice questions could be used to validate continuing education and professional development from reading, possibly using web-based technology. For as long as there is a need to test knowledge in the assessment of doctors and medical undergraduates multiple choice questions will have a part to play, but only as one component of the assessment of clinical competence.