Peer Evaluation in Medical Training Is Everywhere but Poorly Defined, Review Finds

Ask any medical, nursing, or pharmacy student about group work, and the conversation will eventually turn to grading each other. Peer evaluation has become a fixture of collaborative learning across the health professions, used to cultivate teamwork, communication, and feedback skills in the next generation of clinicians. Yet a sweeping new analysis suggests that this ubiquitous practice rests on surprisingly shaky conceptual ground. A scoping review published in BMC Medical Education by researchers at the University of North Carolina Eshelman School of Pharmacy has mapped five decades of research on student peer evaluations and found a field that is not short of activity but is chronically short of clarity. The review, led by Elizabeth A. Haslam with colleagues Rebecca Carlson, Dennis M. Williams, and Zachary R. Noel, combed through more than 2,400 records and identified 79 studies published between 1972 and 2025 that described peer evaluation among students in health professions programs operating within collaborative learning environments.

The scale of the undertaking reflects both the popularity of the practice and the difficulty of pinning it down. Following the established scoping review frameworks of Arksey and O’Malley and Levac and colleagues, and reporting in accordance with the PRISMA-ScR guidelines, the team searched PubMed, Embase, Scopus, and CINAHL from their inception through October 2025. Two reviewers independently screened titles, abstracts, and full texts, and data on terminology, instruments, implementation, and outcomes were extracted using a predefined codebook. The search strategies were deliberately broad, capturing not only the term peer evaluation but also its frequent synonyms, peer assessment, peer feedback, and peer appraisal, crossed with the full vocabulary of collaborative learning, from teamwork and group work to leadership and contribution. That terminological sprawl turned out to be one of the study’s central findings in itself.

The headline numbers reveal a discipline heavily skewed toward one corner of the health professions. Medicine accounted for 77.2 percent of the included studies, dwarfing the representation of nursing, pharmacy, dentistry, and the allied health fields. Most research was situated within team-based learning, which featured in 30.4 percent of studies, or problem-based learning, at 22.8 percent. Strikingly, only 10.1 percent of studies involved interprofessional settings, despite the fact that modern healthcare delivery is fundamentally interprofessional and that accreditation bodies across medicine, nursing, and pharmacy increasingly demand graduates who can collaborate across disciplinary boundaries. The evidence base, in other words, has grown up in single-profession classrooms while the clinical world it prepares students for looks very different.

When the researchers examined the tools used to gather peer evaluations, the picture became even more fragmented. A majority of studies, 60.8 percent, relied on custom-developed instruments created ad hoc by the investigators themselves, rather than established, validated measures. Only 8.9 percent of studies used the Comprehensive Assessment of Team Member Effectiveness, known as CATME, one of the best-researched peer evaluation instruments available, and an equal proportion used the Koles method. Other established tools, including the Maastricht Peer Activity Rating Scale, the Professional Associate Ratings, the Team Performance Scale, and the Peer Evaluation Scale for Team-Based Learning, appeared only sporadically. The consequence is a literature in which nearly every study measures something slightly different with something slightly different, making meaningful comparison across institutions, disciplines, and decades extraordinarily difficult.

The theoretical grounding of the field proved equally thin. A remarkable 83.5 percent of the included studies referenced no explicit theoretical framework at all, meaning that most peer evaluation schemes are designed and deployed without a stated account of why the practice should work, what psychological or educational mechanisms it engages, or what outcomes it should be expected to produce. In an era when educational interventions are increasingly expected to articulate their theoretical basis, this finding suggests that peer evaluation has spread largely through tradition and institutional habit rather than through theory-driven design. The authors argue that this absence of frameworks is a key reason the literature has accumulated breadth without accumulating coherence.

The formats of evaluation were more consistent, though still revealing. Numerical rating scales dominated, appearing in 78.5 percent of studies, and were frequently paired with narrative comments, which featured in 65.8 percent. This combination reflects a practical consensus of sorts: numbers provide gradable, comparable data, while free-text comments give students the qualitative feedback that many educators consider the real point of the exercise. Beneath the format variation, however, the review found genuine convergence on content. Across the five decades of studies, the constructs being assessed settled into a recognizable cluster: professionalism, communication, teamwork, and contribution to the group’s work. Whatever the instrument, educators appear to agree on what qualities matter when students judge one another.

Where the field falters, according to the review, is in the details of implementation. Peer evaluation was most often formative, used to help students improve rather than to assign grades, in 49.4 percent of studies, yet in roughly one-third of studies the purpose of the evaluation was simply not specified. More troubling still, key implementation parameters were frequently underreported. Whether evaluations were anonymous or identified, when they occurred relative to the collaborative activity, whether they carried grading stakes and how high those stakes were, who could see the feedback that was generated, and whether students received any training in how to evaluate their peers were all commonly left unstated. These are not trivial omissions. Research on peer assessment has long suggested that anonymity, stakes, and training can substantially influence the accuracy and candor of student judgments, and without knowing these parameters, readers cannot interpret the reported results or replicate the practices.

The review’s conclusions are captured in a phrase that is likely to circulate widely in education circles: peer evaluation in health professions education is not underused but under-specified. The practice is everywhere, embedded in team-based learning courses, problem-based curricula, clinical rotations, and interprofessional exercises across the globe. What is missing is the shared infrastructure that would allow the accumulated experience to add up to knowledge. Inconsistent terminology means that studies of peer evaluation, peer assessment, and peer feedback may or may not describe the same activity. Reliance on custom instruments means that results cannot be benchmarked against one another. Limited theoretical grounding means that failures and successes alike are difficult to explain. And incomplete reporting means that even well-designed studies cannot serve as reliable templates for educators seeking to adopt best practices.

Importantly, the authors stop short of calling for a single mandated instrument. Standardization imposed from above, they suggest, would ignore the legitimate diversity of contexts in which peer evaluation operates, from a problem-based tutorial in medicine to a pharmacy team-based learning session to an interprofessional simulation. Instead, the field would benefit from three more modest commitments: shared definitions that clarify what is meant by peer evaluation and how it differs from adjacent practices, a common core of assessed constructs building on the convergence the review documented around professionalism, communication, teamwork, and contribution, and minimum reporting standards ensuring that future studies specify their timing, anonymity, stakes, feedback visibility, and training procedures. For the thousands of educators who deploy peer evaluation every semester, and for the students whose grades and feedback increasingly depend on it, the message of this review is both sobering and actionable. The practice has earned its place in health professions education over more than fifty years of use; the task now is to give it the conceptual and reporting rigor that its ubiquity demands.

Subject of Research: Student peer evaluation practices in health professions education

Article Title: A scoping review of student peer evaluations in health professions education

Article References: Haslam, E. A., Carlson, R., Williams, D. M., & Noel, Z. R. (2026). A scoping review of student peer evaluations in health professions education. BMC Medical Education. https://doi.org/10.1186/s12909-026-10567-2

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10567-2

Keywords: peer evaluation, peer assessment, peer feedback, health professions education, team-based learning, problem-based learning, collaborative learning, medical education, scoping review, interprofessional education, assessment instruments, reporting standards