Apart from its ability to assess appropriate cognitive skills, any assessment instrument should be able to withstand the scrutiny of content and construct validity, reliability, fidelity and at the same time discriminate the performance levels of the cohort being tested. We suggest that a well-constructed peer-reviewed multiple-choice question meets many of the educational requirements and advocate that this format be considered seriously when assessing students. Benefits of automated marking, and potentially high reliability at low cost make MCQs a viable option when writing high stakes assessments in clinical medicine.