Playing the game: The educational role of gamified peer‐led assessment

‘Assessment drives learning’ is an often-repeated phrase highlighting the educational benefits that can be achieved through assessment activities. Although typically mentioned in relation to formative and summative examinations, recent research has highlighted the importance of implementing broader curricular assessment interventions to enhance learner engagement and promote mastery-level competency. One such approach draws upon the well-recognised educational benefits of peer-assisted learning that can be further enhanced using gamification to motivate learners to both design and review assessment activities for their peers and answer those created by others. This toolbox article describes the educational principles that underpin gamified peer-led assessment (PLA) and offers practical recommendations for clinical teachers considering implementing such schemes in their own institutions. We draw upon our collective expertise in both designing and evaluating a formal dedicated online PLA platform (BH and JW) and providing informal PLA opportunities within an undergraduate curriculum (HT and BH).


| INTRODUCTION
'Assessment drives learning' is an often-repeated phrase highlighting the educational benefits that can be achieved through assessment activities. Although typically mentioned in relation to formative and summative examinations, recent research has highlighted the importance of implementing broader curricular assessment interventions to enhance learner engagement and promote mastery-level competency. 1 One such approach draws upon the well-recognised educational benefits of peer-assisted learning 2 that can be further enhanced using gamification 3 to motivate learners to both design and review assessment activities for their peers and answer those created by others. This toolbox article describes the educational principles that underpin gamified peer-led assessment (PLA) and offers practical recommendations for clinical teachers considering implementing such schemes in their own institutions. We draw upon our collective expertise in both designing and evaluating a formal dedicated online PLA platform (BH and JW) and providing informal PLA opportunities within an undergraduate curriculum (HT and BH).

| PLA
PLA is a student-driven approach that involves learners in all stages of the assessment design process including item writing, item qualityassurance review and item answering. Through their contributions to a peer-generated item bank, learners enhance the learning of the entire cohort, as the item bank is made available to peers at the same level and to near-peers at stages above and below. We use the term 'items' to encompass all assessment types from knowledge-recall and knowledge-application formats (such as multiple-choice questions) to stations used in clinical assessments.
PLA is a student-driven approach that involves learners in all stages of the assessment design process. Through engaging in the task of writing items and reviewing their peers' contributions, learners are required to meaningfully apply their own knowledge and skills. This process stimulates self-directed learning and helps learners address areas of weakness. When designing clinically oriented items, item writing can also encourage learners to apply their clinical reasoning by considering plausible distractors and selecting the key features to include within a patient vignette.
Answering peer-generated items draws upon the concept of test-enhanced learning, which suggests that repeated formative practice allows assessment to be used as a tool both for learning and as learning. 4 PLA facilitates the creation and use of potentially large item banks to drive participants' learning. The provision of feedback, as detailed later, is a key component to enhance learners' understanding and longer-term retention moving them beyond mere recall. PLA therefore helps learners' deepen their comprehension of essential concepts leading to improved summative assessment scores. [5][6][7] PLA facilitates the creation and use of potentially large item banks to drive participants' learning.
Furthermore, taking on the roles of writer and reviewer can enhance learners' assessment literacy. Assessment literacy refers to learners' understanding of the nature of assessments they encounter such as the rationale behind particular assessment strategies and tools, the assessment criteria and how and why particular standards are set. By placing the learner in the assessment designer's shoes, assessment performance is enhanced; the more learners understand about their assessments, the more likely they are to achieve positive outcomes. 8 The benefits of PLA are summarised in Box 1.

| GAMIFICATION WITHIN PLA
Although there are many educational benefits to implementing PLA schemes, learners may not fully appreciate the reasons to participate, or they may view the process as an unnecessary additional burden.
Incorporating gamification into the scheme offers a helpful way to incentivise and maintain ongoing learner engagement. Gamification involves integrating game-design elements such as point accumulation, rewards and competition into non-game contexts. 3 Examples of gamification approaches are shown in Table 1. There is a growing body of evidence demonstrating that gamification can enhance learner engagement and enjoyment, especially considering the ubiquity of technological devices among learners. For example, work exploring learner engagement on a peer-assessment platform found that activating a gamification feature (virtual badges) significantly BOX 1 Advantages of peer-led assessment LEARNER: • Enhance applied knowledge and reasoning skills  Winning virtual currency allows learners to build up a stock of 'virtual money' that can be exchanged for virtual or real-world in a marketplace.
Learners therefore see their efforts rewarded in the virtual or real world increased learner engagement. 9 In other analyses, learners reported that gamification enhanced their enjoyment of the learning process. 7 Incorporating gamification into the scheme offers a helpful way to incentivise and maintain ongoing learner engagement.
The case study in Box 2 describes the successful implementation of gamified PLA in the context of an online medical student question writing platform. In this system, learners are awarded points for item writing, reviewing and answering which forms the basis of competitive leader boards with the potential for prizes for top performers.
Progress mechanics are used to create levels of achievement based on, for example, number of items contributed and/or completed. Realworld prizes can also be used to complement virtual 'badges' indicating level-based accolades. These drivers are effectively used to promote learners' extrinsic motivation with the PLA scheme that maintains ongoing engagement that was initially driven by intrinsic drivers such as a desire to improve assessment performance.
The benefits of introducing gamification within PLA can be best understood using self-determination theory (SDT). 10 According to SDT, learner motivation can range from amotivation (the absence of motives negating engagement), extrinsic motivation (driven by specific outcomes including rewards and punishments) and intrinsic motivation (engaging willingly due to self-discovered enjoyment and fulfilment). 10  online item review process managed within the system. However, these platforms often require funding for acquisition. In contrast, lower-fidelity approaches can still yield the benefits of learners involving themselves in assessment creation but may appear 'clunky' to participants and gamifying these approaches can be more complicated.
Faculty will therefore need to conduct a needs and resource assessment to inform their chosen system.

| PARTICIPANT AND FACULTY TRAINING
For the scheme to succeed, items must be well constructed and constructively aligned to the relevant learning outcomes. Providing training for both participants and faculty is therefore crucial. Providing style guides is a useful way to ensure that learners maintain consistency in item syntax and structure when writing new questions. 12 These can include discussion on how to successfully write items to minimise flaws that are often apparent to a 'test-wise' learner.
Guidance on avoiding copyright issues (e.g. using images from other resources) is also important. In the case of single-best answer items, training should cover how to best create a case vignettes and plausible distractors. 12 Ensuring the quality of peer-generated content is essential to address both real and perceived staff and learner concerns. Training should therefore extend to those taking part in the review process. 13 Reviewers may be fellow peers in the cohort, learners from other cohorts or disciplines or even senior/qualified colleagues such as post-graduate trainees keen to advance their own involvement in education. Rubrics can guide the review processes to critique the item for issues such as factual accuracy, syntax and structure issues or flaws that assist the test-wise learner. 14  Educators should also be mindful of the potential of the scheme to highlight learners who may be struggling academically. Early detection of struggling learners is crucial to successful remediation. 15 Potential warning signs may include low levels of participation in any of the item writing, review or answering stages or poor performance in answering items. It is therefore important that faculty have systems in place to identify and provide support for these learners. Faculty may also wish to moderate reviewer comments to ensure that feedback provided is appropriate and free of personal criticism of the item-author, which could further demotivate the struggling learner.

| CONCLUSIONS
Gamified PLA has the potential to enhance learners' educational experience, helping them consolidate their own learning through the process whilst simultaneously developing their own assessment literacy. Additionally, institutions benefit by offering their learners a rich peer-curated and ever-expanding item bank for formative practice. The educational principles and practical steps described in this Toolbox article will guide educators in successfully implementing this win-win educational intervention. A summary of key tips is found in Box 3.