Table 2

Overview of included studies

Author, year, country, and journalAimDesignParticipantsMain findingsQuality*
Arnold, 200552Identify factors that encourage or discourage student participation in peer assessmentQualitativen=61, medical students in years 1, 3 and 4The characteristics of the peer assessment system and the environment can encourage or discourage participation. Themes: (1) Students’ struggle with peer assessment, (2) Characteristics of a peer assessment system, and (3) Environmental factorsModerate
USAGrounded theory
Journal of General Internal MedicineFocus groups (16) at two medical schools
Cho, 201641Investigate the effect of peer-group size on competency-based skillsQuantitative Cluster Randomised clinical trialn=115, medical students in year 6Smaller groups (4.1) show more active and preferred than large groups (8,1). Group size did not impact scores.High
England
BMC Medical Education
Chou, 201339Examine the role of prior peer-learning relationships between students in their delivery and receipt of feedback on clinical communication skillsMixed methodn=72 medical students in year three with prior peer learning relationshipsStudents with prior peer learning relationships more likely to provide specific corrective feedback than those without prior relationships. No significant difference between groups regarding how feedback was received.Moderate
USACase–controln=36 students in control group with no prior peer relationships.
Medical EducationDescriptive statistics 
 Survey, video observations 
Cushing, 201135Investigate the benefits of formative peer feedback in communication skills and develop a training programme in peer feedbackMixed methodn=45 medical students in year 1Students valued the learning opportunity of both being examiner and observer. They preferred more in-depth feedback and feedback from tutors. They expressed anxiety about giving negative feedback to a peer and had mixed views on giving feedback (relaxed or pressured) and its use in clinical placements.High
UKQuestionnaire (20 items) at two occasions with 6 months in between.n=48 nursing students in year 1
Medical TeacherFocus groups (five medical- and two nurse students) 
Elshami, 201750Assess perception of formative peer assessmentQualitativen=19 (24†) diagnostic radiography students in year 3Formative peer assessment gives valuable feedback from same level or more experienced peers. Need for training and detailed rubrics.Moderate
United Arab EmiratesAction research
RadiographyFocus groups (3)
 Content analysis
Emke, 201738Demonstrate that perceptual errors related to professionalism behaviours can be detected early through repeated multisource feedbackQuantitativen=246 medical students in year 2Multiple peer assessments and feedback a tool predictor of unprofessional behaviour.Moderate
USA
Teaching and Learning in Medicine
Iqbal, 201636Explore students’ and tutors’ perception of key collaborative behaviours that impact collaborative learning and interactionQualitativen=22 medical students in year one and twoBeing respectful, giving constructive feedback, and being engaged and prepared had positive impact on both learning and group interaction. Passiveness, unreliability, irresponsibility, and condescending attitudes had a negative impact on learning and interaction. Similar results from teachers.High
AustraliaFocus groups (5) with studentsn=8 teachers
BMC Medical EducationInterviews (8) with teachers 
 Thematic analysis 
Koh, 201051Explore how academic staff experience, understand and interpret the process of formative assessment and feedback of theoretical assessmentQualitativen=20 academic staff in nurse educationTeachers see themselves as key facilitators and think students prefer teacher feedback. Students are assumed to have the skill to peer assess and give feedback but are unprepared and need support and introduction early in education. Teachers need professional development themselves.Moderate
UKPhenomenology
Nurse Education in PracticeSemi-structured interviews (22)
 Thematic analysis
Mui Lim, 201049Improve students learning through interactive formative assessment and student generated questionsMixed methodsn=115 occupational therapy students in year 1 in 2009 compared withSignificant improvement in exams result from being part of interactive formative assessment, which is beneficial for learning and identifying knowledge gaps.Moderate
AustraliaCohort studyn=98 students in 2008
International Journal of Therapy and RehabilitationEvaluation questionnaire 
Martin, 201448Examine collaborative testing versus traditional test taking with undergraduate nursing students in a nine-station OSCEMixed methodn=70 nursing studentsSignificantly higher scores in collaborative testing than in traditional testing.Moderate
CanadaCross-over design SurveyThemes: (1) studying more/studying differently, (2)/ cognitive collectivism (3), ‘it stuck in my head better’ (4), confidence, and (5) practicing how to share knowledge and negotiate.
Nurse Education TodayFocus groups
Moineau, 201142Compare scores and experiences of formative assessment from faculty and senior students during OSCE-examinationsQuantitativen=66 medical students in year 2Students (year 4) assessing students (year 2) with checklists in OSCE-examinations equally assessed compared with faculty members. A positive learning experience expressed from both students and faculty.Moderate
CanadaCross sectionaln=27 year four student examiners
Medical EducationPrequestionnaire and postquestionnairen=27 teaching doctors
Nofziger, 201037Investigate the impact of peer assessment on future professional development and students’ experiencesQualitativen=70 medical students in year 267% found peer assessment helpful, reassuring, or confirming something they knew; 65% reported important transformations in awareness, attitudes, or behaviours because of peer assessment. Change was more likely when feedback was specific and described an area for improvement.Moderate
USAQuestionnaire and narrative comments Frequency countn=48 in year 4
Academic Medicine  
Rees, 200246Explore students’ perceptions of communication skill assessmentQualitativen=7 medical students in year 1Year 4 and 5 more positive than younger students. Opportunities to compare communication skills with peers from same level. Learning experience being the assessor. No constructive criticism from peers. Difficult to be objective and to give feedback.High
UKFocus groupsn=7 in year 2
Medical Education n=10 in year 3
  n=5 in year 4
  n=3 in year 5
Satterthwaite, 200843Investigate if any differences existed between marks given by a peer group and those given by experienced assessorsQuantitativen=65 dental studentsNo significant difference in grades between experienced examiners and peer group.Moderate
UKCross sectional
European Journal of Dental Education 
Spandorfer, 201447Determine whether peer assessment improves students work habits and interpersonal attributes and whether it is accepted by students, focusing on low performing studentsMultimethodsn=267 medical students in year 1; follow-up in year 2Significant improvement after on-line peer feedback between test 1 and 2.Moderate
USAPaired sample t-test Pearson correlation coefficientsThemes: (1) Initiative, (2) Communication, (3) Respect, (4) Preparation, and (5) Focus.
Anatomical Science EducationSurvey-content analysisStudents prefer anonymous feedback from peers.
Tai, 201640Investigate students’ experience of peer-assisted learning.Mixed methodsn=10 medical students in year 1 (observed)Observing and giving feedback to peers contributed to learning, but students value feedback from teachers for validation. Students want to preserve social relationships with peers; therefore, feedback is not so constructive. Peers provide a supportive learning environment.High
AustraliaEthnographicn=191 students in year 3 (survey) 
Advances in Health Science EducationSurvey, observations, and interviews  
 Thematic analysis  
Tricio, 201645Analyse written feedback provided as a part of a formative and structured peer assessment protocol.Multimethodsn=40 dental students in year two in pre-clinical skills laboratoryYear 2 focuses on practical and clinical knowledge; in contrast, year 5 focuses comments on communication, management, and leadership. Year 2 gives more positive comments on peer performance than year 5.Moderate
UKDescriptive statisticn=68 dental students in year 5 in clinic
European Journal of Dental EducationThematic analysis
Vaughn, 201644Evaluate the use, quality, and quantity of peer video feedback and compare peers and faculty feedback.Quantitativen=24 medical students‡Significant change in performance across three periods in both groups. Peer feedback group performed better at final assessment than faculty feedback group (not significant). Peers gave higher scores than faculty. No significant differences when using a checklist.Moderate
USACross-sectional
The American Journal of SurgeryPaired t-test, Mann-Whitney statistic
 Survey

  • *High equals majority of items in the critical appraisal tools.

  • †Twenty-four students included in the intervention, and 19 attended the focus group session.

  • ‡Twelve students received faculty feedback, and 12 students received peer feedback.

  • OSCE, objective structured clinical examination.