[Structure of text and multiple-choice questions in continuing medical education (CME) in two specialist journals]

In Germany, accredited CME articles have to present ten multiple-choice questions (MCQs) per article for knowledge assessment [1]. It was the aim of this study to describe the selection of key messages for construction of MCQs and their relation to clinical relevance of the content.

23 CME articles in two specialist journals (Der Orthopäde [The Orthopedist] and Der Unfallchirurg [The Trauma Surgeon]) were analyzed. First, the key messages of the text as marked by the authors were identified, and then, a subset of top key messages was selected on the basis of clinical relevance. This was followed by a description, to what extent both sets of messages had been used for the construction of MCQs.

1,333 key messages were identified which could have been used for 1,048 test items in 216 MCQs. 256 key messages had never been used in MCQs. 434 key messages had been used as clinically meaningful distractors and 235 as senseless distractors, respectively. In only 144 cases, the key message was the topic of the MCQ. Even top key messages could only be found in 23-90% of the test items of MCQs, which had a key message as topic.

Specialist CME in print media contains too much information to be adequately mirrored in the limited number of MCQs. However, the more deliberate use of key messages in the MCQs could yield a better result compared to the present situation.