title: How are we assessing near-peer teaching in undergraduate health professional education? A systematic review.
abstract: BACKGROUND
  Near Peer teaching (NPT) is reported as an effective pedagogical approach to student learning and performance. Studies in medicine, nursing and health sciences have relied mainly on self-reports to describe its benefits, focusing on psychomotor and cognitive aspects of learning. Despite increasing research reports on peer teaching internationally, little is known about the various domains of learning used in assessment of performance and objective learning outcomes of NPT.
  
  
  OBJECTIVE
  To determine the domains of learning and assessment outcomes used in NPT in undergraduate health professional education.
  
  
  METHODS
  Quantitative systematic review was conducted in accord with the PRISMA protocol and the Joanna Briggs Institute processes. A wide literature search was conducted for the period 1990-November 2015 of fourteen databases. Grey literature was undertaken from all key research articles. Studies meeting the inclusion criteria were eligible for consideration, including measured learning outcomes of near-peer teaching in undergraduate education in nursing, medicine and health sciences. Set limitations included publications after 1990 (2015 inclusive), English language and objective learning outcomes. A quality appraisal process involving two independent reviewers was used to analyse the data.
  
  
  RESULTS
  Of 212 selected articles, 26 were included in the review. Terminology was confusing and found to be a barrier to the review process. Although some studies demonstrated effective learning outcomes resulting from near-peer teaching, others were inconclusive. Studies focused on cognitive and psychomotor abilities of learners with none assessing metacognition, affective behaviours or learning outcomes from quality of understanding.
  
  
  CONCLUSIONS
  The studies reviewed focused on cognitive and psychomotor abilities of learners. Even though evidence clearly indicates that metacognition and affective behaviours have direct influence on learning and performance, indicating more research around this topic is warranted. Methodological quality of the studies and lack of theoretical frameworks underpinned by educational psychology may have contributed to inconsistencies in learning outcomes reported.
authors.affiliation: School of Nursing and Midwifery, 10 Chancellors Walk, Monash University, Clayton, Victoria 3800, Australia. Electronic address: susan.irvine@monash.edu.
authors.forename: Susan
authors.initials: S
authors.lastname: Irvine
authors.affiliation: Department of Community Emergency Health and Paramedic Practice, Monash University, Level 2, Building H, Peninsula Campus, McMahons Road, Frankston VIC 3199, Australia. Electronic address: brett.williams@monash.edu.
authors.forename: Brett
authors.initials: B
authors.lastname: Williams
authors.affiliation: School of Nursing and Midwifery, 10 Chancellors Walk, Monash University, Clayton, Victoria 3800, Australia. Electronic address: lisa.mckenna@monash.edu.
authors.forename: Lisa
authors.initials: L
authors.lastname: McKenna
mesh_terms: D004517:Education, Professional; D006801:Humans; D007858:Learning; D010379:Peer Group; D013336:Students, Health Occupations; D013663:Teaching
keywords: Assessment; Health professional students; Peer teaching; Systematic review; Undergraduate