Open Access Research article

Why peer assessment helps to improve clinical performance in undergraduate physical therapy education: a mixed methods design

Marjo JM Maas12*, Dominique MA Sluijsmans3, Philip J van der Wees2, Yvonne F Heerkens24, Maria WG Nijhuis-van der Sanden2 and Cees PM van der Vleuten5

Author Affiliations

1 HAN University of Applied Sciences, Department Allied Health Studies, Kapittelweg 33, 5425 EN Nijmegen, The Netherlands

2 Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands

3 Zuyd Hogeschool, Department Educational Research, Heerlen, The Netherlands

4 Dutch Institute of Allied Health Care, Amersfoort, The Netherlands

5 Maastricht University, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands

For all author emails, please log on.

BMC Medical Education 2014, 14:117  doi:10.1186/1472-6920-14-117

Published: 13 June 2014



Peer Assessment (PA) in health professions education encourages students to develop a critical attitude towards their own and their peers’ performance. We designed a PA task to assess students’ clinical skills (including reasoning, communication, physical examination and treatment skills) in a role-play that simulated physical therapy (PT) practice. Students alternately performed in the role of PT, assessor, and patient. Oral face-to-face feedback was provided as well as written feedback and scores.

This study aims to explore the impact of PA on the improvement of clinical performance of undergraduate PT students.


The PA task was analyzed and decomposed into task elements. A qualitative approach was used to explore students’ perceptions of the task and the task elements. Semi-structured interviews with second year students were conducted to explore the perceived impact of these task elements on performance improvement. Students were asked to select the elements perceived valuable, to rank them from highest to lowest learning value, and to motivate their choices. Interviews were transcribed verbatim and analyzed, using a phenomenographical approach and following template analysis guidelines. A quantitative approach was used to describe the ranking results.


Quantitative analyses showed that the perceived impact on learning varied widely. Performing the clinical task in the PT role, was assigned to the first place (1), followed by receiving expert feedback (2), and observing peer performance (3). Receiving peer feedback was not perceived the most powerful task element.

Qualitative analyses resulted in three emerging themes: pre-performance, true-performance, and post-performance triggers for improvement. Each theme contained three categories: learning activities, outcomes, and conditions for learning.

Intended learning activities were reported, such as transferring prior learning to a new application context and unintended learning activities, such as modelling a peer’s performance. Outcomes related to increased self-confidence, insight in performance standards and awareness of improvement areas. Conditions for learning referred to the quality of peer feedback.


PA may be a powerful tool to improve clinical performance, although peer feedback is not perceived the most powerful element. Peer assessors in undergraduate PT education use idiosyncratic strategies to assess their peers’ performance.

Peer assessment; Peer feedback; Self-assessment; Clinical performance