IntroductionArtificial intelligence (AI) holds promising potential for generating educational resources such as personalized assessments. Despite this appeal, the impact of AI-assisted multiple-choice question (MCQ) authoring on item quality and on teachers' editing behavior remains insufficiently studied.MethodsThis study (N = 152 items from 19 teachers) compares MCQ quality across three conditions—teacher-only (T), AI-only (AI), and teacher–AI collaboration (T-AI)—using a 19-criterion item-wri