Peer Assessment and Professionalism in Arab Medical Education Settings

Abstract

Background: Professionalism is a cornerstone of medical education, integral to fostering ethical practice, accountability, and patient-centred care, as emphasised in recent literature(McMahon et al., 2024; Sattar and Yusoff, 2025). Despite its recognised importance, defining professionalism remains challenging due to its multifaceted and context-dependent nature, with interpretations varying across cultures and institutions (Cruess, Cruess and Steinert, 2010; Tayeb et al., 2023). Traditional assessment methods, such as faculty evaluations and standardised tests, often fall short in capturing the nuanced behaviours and interpersonal skills that constitute professionalism (Tay et al., 2020). In response to these limitations, peer assessment has emerged as a promising approach that could encourage learners to reflect on and evaluate each other’s professional behaviours critically (Stenberg et al., 2021). However, a review of the literature suggests that the application of peer assessment in evaluating professionalism remains underexplored in Arab medical education contexts (Al Gahtani, Jahrami and Silverman, 2021). This thesis aims to investigate how professionalism is conceptualised and assessed within Arab medical education, with a particular focus on the potential of peer assessment as a tool for measuring professional behaviours among medical students. Methods: This research comprises three complementary studies. The first study was a scoping review that mapped the existing literature on peer assessment and professionalism in Arab medical education. The second study utilised semi-structured interviews with medical students and educators to explore their perceptions of professionalism and peer assessment within the cultural context. The third study involved expert focus groups to develop a culturally sensitive peer assessment tool tailored to the needs and values of Arab medical education settings. Results: The findings across the three studies highlight the influence of cultural context on how professionalism is understood, assessed, and potentially developed through peer assessment in Arab medical education. The first study, a scoping review, highlighted the limited use of peer assessment in the region and revealed diverse global approaches to evaluating professionalism, with notable gaps in culturally contextualised frameworks. The second study, based on interviews and a focus group, found that cultural factors such as collectivism, hierarchical structures, family involvement in decision-making, and gender dynamics are strongly influencing the conceptualisation and practice of professionalism. Challenges identified included resistance to critique, implicit biases, and the tension between individual responsibility and group loyalty. The third study, which used a focus group to refine a peer assessment tool, demonstrated consensus around key competencies such as effective communication, ethical conduct, cultural sensitivity, and professional boundaries. Participants emphasised the importance of adapting peer assessment frameworks to reflect these cultural realities while maintaining alignment with international standards. Conclusion: This research contributes a culturally grounded, evidence-informed framework for assessing professionalism in Arab medical education. By integrating insights from a scoping review, interviews, and expert consensus, it demonstrates how professionalism can be evaluated through peer assessment that respects both global standards and regional values. The findings highlight the importance of culturally responsive assessment design, structured peer feedback, and reflective learning environments. The developed tool offers a foundation for institutions to promote professionalism as an educational and ethical competency. Future work should focus on piloting the tool, evaluating its psychometric robustness, and embedding it within professionalism curricula to support formative learning and quality assurance across Arab medical schools.