[The quality of CME questions as a component part of continuing medical education--an empirical study]

Changes in physician-training requirements have led to a significant increase in continuing medical education (CME) courses. Structured CME courses based on print media in combination with outcome evaluation offers one opportunity for earning credit points. On the international stage, CME courses are increasingly directed towards measurable patient benefit. Comparative assessment of quality and practical orientation in training courses is required.

Two hundred items in twenty training units from four established German medical journals were analysed for comparison-based evaluation. The criteria applied were training goals, as well as item construction, authors' requirements and question quality. The items were analyzed independently by two persons trained and experienced in preparing and reviewing items. The analyses from the two assessors were then compared, and any deviations were subjected to mutual consultation.

Question formulation showed weaknesses in all the training units. In 52% of the items a clear question was lacking, and all of the training units contained items with concealed hints indicating the correct answer. Only 10% of the questions were preceded by a cameo case study presenting a clinical scenario, and only 14.5% of the items asked for a correct clinical decision.

The CME questions from the medical journals selected show weaknesses in formulation, and mostly tested factual knowledge. Differences were revealed between publishing houses yielding insights into the requirements made of the authors by the publishers. The question preparation process is still deficient. Adherence to international standards in item construction may lead to an improvement in quality, which would also enhance the implicit transferability of content learned to actual clinical situations, thus improving the practical usefulness of training courses.