Assessment is an important component in the learning process,¹ measuring and documenting students’ skill acquisition to identify areas for improvement.² Assessment can be conducted in various formats and its effectiveness is dependent on how it is valued by students.³ In traditional assessments. students are often expected to demonstrate their understanding of content or learned skills through written assignments, tests, oral presentations or practical performances.⁴ In peer assessment, scholars have distinguished two main applications: as a tool for evaluation and as a learning tool.⁵

Peer assessment is a structured process, in which students assess and provide comments on each other’s work as well as share learning experiences.⁴ It has been associated with improved self-awareness, personality development and participation from students in the learning process.⁶ Learner-centred assessment methods, such as peer assessment, are complementary to traditional assessment as they promote problem-based learning and encourage student interactions.⁷ As part of peer assessment, students learn how to deliver and accept constructive criticism as well as provide feedback.⁸ Curran et al.⁹ found that while peer assessment can positively impact learning, social factors such as friendships may compromise its reliability because of biased feedback.

Peer assessments have long been utilised as an educational intervention both within and outside of the health science training programmes.¹⁰ Research shows that higher education students trained to critically reflect on their peers’ performances develop self-assessment skills that can enhance self-directed learning.¹⁰ In peer assessment, students may act as either the assessor and/or the assessee. Peer assessment allows students the opportunity to practice feedback processes while learning in a clinical environment. However, recent research has focused more on the impact on the assessee rather than the assessor.¹¹ The impact of peer assessments is predominantly influenced by the quality of feedback. Successful feedback is further dependent on the provider’s tone, content and timing,¹² making it crucial to understand the influence of such elements in order to derive benefit.

According to Millers Pyramid of Clinical Competence, a theory developed by George Miller, assessment methods employed progress from evaluating foundational knowledge to assessment of clinical techniques.¹³ Therefore, emphasising the importance of assessment is an essential component of an efficient educational programme. There is, however, a lack of evidence regarding the efficacy of peer assessments when used as a teaching and learning tool during 3rd and 4th year clinical modules in undergraduate optometry training. Optometry training in South Africa is a 4-year undergraduate bachelor’s programme, currently offered at four training institutions in the country. However, little is known about the impact of peer assessment on students’ learning and skills development. Therefore, this research aimed to investigate the experiences and perceptions of undergraduate optometry students at the University of KwaZulu-Natal regarding peer assessments as a learning tool and to explore the potential benefits and limitations of this educational intervention in clinical training.

Three main themes emerged from the data, as shown in Figure 1.

This study investigated the experiences and perceptions of undergraduate optometry students towards peer assessment as an educational strategy. Assessment refers to the process of objectively evaluating the knowledge and skills of students to draw an accurate conclusion regarding their performance and competencies.¹⁷ However, this study found that students perceived the quality of peer assessment to be influenced by various factors such as personality, degree of judgement and attitudes. Although it may be contended that the above factors could also apply to formal preceptors, one may deduce that formal assessors would possess the necessary experience, seniority and maturity that would better equip them to navigate such situations.

The role of existing friendships affecting peer assessments was notably highlighted. Students believed that loyalty among peers resulted in leniency during evaluation. Similar findings were reported in Indonesia.¹⁸ Because of the informal dynamics of friendships, students in this study reported that peer assessments were not always treated with the seriousness it warranted. The lack of seriousness and tendency towards leniency often resulted in inflated scores, which reportedly affected preparedness for formal assessments and limited skills development. To address the issue of leniency, the researchers recommend modifying the peer assessment approach to add elements of anonymity. For example, optometry students can be video recorded performing clinical techniques, which can later be viewed and assessed separately by two unknown peers. It can be postulated that concealing of identity removes the fear of friendships being compromised, improving honesty in assessments. In addition, the use of more than one assessor per student may improve objectivity and the comparison of grades from different assessors can be used to establish the threshold of a student’s performance. Marin et al.¹⁹ supported the inclusion of technological advancements to combat identified challenges associated with peer assessment; however, Pandero²⁰ argued that a significant trade-off would be lack of peer interaction, which is necessary for modelling and learning. As a result, the recommendation to incorporate both in-person and virtual peer assessments may provide a more balanced equation opposed to use of a single method.

In contrast to findings of peer leniency, a study by Hegg et al.²¹ reported that facilitators displayed more leniency when compared to peer assessors during an evaluation of team performance. Therefore, indicating that peer assessors applied a stricter approach than necessary. These findings highlight the inconsistencies that can occur when peers are placed in a position to assess and necessitate the need for training on their role, assessment criteria and execution.

The process of providing and receiving feedback, which is an important aspect of assessment aiding the learning process,²² was found to be challenging for both peer assessors and assessee. Peer assessors struggled with the position of authority. The challenge of being on the same level as their colleague made it difficult to provide constructive feedback. In some cases, where peer assessors struggled to execute their authoritative role as an appraiser, the lack of confidence and expertise was detected by those being assessed. This is in keeping with findings from Cheng and Warren²³ where students expressed a more favourable attitude towards being evaluated, rather than evaluating other students. De Wever and Noroozi²⁴ explained that not all students possess the individual traits that enable stepping out of their comfort zone to be an assessor. Adachi et al.²⁵ added that the act of giving and receiving feedback involves interpersonal skills that are difficult to explicitly teach. These findings and supporting literature indicate the need for additional support to equip students to fulfil their roles during peer assessment. Echoing the above, research has shown that when students are trained to adequately assess their peers and to provide meaningful feedback for improvement, it can improve their critical evaluation skills. Furthermore, increasing student’s familiarity with peer assessment and improving their ability to peer assess have been associated with alleviating the perceived burden sense of responsibility that peer assessors face.¹⁵ The above literature and findings in this study emphasise the need to further capacitate peer assessors.

From the perspective of being assessed, students struggled to address peer assessors who provide incorrect feedback. Thus, indicating the gaps in clinical knowledge of some peer assessors and the impact of lack of expert input. These findings indicate the need to create a safe space for feedback review, by encouraging students to be open minded and willing to learn collaboratively, as per the goals of peer assessment. In addition, it is recommended that expert oversight is used to compliment peer assessments, in order to validate the feedback being provided and the corresponding mark allocated.

Despite these challenges, students expressed several benefits associated with peer assessments. A comfortable learning environment increases students’ attention and promotes a meaningful learning experience where students are more likely to relax, creating freedom to open up and share their thoughts.²⁶ This study echoed the literature as students reported that a comfortable learning environment, facilitated by student-to-student interaction, allowed for the acquisition of new techniques from their peers. Furthermore, the experiences of reduced intimidation when being assessed by a peer as compared to clinical consultants suggest that peer assessment may foster greater self-awareness. Cheng and Warren²³ found that involving students in peer assessment can give rise to a positive attitude towards learning and active participation in the classroom because students find it easier to communicate with and comprehend each other.

Furthermore, the element of relatability among peers and the ability to reflect on weakness were key benefits of peer assessment. Therefore, contributing towards building clinical competency. Curran et al.⁹ supports the above, confirming that peer assessment can provide valuable formative feedback on professional behaviours and skills. Students further cited the advantage of learning through observation from their peers, which aligned with findings by Maas et al. in the Netherland.¹⁰ El-Senousy,²⁷ added that learning through peer observation was facilitated by peer motivation as well as problem-solving skills. Participants in this study further reported that student-to-student interaction was beneficial as it helped them to learn through observation, reiterated by Maas et al. in the Netherlands.¹⁰ These findings emphasise the importance of providing opportunities for students to practice self-assessment and develop their composite skills. In addition, Dooley and Bamford²⁸ found that apart from supporting student learning, peer assessment offered opportunities for early detection, monitoring and/or timely remediation of students who display difficult or challenging behaviours.

Learning together was an important advantage of peer assessments emerging from this study. El-Senousy²⁷ concurred that the premise of peer assessments lies within its characteristics of teamwork, collaborative learning and mutual engagement. It was further revealed that learning through exposure yielded positive outcomes as peer assessors gained familiarity with the evaluation rubric tools, enabling enhanced understanding during their own assessments.

Despite the favourable aspects of peer assessment, several limitations were identified in this study. One of the key findings was that simulated patients, through peer assessment, did not present as a sufficient academic challenge, thus failing to provide a meaningful critical thinking opportunity. As such, this limitation in exposure to managing real patients in a peer assessment environment did not provide a true reflection of clinical skills. Kozmenko and Wallanberg²⁹ agree that clinical skills are best learned in the context of realistic, highly dynamic and complex clinical settings. While majority of existing literature focuses on peer assessment as a standard educational method, the findings in this study contribute to the uniqueness that presents when peer assessments are applied in the health field, such as the discipline of optometry.

Other concerns include peer assessors’ lack of knowledge, evidenced by reported uncertainty in clinical techniques. This has implications for passing on incorrect information to students as well as inaccurate gradings. Rubrics are the guidelines for student assessment that assist in clarifying expectations and how a student can meet them. A lack of knowledge of assessment criteria will also affect the ability to carry out a reliable and valid assessment.³⁰ The above findings motivate for expert oversight to be integrated in the peer assessment process. Students are regarded as novices in the field when it comes to making sound judgements, which is also referred to as a lack of epistemic authority.³¹ With their novice status, students may be concerned about assisting their peers in improving performance given their non-authoritative status and potential impact on their peers’ grades.

The inclusion of peer assessment in the overall summative grade was met with contention. While some students welcomed that peer assessment boosted their final mark, others felt that it should be omitted or carry less weight because of limited credibility arising from leniency. However, research has shown that student motivation diminished when peer assessment had no significant impact on summative assessment.³² According to Yorke,³³ systems of summative assessment may therefore need to include peer feedback to motivate students. Consequently, this study suggests that for peer assessment to be an accurate reflection of student performance, rubrics should be designed in such a way to minimise subjectivity.

Finally, as peer assessors apply assessment strategies that differ considerably from experts,⁹ it is recommended that expert oversight be incorporated into the design of peer assessment tasks, in order to quality assure assessment results where grades are utilised for summative purposes.

Peer assessment holds value as a peer learning opportunity and complementary educational intervention in undergraduate optometry training. It creates an enabling environment for peer learning to take place and can be used to facilitate practice that improves clinical competency. Peer assessments can also be used to develop students’ skills in providing feedback and understanding assessment processes. However, peer assessment presents as a complex intervention influenced by multiple possible factors. Feedback may be influenced by pre-existing friendships, reducing its full value as feedback may not always be honest, and grading is likely to be lenient or, in some cases, too strict. Therefore, the integration of expert oversight is recommended to quality assure the learning process. Furthermore, where grading is required as part of summative assessments, the results should be treated with caution because students experience difficulty being objective and providing honest critique to their peers. In addition, the use of technological interventions, such as virtual sessions and strategies to maintain anonymity, may further assist in ensuring objectivity. The assignment of more than one peer assessor may also assist in obtaining a holistic view of a student’s performance. In order to maximise the learning opportunity, preparing students to provide and receive honest and constructive feedback is critical to the successful use of peer assessment as an educational intervention and is a skill that should be developed in optometry education.