Mastery or Compliance? Themes of Australian Medical Student Engagement during Peer Mini-CEXs

Phenomenon: Increasingly, peer feedback and assessment exercises are being introduced into health professional degree programs with many proposed benefits including the unique feedback received from peers and development of clinical education skills. However, studies investigating the bidirectional significance of peer feedback in workplace-based assessments (WBAs) are limited. The peer assessed mini-clinical evaluation exercise (peer mini-CEX) is a WBA conducted as part of The University of Melbourne Doctor of Medicine course, which involves peers assessing one another in a clinical setting. Approach: This research investigated students' perceptions of the bidirectional effects of peer feedback on medical students undertaking peer mini-CEXs. Between August and October 2023, we conducted semi-structured interviews of penultimate and final year medical students. We undertook an exploratory qualitative study based on social constructivist theory. We transcribed the interviews and analyzed them via inductive thematic analysis, which led to the development of themes and the thematic map. Findings: Fourteen students, including eight third-year and six fourth-year students, participated in the study. Students appeared to engage in two general approaches to the peer mini-CEX: a mastery approach or a compliance approach. These themes encapsulated a tension between the desire to achieve deeper learning versus a strategic approach to assessment. When students took a mastery approach, perceived bidirectional benefits clustered around improvements in feedback provision and reception, more intentional observation and reflection leading to enhanced clinical skills, and development of professional communication skills. If students took a compliance approach, the reported outcomes were limited or undesirable with students viewing the assessment as a tick box exercise and identifying the limitations of peer feedback. A third theme, the social milieu, illustrated the influence of the social context on peer interactions and whether a mastery or compliance approach was undertaken. Insights: This study is the first to explore students' perceptions of the nuanced bidirectional effects of peer feedback in a WBA. Participants report benefits of the peer mini-CEX in domains such as clinical skills, professionalism, communication, and feedback provision and reception. However, even engaged students often described adopting a superficial approach to the peer mini-CEX, resulting in minimal learning. Our findings indicate the influence of the social milieu on peer assessment and feedback processes. With contemporaneous feedback training and priming, peer assessment and feedback can be a valuable exercise for medical students. Further research into peer feedback in WBAs is required.