Interventions to Improve the Quality of Multiple-Choice Questions: A Systematic Review and Meta-Analysis

This article aimed to identify, review, and synthesize the literature on interventions to improve the quality of multiple-choice questions (MCQs) in health professions education and to evaluate the effectiveness of faculty training and peer review of items in enhancing item quality.

Both faculty training and peer review were found to improve MCQ quality, with peer review associated with a greater effect. Most studies were quasi-experimental and assessed item quality using objective metrics such as discrimination index, difficulty level, and distractor efficiency. Faculty training showed variable effectiveness depending on format and duration, with longitudinal workshops yielding more consistent improvements. Peer review interventions produced substantial gains in item quality. Meta-analysis of 6 eligible studies showed a significantly higher effect size for peer review (Cohen's d = 1.68) compared with faculty training (Cohen's d = 0.98). Resource-efficient approaches such as self-paced modules and targeted review of flawed items emerged as promising strategies.

Improving the quality of MCQs is critical for valid and reliable assessment in health professions education. A brief one-time faculty training workshop may yield limited benefits, whereas ongoing development programs and cost-effective alternatives can provide sustainable improvement. Institutions should prioritize evidence-based, resource-conscious approaches to faculty development and peer review as a routine component of MCQ quality assurance.