Summative assessment in professional higher education is important for student learning and making sound decisions about advancement and certification. Despite rigorous pre-test quality assurance procedures, problematic assessment items are always discovered post-test. This article examines the implementation of external peer review of items by clinicians in a six-year undergraduate medical programme. The purpose of the article is to identify to what extent clinicians consider multiple choice items to be acceptable for use in examinations, and what comments they provide on items they believe should be revised or not be used at all. 170 clinicians were recruited and reviewed 1353 multiple choice questions. Results showed that one out of five items reviewed were not approved. There were three main reasons for not approving items: (i) relevance of item content, (ii) accuracy of item content and (iii) technical item writing flaws. The article provides insight into a promising quality assurance procedure suitable for in-house examinations in professional higher education
