Formative peer assessment in higher healthcare education programmes: a scoping review

Objectives Formative peer assessment focuses on learning and development of the student learning process. This implies that students are taking responsibility for assessing the work of their peers by giving and receiving feedback to each other. The aim was to compile research about formative peer assessment presented in higher healthcare education, focusing on the rationale, the interventions, the experiences of students and teachers and the outcomes of formative assessment interventions. Design A scoping review. Data sources Searches were conducted until May 2019 in PubMed, Cumulative Index to Nursing and Allied Health Literature, Education Research Complete and Education Research Centre. Grey literature was searched in Library Search, Google Scholar and Science Direct. Eligibility criteria Studies addressing formative peer assessment in higher education, focusing on medicine, nursing, midwifery, dentistry, physical or occupational therapy and radiology published in peer-reviewed articles or in grey literature. Data extractions and synthesis Out of 1452 studies, 37 met the inclusion criteria and were critically appraised using relevant Critical Appraisal Skills Programme, Joanna Briggs Institute and Mixed Methods Appraisal Tool tools. The pertinent data were analysed using thematic analysis. Result The critical appraisal resulted in 18 included studies with high and moderate quality. The rationale for using formative peer assessment relates to giving and receiving constructive feedback as a means to promote learning. The experience and outcome of formative peer assessment interventions from the perspective of students and teachers are presented within three themes: (1) organisation and structure of the formative peer assessment activities, (2) personal attributes and consequences for oneself and relationships and (3) experience and outcome of feedback and learning. Conclusion Healthcare education must consider preparing and introducing students to collaborative learning, and thus develop well-designed learning activities aligned with the learning outcomes. Since peer collaboration seems to affect students’ and teachers’ experiences of formative peer assessment, empirical investigations exploring collaboration between students are of utmost importance.

Title -Fine. Abstract -Disc:" For formative peer assessment to be effective it needs to be implemented in a collaborative learning environment." Not covered by the data in the abstract nor the body, should be removed. -Disc: "Since peer collaboration seems to affect students' and teachers' experiences of formative peer assessment empirical investigations exploring collaboration between students is of utmost importance." Fine conclusion and rating of the authors. Results -Fine to me. What I miss is the organizational costs and benefits of peer-assessment (see disc) Discussion -I like your presentation with the 2 steps and perfectly agree that aims of the peer-assessment should be transparent. What I do not agree with is that the purpose of peer-assessment should monorational and just for the good of it (to improve the collaborative learning). Please discuss: -(1) Peer-assessment helps to improve the educational skills for the peer-assessors themselves. By changing the point of view =slip into the assessors position they widen their understanding for the process of learning and assessment. (compare Burgess A, Clark T, Chapman R, Mellis C. Senior medical students as peer examiners in an OSCE. Med Teacher. 2013;35(1):58-62. AND Homberg A, Hundertmark J, Krause J, Brunnée M, Neumann B, Loukanova S. Promoting medical competencies through a didactic tutor qualification programme -a qualitative study based on the CanMEDS Physician Competency Framework. BMC Med Educ 2019;19:187. doi: 10.1186/s12909-019-1636-5) -(2) In high volume programs with 400 or 500 (medical) students per year (!) peer tutoring is the basis of small group learning and peer assessment is the basis for costly assessment such as the OSCE. This is the case for high volume programs (compare: Schwill et al. BMC Medical Education (2020) 20:17 https://doi.org/10.1186/s12909-019-1898-y) and even more for any higher education in healthcare out of our first world perspective!!! -Compare Page 10, L 306ff "Otherwise, there is a risk that students might perceive peer assessment as an activity meant to ease the burden on the teachers." Please rephrase, to me it appears rather polemic.
-Synthesis (comment): Only by being transparent on the educational and financial resources of the faculty as well as on the personal benefits for peers as assessments we treat our students the way to be treated: as individuals who are able to judge and decide for themselves! Limitations! -Please add that there was an end-date of the research period, an no studies after "x.x.2019" could be included The authors give a good description of peer assessment and its strengths and barriers. What is the difference between peer assessment and peer learning? Should probably be highlighted in the background.
Thank you for your thoughtful and insightful comments and suggestions. We have tried to respond to your comments.
It is a wise question. However, we have chosen to focus peer assessment as an educational approach where feedback, communication, reflection, and collaboration between peers are key characteristics and as a learning activity in itself, regardless of educational model. We think that if we describe peer learning we also have to describe other peer collaborative models as for example, peer assisted learning, problem based learning, peer tutoring etc.

No changes made
Four relevant questions are asked and answered.
Thank you very much.
Two researchers have not independently participated in all levels of a study selection. Only one author have screened titles and abstracts and read full-text for We thank you for acknowledging this and agree that we have not expressed this clearly enough.
We have tried to rephrase and hope that this may better describe the team contribution in the screening process (p. 6) inclusion and exclusion. Two authors should independently extract data from the first five to ten included studies using the datacharting form and meet to determine whether their approach to data extraction is consistent with the research question and purpose, according to Levac. This number is not accomplished in this scoping review. Furthermore, only 15 of 37 articles were critical appraised by two authors.
Thank you and we agree that this may be seen as a limitation in a scoping review. We have tried to clarify how data was extracted by using the developed charting form (appendix 2) as a basis in our critical discussion among the team members (p 6, 7).
p.6, 7 The rationale for choosing four databases is not discussed in study limitations. Could other databases broadened the field?
Thank you, we have tried to be more precise in the method section how the databases were chosen and added the consultation with a librarian (p 5) We have also addressed this as a limitation of the study (p.12).

p. 5, 12
This section is also missing a reflection of why doing critical appraisal in a scoping review.
We have made some clarification concerning our reason for conducting a critical appraisal. (p.6) p.6 Some typo's, i.e line 46, 289. Reference 12 and 19 are the same.
Thank you for your attention. Space between words and references has been corrected.
p. 2 and 10 p.4 Well-written text, informative tables, but limitations in the methodology for performing scoping reviews.
Thank you. We respectfully acknowledge your valuable comments and hope that you will find our amendments to the methodology section satisfying.

Reviewer #2
Author Respond Changes made to article Title -Fine.
Thank you for your thoughtful and insightful comments and suggestions. We have tried to respond to your comments. Abstract -Disc:" For formative peer assessment to be effective it needs to be implemented in a collaborative learning environment." Not covered by the data in the abstract nor the body, should be removed.
Thank you. We do agree and has removed the statement from the discussion in the abstract. (p 2) p.2 Disc: "Since peer collaboration seems to affect students' and teachers' experiences of formative peer assessment empirical investigations exploring collaboration between students is of utmost importance." Fine conclusion and rating of the authors.
Thank you for the comment.  Results -Fine to me. What I miss is the organizational costs and benefits of peer-assessment (see disc) Thank you. For the legibility, and as presented at page 8, line 228, we chose to present the result of the context, rational and interventions for formative assessment in a table (3). However, we do agree with your comment and have tried to highlight the cost benefits in the discussion (p. 10 and 11). However, cost benefits are not thoroughly discussed in the included studies and we have only chosen to add cost benefits in our discussion.

Discussion
Thank you for your comments and suggestions 10 I like your presentation with the 2 steps and perfectly agree that aims of the peer-assessment should be transparent. What I do not agree with is that the purpose of peerassessment should mono-rational and just for the good of it (to improve the collaborative learning). Please discuss: -(1) Peer-assessment helps to improve the educational skills for the peer-assessors themselves. By changing the point of view =slip into the assessors position they widen their understanding for the process of learning and assessment.

REVIEW RETURNED
30-Nov-2020 GENERAL COMMENTS I think you have done a good job with the revision of the paper and have answered out the earlier review comments.

GENERAL COMMENTS
Thank you very much for the opportunity to review the revised version of the manuscript. Your have extensively worked on the manuscript and integrated the reviewer's comments. I think the work merits publication and is a good overview about the current situation.