This study aimed to investigate the perception of peer assessment among university healthcare students and its impact on their learning experience. To achieve this, we sought to answer the following research questions: (1) How do healthcare students perceive the use of peer assessment; and (2) what factors may influence healthcare students' perceptions of peer assessment?
The main findings reveal interesting insights regarding the perception of peer assessment among university healthcare students. First, it was observed that older students had less experience on peer assessment. Students recognized the inclusion of peer feedback as an integral component of the learning process, acknowledging its potential to enhance student engagement. Furthermore, they emphasized that feedback is a shared responsibility, extending beyond the teaching staff to involve the active participation of students themselves. In terms of disciplinary differences, physiotherapy students stood out by believing more strongly than other disciplines that feedback should solely be given by the teaching staff. On the other hand, nursing students expressed a higher level of confidence than the rest in the helpfulness of their feedback to their colleagues. Overall, students believed that the feedback they provide is of good quality and can positively influence their peers. However, it was observed that physiotherapy students tended to be more critical of the quality of their own feedback.
In general, students felt less confident in the quality of their peers' feedback and its effectiveness in helping their own learning process. Additionally, they recognized the importance of certain skills related to peer feedback, such as being able to give constructive peer feedback, handle critical peer feedback, and improve their work based on peer feedback. Interestingly, human nutrition and dietetics and occupational therapy students placed more emphasis on the ability to handle critical peer feedback as an important skill. Moreover, students in a hybrid format expressed a higher belief more than students in a face-to-face s format in the importance of being able to give constructive peer feedback.
Students’ perception on peer assessment
There is a general consensus among researchers regarding the utility of peer feedback as a valuable tool for improving student learning (Dochy et al., 1999; Gatfield, 1999; Latifi et al., 2021; Lindblom-Ylänne et al., 2006; Michaelsen et al., 2023; Vickerman, 2009). Moreover, our data supports the notion that as students’ progress in their studies, they become more convinced about the value of peer feedback and its impact on the learning process.
However, when it comes to the suitability of feedback solely provided by the lecturer, there is no consensus among respondents. Specifically, our findings indicate that physiotherapy students were more inclined towards the belief that only the lecturer should give feedback, suggesting a preference for evaluation by the teacher rather than their peers. This preference might stem from the different educational background they have been exposed to. In many physiotherapy programs, the instructional and evaluative roles are predominantly fulfilled by lecturers, which contrasts with the more active role of learners in other programs (Dolin Ed. & Evans Ed., 2018).
Interestingly, we observed that, as students’ progress to their final courses, their perspective shifts, and they no longer view the lecturer as the sole provider of feedback. This observation might be explained by their personal maturity, increased knowledge of the course content, and growing confidence in their own feedback. In addition, their experience as students likely contributes to a better understanding of what aids their learning process.
Peer assessment experience
Our findings showed that most students had actively participated in peer assessment, although it was more prevalent among the students of the earlier years of their studies, compared to those in higher years. This discrepancy could be attributed to various factors, such as the implementation of teaching innovation courses for faculty members or the introduction of new teaching staff. However, our understanding suggests that this difference could be largely due to the need for teaching staff to adapt and innovate during the COVID-19 pandemic (Chan, 2023). Some authors have observed the introduction of peer assessment during this period of time (Nikolova & Ivanov, 2022; Virarkar et al., 2021). It is possible that the pandemic has prompted teachers to reconsider their teaching methods and has opened the door to introduce new classroom practices, such as peer assessment.
Despite most students claimed that they have discovered peer assessment for the first time at university, this is not the case for all in degree programs. Nursing students, for instance, entered to university with more prior experience in peer assessment. This difference might be influence by the origin and profile of these students, as physiotherapy and occupational therapy students usually come from outside the Catalan educational system (e.g., in physiotherapy there are 70% French students), where the teaching methodologies differ. These variations in educational systems may impact the presence or absence of previous experience in peer assessment.
Confidence in their skills for peer assessment
Peer assessment has been recognized as a valuable tool for student learning , particularly when they take on the role of assessor and assessed, as opposed to being solely assessed (Reinholz, 2016). In this study, most students expressed a belief that the feedback they provide to their peers is of high-quality feedback. This aligns with the idea that when students assess others, they engage in a formative process that positively impacts their own learning (van Zundert et al., 2010). Consequently, students may perceive their own feedback as valuable due to the experience gained through the peer assessment process.
On the other hand, students felt that the feedback received from their peers was of lower quality compared to the feedback they offered. Previous research suggests that anonymity in peer assessment has been suggested to result in more constructive and honest feedback (Panadero & Alqassab, 2019)(Rotsaert et al., 2018). However, it is worth noting that many teachers do not implement anonymous peer assessment (Panadero & Brown, 2017). When feedback is not anonymous, it may be influenced by social interrelationships, potentially giving students the perception that it is not an honest and fair evaluation, resulting in a perceived low quality. Unfortunately, due to the absence of questions addressing anonymity within the questionary used, the importance of anonymity in our current study cannot be established.
Interestingly, students in the physiotherapy degree expressed less confidence in the quality of the feedback provided. This observation might be attributed to many students in this degree come from different educational backgrounds, which often follow a more traditional teaching model where the teacher assumes the main teaching role in the educational process. Consequently, students might have perceived that their peers, lacking the experience and knowledge of a teacher, are unable to provide high-quality feedback. This perception might stem from the traditional model where teachers oversee the evaluative process.
Moreover, most students in this study stated they lacked confidence in the feedback received from their peers, believing it would not help them improve their future performance. However, contrary to this perception, Double et colleagues (Double et al., 2020) argued that peer assessment is particularly beneficial for tertiary-level students in improving academic performance due to their maturity. It is important to note that the same authors highlight several factors that might affect the positive effects of peer assessment, such as the rubrics, anonymity, and experience in peer assessment.
Effective communication plays a crucial role in the peer assessment learning process. When students receive feedback from their peers, it is often conveyed in a language commonly used by students, making it less intimidating (Double et al., 2020). However, if students lack confidence in the feedback they receive, it becomes important to investigate the format of the feedback received form their peers. Exploring whether students received written comments, grades, or verbal feedback could provide valuable insights. In this regard, it would be crucial to consider whether the assessed students had the opportunity to engage in communication with their peers who evaluated their work. This aspect is important to examine as a lack of communication could potentially hinder the effectiveness of the peer assessment process.
Anonymity also plays a crucial role in the peer assessment process since it significantly improves the quality of assessments and fosters a more positive perception of the entire process. Anonymity proves beneficial by ensuring fair judgement from evaluators and enhancing the acceptance of feedback by the assessees (Rotsaert et al., 2018). Thus, it is essential to emphasize that anonymity should be guaranteed throughout the entire process to reap its benefits fully.
In this study, a significant proportion of participants indicated that the feedback they received had limited impact on their subsequent performance. This perception could be attributed to several factors, including the format of the feedback provided, the absence of anonymity, and the relative inexperience of participants in peer assessment. On the other hand, nursing students across all degree levels held a different belief, expressing confidence that the feedback they received would positively impact their future performance. It is well recognized that historically nurses used to work under the directives of physicians. However, in the contemporary era, collaboration, communication, and shared decision-making among all healthcare professionals have become crucial in promoting patient safety and quality of care (House & Havens, 2017). Nowadays, the role of nurses is interwoven with the collaboration with the entire healthcare team, ensuring optimal care for patients. This collaborative approach is taught and ingrained in the nursing teaching philosophy of higher education schools. These factors might explain why nursing students, unlike their counterparts in other healthcare disciplines, are more receptive and value the feedback received from their peers.
Importance of peer assessment
The participants in the study highly valued peer assessment as an ability to provide constructive feedback to their colleagues, recognizing its significance as a valuable learning tool in their health education, helping them to develop academically and professionally (Alsahafi et al., 2022; Winstone et al., 2017). Patient-centred care improves satisfaction, quality of life and health outcomes (Reid et al., 2022; Robinson et al., 2013). This model of care involves effective communication between the healthcare professional and the person being treated. Possibly, academically working on assertive communication can also have a positive effect on the teaching and learning experience.
Our findings showed that students attending classes in a hybrid format placed a higher value on peer assessment as an important ability for providing constructive feedback, compared to those in the face-to-face format. This disparity could be attributed to various factors. Since the students in hybrid format were older, they could have likely more maturity and work experience, allowing them to understand of the significance and impact of constructive evaluation. Moreover, it could also be explained by the limited opportunities for synchronous contact in hybrid classes often lead to a greater reliance on written feedback. This reliance on written communication for providing and interpreting constructive feedback may require more reflection, time, and effort.
On the other hand, the study participants emphasized the importance of developing the ability to receive critical evaluation as a part of peer assessment. In professions such as healthcare, where professionals interact with colleagues and make decision through argumentation, accepting critical assessments and incorporating them into self-reflection is a fundamental skill for ensuring safe patient care (Stenberg et al., 2018). Therefore, it is essential to support students with activities that promote these skills during their training stage. The higher importance placed on this competence by students in the human nutrition and dietetics and occupational therapy programs compared to students in the other degree programs could be attributed to their unique profile. The maturity and work experience of these students likely exposed them to teamwork and the understanding of its importance in promoting the quality of healthcare. Teamwork requires values such as commitment responsibility and trust, and maintaining a fluid collective dynamic , among other values (Paravic Klijn & Lagos Garrido, 2021).
Furthermore, participants in the study also highlighted the importance of peer feedback as a valuable tool for professional improvement. Peer assessment is one of the strategies that health professionals apply for their development to uphold professional standards in healthcare and enhance their development (Maas et al., 2014). These professionals anticipate interacting with colleagues and individuals under their care, knowing that they will be evaluated. Perhaps, they perceive this evaluation as an opportunity for professional growth and lifelong improvement.
However, it is important to note some limitations inherent in this study. The cross-sectional design prevents the establishment of causal relationships between variables. In addition, the study relied on self-reported data, which may introduce recall bias or social desirability bias. The study was also limited to a specific geographical area and population, which may affect the generalizability of the findings.
One of the main limitations of this study is the lack of exploration of the importance of anonymity in the peer evaluation process. The data collection tool used did not include questions about this topic, which could have provided valuable insights into the importance of anonymity among students.