peer review questions for presentations

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Peer Review Presentation

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This presentation is designed to acquaint your students with the concept of peer review. This presentation will include the who, what, where, when, and why of peer review. The slides presented here are designed to aid the facilitator in an interactive presentation of the elements of peer review. This presentation is ideal for any level of writing, including freshman composition.

Center for Teaching Innovation

Resource library, teaching students to evaluate each other, why use peer review.

Peer assessment, or review, can improve overall learning by helping students become better readers, writers, and collaborators. A well-designed peer review program also develops students’ evaluation and assessment skills. The following are a few techniques that instructors have used to implement peer review.

Planning for peer review

Identify where you can incorporate peer review exercises into your course.
For peer review on written assignments, design guidelines that specify clearly defined tasks for the reviewer. Consider what feedback students can competently provide.
Determine whether peer review activities will be conducted as in-class or out-of-class assignments (or as a combination of both).
Plan for in-class peer reviews to last at least one class session. More time will be needed for longer papers and papers written in foreign languages.
Model appropriate constructive criticism and descriptive feedback through the comments you provide on papers and in class.
Explain the reasons for peer review, the benefits it provides, and how it supports course learning outcomes.
Set clear expectations: determine whether students will receive grades on their contributions to peer review sessions. If grades are given, be clear about what you are assessing, what criteria will be used for grading, and how the peer review score will be incorporated into their overall course grade.

Before the first peer review session

Give students a sample paper to review and comment on in class using the peer review guidelines. Ask students to share feedback and help them rephrase their comments to make them more specific and constructive, as needed.
Consider using the sample paper exercise to teach students how to think about, respond to, and use comments by peer reviewers to improve their writing.
Ask for input from students on the peer review worksheet or co-create a rubric in class.
Prevent overly harsh peer criticism by instructing students to provide feedback as if they were speaking to the writer or presenter directly.
Consider how you will assign students to groups. Do you want them to work together for the entire semester, or change for different assignments? Do you want peer reviewers to remain anonymous? How many reviews will each assignment receive?

During and after peer review sessions

Give clear directions and time limits for in-class peer review sessions and set defined deadlines for out-of-class peer review assignments.
Listen to group discussions and provide guidance and input when necessary.
Consider requiring students to write a plan for revision indicating the changes they intend to make on the paper and explaining why they have chosen to acknowledge or disregard specific comments and suggestions. For exams and presentations, have students write about how they would approach the task next time based on the peer comments.
Ask students to submit the peer feedback they received with their final papers. Make clear whether or not you will be taking this feedback into account when grading the paper, or when assigning a participation grade to the student reviewer.
Consider having students assess the quality of the feedback they received.
Discuss the process in class, addressing problems that were encountered and what was learned.

Examples of peer review activities

After collection, redistribute papers randomly along with a grading rubric. After students have evaluated the papers ask them to exchange with a neighbor, evaluate the new paper, and then compare notes.
After completing an exam, have students compare and discuss answers with a partner. You may offer them the opportunity to submit a new answer, dividing points between the two.
In a small class, ask students to bring one copy of their paper with their name on it and one or two copies without a name. Collect the “name” copy and redistribute the others for peer review. Provide feedback on all student papers. Collect the peer reviews and return papers to their authors.
For group presentations, require the class to evaluate the group’s performance using a predetermined marking scheme.
When working on group projects, have students evaluate each group member’s contribution to the project on a scale of 1-10. Require students to provide rationale for how and why they awarded points.

Peer review technologies

Best used for providing feedback (formative assessment), PeerMark is a peer review program that encourages students to evaluate each other’s work. Students comment on assigned papers and answer scaled and free-form questions designed by the instructor. PeerMark does not allow you to assign point values or assign and export grades.

Contact the Center for a consultation on using these peer assessment tools.

Cho, K., & MacArthur, C. (2010). Student revision with peer and expert reviewing. Learning and Instruction , 20 (4), 328-338.

Kollar, I., & Fischer, F. (2010). Peer assessment as collaborative learning: A cognitive perspective. Learning and Instruction , 20 (4), 344-348.

The Teaching Center. (2009). Planning and guiding in-class peer review. Washington University in St. Louis. Retrieved from http://teachingcenter.wustl.edu/resources/writing-assignments-feedback/planning-and-guiding-in-class-peer-review/ .

Wasson, B., & Vold, V. (2012). Leveraging new media skills in a peer feedback tool. Internet and Higher Education , 15 (4), 1-10.

Xie, Y., Ke, F., & Sharma, P. (2008). The effect of peer feedback for blogging on college students’ reflective learning processes. Internet and Higher Education , 11 (1), 18-25.

van Zundert, M., Sluijsmans, D., & van Merriënboer, J. (2010). Effective peer assessment processes: Research findings and future directions. Learning and Instruction , 20 (4), 270-279.

09 Sep 45 Examples of Peer Review Questions

45 examples of peer review questions complied and explained by the experts..

Conducting a comprehensive peer review is crucial for understanding an employee’s performance from multiple angles. While managers can provide a valuable perspective based on their supervisory experience, peer reviews add another layer of insight that is often more granular and reflective of day-to-day interactions. To capture a well-rounded view of an employee’s skills, behaviors, and contributions, a diverse set of questions is essential.

In this compilation, we have provided a list of 45 peer review questions that cover a range of topics from teamwork and communication to ethical behavior and technological skills. These questions are designed to elicit specific types of feedback that collectively contribute to a nuanced and thorough performance assessment.

1. How well does the employee collaborate with team members on projects and tasks?

This question aims to assess the individual’s ability to work well within a team context. It delves into how effectively the employee engages with colleagues, contributes to team discussions, and helps achieve common goals. Peers are often best positioned to evaluate these aspects because they work alongside the individual in a collaborative setting. Responses to this question can also reveal how well the employee understands and contributes to team dynamics.

2. Can you provide an example of when the employee demonstrated strong problem-solving skills?

This question seeks to uncover concrete instances where the employee exhibited the ability to approach challenges logically and arrive at effective solutions. It helps to determine the employee’s aptitude for critical thinking, resourcefulness, and decision-making. Peer input can be invaluable here, as colleagues may have directly benefited from or observed the individual’s problem-solving skills in action.

3. How would you rate the employee’s communication skills, particularly in stressful situations?

The objective of this question is to gauge how well the employee communicates under pressure. Whether it’s handling a difficult client or navigating a project setback, effective communication is key. Peers who have worked closely with the individual in high-stress scenarios can offer a firsthand perspective on the employee’s communication effectiveness, including clarity, diplomacy, and the ability to keep the team informed.

4. Has the employee taken the initiative to lead any projects or initiatives? If so, how successful were they?

This question aims to identify any leadership qualities the employee may have demonstrated. It looks into whether the individual has proactively taken on responsibilities, motivated others, and successfully seen a project or initiative through to completion. Peers can offer insights into how the employee’s leadership affected team morale, project outcomes, and overall productivity.

5. Can you comment on the quality and timeliness of the employee’s work?

This question is designed to evaluate the employee’s commitment to delivering high-quality work within designated timelines. It touches on aspects such as attention to detail, accuracy, and punctuality. Peer feedback is valuable here as colleagues often depend on each other to complete tasks on time and to a certain standard, impacting the overall team performance.

6. How well does the employee handle constructive criticism and feedback?

This question aims to assess an employee’s ability to accept, internalize, and act upon constructive criticism. The ability to handle feedback well is crucial for personal and professional growth. Peers are often in a position to provide feedback directly or observe how an individual reacts to feedback from others, making their insights particularly valuable for this metric.

7. Does the employee contribute to a positive and inclusive work environment?

The focus here is on the employee’s role in fostering a healthy, inclusive, and positive work atmosphere. This can include anything from encouraging team members and celebrating successes to treating everyone with respect and fairness. Peers can provide a ground-level perspective on how an individual’s attitude and actions affect the overall team culture.

8. Can you cite an instance where the employee showed adaptability to sudden changes in projects or priorities?

This question is designed to gauge the employee’s flexibility and adaptability. In today’s fast-paced work environment, plans can change rapidly, and employees must adapt swiftly to meet new demands or shifts in focus. Peers who have had to adapt alongside the individual can provide valuable insights into the employee’s ability to cope with changes effectively.

9. How effectively does the employee manage their time and resources?

Time management is a critical skill in virtually every role. This question looks at how well the employee juggles multiple tasks, prioritizes work, and utilizes resources to get the job done. Peers can offer unique perspectives, especially if they have collaborated on projects that required joint time and resource management.

10. How consistently does the employee demonstrate ethical behavior and integrity in their work?

Ethical behavior and integrity are foundational to any role and organization. This question aims to explore how reliably the employee adheres to ethical standards and displays honesty in their work. Peers are often well-placed to comment on this, as they interact with the individual in various work scenarios and can attest to their ethical conduct.

11. How well does the employee handle conflict within the team?

This question seeks to understand an employee’s conflict-resolution skills. Conflict is inevitable in any work setting, and the way an employee manages it can greatly affect team dynamics and productivity. Peers are usually the ones who experience these conflicts first-hand, making their evaluation critical in understanding how well the individual deals with disputes or disagreements.

12. Can you identify a skill or area in which the employee has shown significant improvement?

The purpose of this question is to recognize and celebrate growth. It provides a platform for peers to point out areas where they’ve seen noticeable improvement in the employee’s skills or behavior. This could be especially valuable for individuals who have been working on specific performance goals or undergoing training programs.

13. How well does the employee balance individual tasks with team responsibilities?

This question aims to assess the employee’s ability to manage personal workload while contributing to team goals. It’s important for team members to strike a balance between individual accomplishments and collective responsibilities. Peers can offer insights into whether the employee has been effective in balancing both.

14. Does the employee exhibit a strong understanding of the company’s mission and objectives?

This question explores the employee’s alignment with the company’s broader mission and objectives. It’s essential for team members to not only focus on their tasks but also understand how their work contributes to the organization’s overarching goals. Peers can often provide insights into whether the employee demonstrates this understanding in daily tasks and interactions.

15. How approachable is the employee for help or discussions related to work?

The objective of this question is to evaluate the employee’s openness and accessibility. Being approachable fosters better communication, teamwork, and a more cohesive work environment. Team members are more likely to seek help, clarify doubts, and share ideas when they find their peers approachable. This is often best assessed by those who interact with the employee on a regular basis.

16. How proactive is the employee in identifying challenges and proposing solutions?

This question seeks to understand an employee’s level of initiative and proactivity. A proactive employee doesn’t just wait for instructions but actively looks for ways to improve processes or solve problems. Peers can offer unique perspectives on whether the employee takes such initiative, as they often work together on tasks that require problem-solving and forward-thinking.

17. Can you comment on the employee’s reliability and dependability in fulfilling commitments?

Reliability is a critical attribute in any work environment. This question aims to gauge how dependable the employee is when it comes to meeting deadlines, showing up for meetings, and fulfilling promises. Peer feedback is particularly valuable here, as colleagues are often the ones who feel the impact of an individual’s reliability or lack thereof.

18. How respectful is the employee of diverse opinions and perspectives?

In today’s diverse work environment, respect for different viewpoints is essential for a harmonious workplace. This question seeks to understand how well the employee listens to, considers, and respects the opinions of others, especially when they differ from their own. Peer reviews can offer valuable insights into an individual’s ability to engage constructively with diversity.

19. How effectively does the employee prioritize tasks and manage stress?

Prioritization and stress management are key to productivity and well-being. This question aims to find out how the employee handles the pressure of multiple tasks or tight deadlines. Peers can often provide firsthand accounts of the individual’s capacity to stay focused and calm under pressure, which is beneficial for both the employee and the team.

20. How receptive is the employee to new ideas and innovative approaches?

Adaptability to change and openness to innovation are important traits in the modern workplace. This question explores whether the employee is willing to consider new ideas and adapt to innovative approaches in doing work. Colleagues who have proposed new ideas or witnessed the employee’s reaction to change can offer valuable insights.

peer review question examples by the experts

21. How well does the employee maintain client or customer relationships?

This question targets the employee’s skills in external relationship-building. In roles where maintaining client or customer relationships is crucial, understanding how well an employee performs in this area is vital. Peers who also interact with clients or work on client-facing projects can provide important context on this aspect of performance.

22. Is the employee effective in sharing knowledge and expertise with the team?

Knowledge sharing is a cornerstone of team growth and cohesion. This question aims to gauge whether the employee willingly shares expertise, insights, or helpful tips with colleagues. This is often a critical factor in team development, and peers are best positioned to comment on how much an individual contributes to this communal knowledge pool.

23. Does the employee actively seek feedback from peers or superiors?

This question investigates the employee’s willingness to engage in self-improvement by actively seeking feedback. An employee who regularly asks for feedback shows a commitment to personal and professional growth. Team members can attest to whether or not the individual has made efforts to request and utilize feedback constructively.

24. How frequently does the employee volunteer for additional responsibilities?

This question assesses the employee’s eagerness to go beyond their designated job role by volunteering for additional tasks or responsibilities. It can indicate a high level of motivation and willingness to contribute more to the team. Peers can give feedback on whether they’ve observed this kind of proactive behavior.

25. Can you provide an example of when the employee successfully navigated a complex situation?

Navigating complexity often requires a mix of skills including critical thinking, diplomacy, and strategic planning. This question asks peers to provide specific instances where the employee displayed these skills in resolving a complicated issue. Such firsthand accounts can offer valuable insights into an employee’s capability to handle complexity effectively.

26. How well does the employee articulate their thoughts and ideas in meetings?

The ability to clearly express thoughts and ideas is key to effective collaboration and decision-making. This question focuses on evaluating the employee’s skills in articulating points during team meetings or discussions. Peers who participate in the same meetings can provide insights into how well the employee communicates their ideas and contributes to collective understanding.

27. Does the employee display a willingness to mentor or guide less experienced team members?

Mentorship can greatly impact team cohesion and individual development. This question aims to determine whether the employee takes the time to guide or mentor less experienced colleagues. Feedback from peers can reveal the extent to which the individual has taken on a mentorship role and the effectiveness of that guidance.

28. How effectively does the employee manage remote work and virtual collaborations?

With remote work becoming increasingly common, this question evaluates how well the employee adapts to virtual work environments. This includes their ability to communicate, manage time, and collaborate effectively when not physically present in the office. Peers who have worked with the employee remotely can offer particularly relevant insights.

29. Can you comment on the employee’s ability to focus on long-term goals while managing short-term tasks?

Strategic vision coupled with day-to-day effectiveness is a valuable skill set. This question explores how well the employee can balance immediate tasks with long-term objectives. Peers who collaborate on both ongoing and future-oriented projects can provide context on how well the individual maintains this balance.

30. How active is the employee in participating in company-wide initiatives or events?

Engagement with company culture and broader initiatives can be an indicator of an employee’s commitment and morale. This question aims to find out how involved the employee is in activities or projects that go beyond their immediate team or department. Feedback from peers can help gauge the employee’s level of organizational engagement.

31. How adept is the employee at handling confidential or sensitive information?

Discretion and confidentiality are critical in many professional settings. This question seeks to understand the employee’s capacity to manage sensitive information responsibly. Peers who have worked on confidential projects with the employee can offer firsthand insights into their reliability in this regard.

32. Can you describe the employee’s effectiveness in cross-departmental collaboration?

Collaboration across departments is often vital for the success of larger organizational projects. This question focuses on the employee’s ability to work well with team members from other departments. Peers from both within and outside the employee’s department can provide valuable feedback on this ability.

33. How attentive is the employee to details in their work?

Attention to detail can be a key attribute for roles that require meticulous planning or execution. This question aims to determine how well the employee maintains accuracy and precision in their work. Peers who have collaborated on detailed-oriented tasks can provide specific examples or general observations.

34. Does the employee consistently meet deadlines without compromising on quality?

The ability to work efficiently without sacrificing the quality of output is crucial. This question focuses on the employee’s ability to manage time in such a way that deadlines are met while maintaining high-quality work. Peers who have been on time-sensitive projects with the employee can offer relevant commentary.

35. How resourceful is the employee when encountering obstacles or limited resources?

Resourcefulness often comes into play when facing challenges or when operating under constraints. This question aims to gauge the employee’s ability to find effective solutions or alternatives when conventional methods are not applicable. Peers can discuss specific instances when the employee demonstrated resourcefulness in overcoming obstacles.

36. How would you rate the employee’s adaptability to rapidly changing situations?

In a fast-paced work environment, the ability to adapt quickly to change is essential. This question aims to evaluate the employee’s flexibility and resilience when faced with unexpected shifts in tasks, priorities, or team dynamics. Peers who have navigated changes alongside the employee can offer particularly useful perspectives.

37. Does the employee display ethical behavior and integrity in their professional interactions?

Ethical behavior and integrity are foundational to any workplace. This question seeks to assess the employee’s adherence to ethical standards and principles. Peers who have observed the employee in various situations, possibly including challenging ethical dilemmas, can provide valuable insights into their ethical conduct.

38. How well does the employee contribute to a positive workplace culture?

A positive workplace culture not only improves employee satisfaction but also productivity. This question asks peers to evaluate the employee’s contributions to creating a positive, inclusive environment. This could range from their attitude and behavior to specific actions that uplift team morale.

39. How willing is the employee to take ownership of both successes and failures?

Accountability is an important trait in any professional setting. This question aims to determine whether the employee is willing to take responsibility for their actions, whether they result in success or failure. Peers can provide examples or general observations to indicate the employee’s level of accountability.

40. Can you provide an example of a project where the employee demonstrated excellent project management skills?

Project management involves a range of skills including planning, executing, and closing projects effectively. This question focuses on evaluating the employee’s aptitude in managing projects from start to finish. Team members who have participated in projects led by the employee can give insights into their project management capabilities.

41. How well does the employee respond to constructive criticism?

Being open to constructive criticism is essential for personal and professional growth. This question aims to gauge how the employee handles feedback, whether they become defensive or use it as an opportunity to improve. Peers who have witnessed or participated in feedback sessions with the employee can offer their perspectives.

42. Does the employee show a genuine interest in the professional development of their peers?

A nurturing work environment often involves team members looking out for each other’s growth and well-being. This question evaluates whether the employee takes an interest in helping their colleagues develop professionally, perhaps by sharing opportunities or offering advice. Peer responses can shed light on this quality.

43. Can you comment on the employee’s crisis management skills?

Crisis management skills become evident when the stakes are high and time is of the essence. This question assesses how well the employee manages stressful, high-urgency situations. Peers who have worked with the employee during a crisis can provide unique insights into their ability to stay calm and make effective decisions.

44. How skilled is the employee in using technology tools relevant to their job?

Technological proficiency is increasingly important in modern workplaces. This question evaluates the employee’s skill level in using job-relevant software, tools, or platforms. Peers who use similar technology can offer a relative assessment of the employee’s technological adeptness.

45. Does the employee make data-driven decisions when applicable?

In many roles, the ability to make data-driven decisions is essential for optimizing performance and outcomes. This question assesses whether the employee effectively uses available data to inform their choices and actions. Peers can comment on instances where the employee either utilized or ignored data in decision-making processes.

Looking for more questions? See questions by Indeed.com.

Thoughts from the ClockIt Team.

In conclusion, peer reviews serve as a vital tool for capturing a multifaceted understanding of an employee’s performance, one that goes beyond the viewpoint of supervisors or self-assessments. This enables more targeted development plans, fosters a culture of continuous improvement, and ultimately contributes to both individual and organizational success. With the 45 peer review questions outlined in this guide, you are well-equipped to create a robust evaluation process that will yield invaluable insights for your team.

Also Read: How to include peer reviews into performance reviews.

Add Peer Reviews in Performance Assessments

Basil Abbas

Basil is the Founder and CTO at ClockIt. With over 10 years of experience in the products space, there is no challenge that is too big in front of him be it sales, marketing, coding, etc. A people person and loves working in a startup for perfection.

Facilitating Effective Peer Review Sessions

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PWR is committed to the use of small-group writing workshops. While some students doubt the value of peer group work, when well executed these groups can be both effective and enjoyable. While some instructors keep students in the same small groups all quarter, other instructors create new student groups for every assignment. Both strategies have merit.

Peer Review Group Suggestions

Pay attention to the way you present the concept of peer review to your students. Explain clearly the rationale for doing this activity and demonstrate your commitment to it.
Make the work count. You may assign points for it as a part of your class activities and informal writing component of your grade; remember that you need to be transparent in your evaluation criteria for anything that you are “grading,” including group work.
Prepare clear and specific Peer Response Guideline Sheets for each peer response session.
In a remote learning context, consider creating peer review groups by student time zone, especially if the peer review groups are meeting outside of class time.
Spend some time with each group. Take notes on the activity, on how well the group is working; who is contributing strong, focused responses; who needs to improve, etc.
At the end of the session, remind the students to turn in all their peer responses with their revised essays.
Take time to respond briefly but cogently to each peer response, noting areas of strength and weakness and ways in which the responder can offer more explicit and helpful advice.
Take time in the next class to refer to some of the most useful comments made in peer response and specify why they are more helpful than others.
Be patient. Experienced instructors say that getting the groups working well together takes several weeks; with persistence and encouragement from you, they will get there.
Consider changing the peer response structure. For instance, have the peer groups act as the editorial board of a journal.

See also some examples of peer review sheets from our PWR Canvas Archive

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Types of Presentation
Additional Suggestions for Success

Communication

The work should clearly communicate the content without calls for clarification.
If written for the general public, simplification of terms and provision of background information would allow attendees to easily grasp the concepts and research results being reported.
If written for fellow scholars and researchers, the content would presume no need for topic education is necessary, that terminology is consistent with the subject area, and research reporting would be at the level of scholarly writing.
The work should be free of grammatical and punctuation errors.
Numbers and data, if used, should be presented in a manner which makes understanding easy to achieve.

Ask yourself:

Does the content wording and use of terms match the intended audience?
Is evidence presented logically and use appropriately?
Is the work clearly and succinctly organized?
Are discussions and research results of subjects, either individual or groups, presented in an objective and respectful manner?
Are sensitive topics and issues presented with thoughtfulness and courtesy?
Works submitted for publication in traditional print resources should follow the publisher’s guide to submissions, especially criteria involving relevant value to the readers.
Works submitted for publication in an electronic format – web site, digital, PDF, etc. – should be cognizant of the type of format and the format’s strengths in appealing to the reader by use of technology, programming, and audio or video motion.
Is the work suitable to the audience targeted?
Does the work present an appropriate and suitable style?
The work should clearly state the purpose of the work, the goals that were designed, the results that occurred, any differences between the goals and the results, and the importance of the research results to the audience or area of interest.
The author should demonstrate scholarship in the field by the quality of supporting evidence, research method, research results, and interpretation of those results.
Is the work objective in its content and presentation?
Are conclusions reached without predeterminations and outside influence?
Is there sufficient evidence, both in terms of amount and substance, to effectively support the outcome?
Does the work provide new evidence or research results that would be of interest to the field, practitioners, and scholars?

Blogs, Listservs, and Social Media

Electronic presentations are a great way to gage collegial ideas and opinions about the topic you have selected to pursue. These formats can be done at varying and convenient times.

Online brevity is the best – adopt Twitter’s 140 character limit, and select words carefully.
Use simple statements.
DON’T SHOUT.
Seek feedback and comments.

Exhibits consist of a visual display of a collection, program, initiative, or body of work (i.e. paintings, drawings, prints, posters, photography, sculpture, ceramics, video, installation, multi-media).

Include a general statement of purpose and statements to provide an intellectual context both for the collection as a whole and for its individual pieces.
Be prepared to respond to comments and questions.

Facilitated Discussions

Facilitated discussions involve the arranging of attendees into groups, such as tables or round chair setup, and provide topics for discussion. Topics can be the same for all attendees and groups, or vary by group.

Provide a brief introduction – remember that you are not the presenter, and the discussions are the purpose of this event.
Develop discussion points, topics, and questions well in advance by polling registered attendees.
Be willing to accept ad-hoc discussion topics relevant to the content.
Provide for adequate Q&A and open comment time at the end.
Ensure that the majority of time allotted for the event is reserved for discussion and report-back.
Record group report-back’s on flip charts or other method, so that attendees may view the report-back comments as they are read out, and receive a written copy after the event.
Foster collegial conversational exchange.
Mingle among the groups or tables to see if attendees are participating, but avoid becoming involved in their discussions.

Keynote Address

The keynote address is perhaps the most challenging presentation. What you say and how well you communicate your ideas, research, findings, and experience sets the tone for the event. High level competency and established experience are the minimum content goals. See Oral Presentations for additional guidance.

Presentation much be absolutely relevant to the event.
This is a stand-alone presentation.
Be prepared to “wow” the audience with a dynamic content, excellent slides, well developed public speaking skills, and inspiration.
Professional credibility is presumed.

Oral Presentations

Oral presentations involve the presentation of a paper or research project with or without visual aids. This is an excellent opportunity to share research findings with colleagues, seek comments, listen to advice, and facilitate discussion and comment.

Focus on the purpose, methodology, challenges, and findings of the research.
Report laboratory and data results, if applicable.
Clearly provide the reason that motivated research interest and commencement.
Disclose the strengths and weakness of the research process, and what was learned from failures.
PowerPoint presentations should be well done. See PowerPoint Use in Presentation for more details.
Subject mastery is presumed.
Expect questions and comments that indicate doubt or disagreement, and respond collegially.
Include a Q&A section at the end of the presentation.
Provide contact information.

Panel Discussions

Panel discussions involve a limited number of panelists, usually 3-5, presenting and discussing their views on a scholarly topic and responding to audience questions.

Select speakers from different perspectives to give balanced presentations.
Before finalizing speaker selection, discuss panel content and purpose to ensure that potential speakers understand the purpose of the panel discussion.
Ask panelists to state their points concisely and clearly, mindful of the limited time for each panelist.
Anticipate questions from both the audience and panelists.
Defer comment and questions from the audience to panelists.
Provide ample time for individual presentations, statements, general discussion, and Q&A.

Peer Review Publications

Poster sessions.

Posters present a visual display of work on poster boards. Presenters should be able to provide a scholarly introduction to their work and be prepared to entertain the viewers’ questions.

Include both charts and pictures.
Develop an eye catching format and design.
Brevity works best, both for what is on the poster and for answering visitors.
Have a one-sheet handout for the main take-away points, including your contact information.
Have business cards available.
Be prepared for many repeats of your 60-second verbal summary.
Expect fast and furious turnovers.
Balance the content – not too sparse but not too detailed and complex.

PowerPoint Use in Presentations

Using PowerPoint or any slide programmed should be viewed as a supplemental visual tool for many types of presentations. They should not be treated as “the” presentation.

Don’t read from the slides.
Look at the screen as little as possible.
Present from knowledge and experience, not from the slides.
Slides should be limited in numbers and complexity.
Charts, graphics, pictures, and other inserts should be simple and visually clear.
Sound, video, and images add value, if content relevant.
Use bullet points. PowerPoint slides do not need full sentences, and should never have a paragraph full of information.
Use images effectively. You should have as little text as possible on the slide. One way to accomplish this is to have images on each slide, accompanied by a small amount of text.
Slides provide focus and guidance, not full details.
Never put your presentation on the slides and read from the slides.

Workshops consist of a brief presentation followed by interaction with the audience. The purpose of a workshop is to introduce the audience to your subject and involve them in using a skill or technique. Learning objectives and anticipated outcomes should be clearly stated.

Content should be timely and relevant.
Content should be take-away – attendees should be able to leave the workshop, go back to their jobs, and begin brainstorming ideas, developing strategies, and implementing projects soon.
Go short on theories and long on how-to methods.
Develop learning objectives and anticipated outcomes, and build content around these goals.
Develop an agenda that more resembles a syllabus.
Select preparation materials, such as articles and documents to read before the workshop.
Include data but do not overwhelm attendees with too much or complex data.
Provide a bibliography or list of suggested readings.

Academic Presentation Formula

Newbies are strongly encouraged to follow this formula. Later and with experience, deviation from the formula is more feasible.

Introduction/Overview/Hook
Theoretical Framework/Research Question
Methodology/Case Selection
Background/Literature Review
Discussion of Data/Results
Q&A, if permitted

The Audience Is Ready to Listen

Avoid presenting too much information about what is already known, and provide this information, if needed, in the introduction. Only discuss literature and background information that relates directly to the topic and research results being presented. Keep this portion of the presentation to five minutes or less. More time will be needed for the presentation of the research results and audience questions and comments.

Practice Practice Practice

Practice the presentation from start to finish before delivering the presentation – several times. Repeated practicing provides delivery confidence, efficient time management, and better speaking skills. Make sure the presentation fits within the time parameters. Practicing also makes it flow better.

Keep To the Time Limit

If the time allotted for the presentation is ten minutes, prepare ten minutes of material. Regardless of the amount of time provided, a little or a lot, finish within or at the end of the allotted time. Practice the presentation with a stopwatch to ensure complicity.

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How to Write a Peer Review

When you write a peer review for a manuscript, what should you include in your comments? What should you leave out? And how should the review be formatted?

This guide provides quick tips for writing and organizing your reviewer report.

Review Outline

Use an outline for your reviewer report so it’s easy for the editors and author to follow. This will also help you keep your comments organized.

Think about structuring your review like an inverted pyramid. Put the most important information at the top, followed by details and examples in the center, and any additional points at the very bottom.

Here’s how your outline might look:

1. Summary of the research and your overall impression

In your own words, summarize what the manuscript claims to report. This shows the editor how you interpreted the manuscript and will highlight any major differences in perspective between you and the other reviewers. Give an overview of the manuscript’s strengths and weaknesses. Think about this as your “take-home” message for the editors. End this section with your recommended course of action.

2. Discussion of specific areas for improvement

It’s helpful to divide this section into two parts: one for major issues and one for minor issues. Within each section, you can talk about the biggest issues first or go systematically figure-by-figure or claim-by-claim. Number each item so that your points are easy to follow (this will also make it easier for the authors to respond to each point). Refer to specific lines, pages, sections, or figure and table numbers so the authors (and editors) know exactly what you’re talking about.

Major vs. minor issues

What’s the difference between a major and minor issue? Major issues should consist of the essential points the authors need to address before the manuscript can proceed. Make sure you focus on what is fundamental for the current study . In other words, it’s not helpful to recommend additional work that would be considered the “next step” in the study. Minor issues are still important but typically will not affect the overall conclusions of the manuscript. Here are some examples of what would might go in the “minor” category:

Missing references (but depending on what is missing, this could also be a major issue)
Technical clarifications (e.g., the authors should clarify how a reagent works)
Data presentation (e.g., the authors should present p-values differently)
Typos, spelling, grammar, and phrasing issues

3. Any other points

Confidential comments for the editors.

Some journals have a space for reviewers to enter confidential comments about the manuscript. Use this space to mention concerns about the submission that you’d want the editors to consider before sharing your feedback with the authors, such as concerns about ethical guidelines or language quality. Any serious issues should be raised directly and immediately with the journal as well.

This section is also where you will disclose any potentially competing interests, and mention whether you’re willing to look at a revised version of the manuscript.

Do not use this space to critique the manuscript, since comments entered here will not be passed along to the authors. If you’re not sure what should go in the confidential comments, read the reviewer instructions or check with the journal first before submitting your review. If you are reviewing for a journal that does not offer a space for confidential comments, consider writing to the editorial office directly with your concerns.

Get this outline in a template

Giving Feedback

Giving feedback is hard. Giving effective feedback can be even more challenging. Remember that your ultimate goal is to discuss what the authors would need to do in order to qualify for publication. The point is not to nitpick every piece of the manuscript. Your focus should be on providing constructive and critical feedback that the authors can use to improve their study.

If you’ve ever had your own work reviewed, you already know that it’s not always easy to receive feedback. Follow the golden rule: Write the type of review you’d want to receive if you were the author. Even if you decide not to identify yourself in the review, you should write comments that you would be comfortable signing your name to.

In your comments, use phrases like “ the authors’ discussion of X” instead of “ your discussion of X .” This will depersonalize the feedback and keep the focus on the manuscript instead of the authors.

General guidelines for effective feedback

Justify your recommendation with concrete evidence and specific examples.
Be specific so the authors know what they need to do to improve.
Be thorough. This might be the only time you read the manuscript.
Be professional and respectful. The authors will be reading these comments too.
Remember to say what you liked about the manuscript!

Don’t

Recommend additional experiments or unnecessary elements that are out of scope for the study or for the journal criteria.
Tell the authors exactly how to revise their manuscript—you don’t need to do their work for them.
Use the review to promote your own research or hypotheses.
Focus on typos and grammar. If the manuscript needs significant editing for language and writing quality, just mention this in your comments.
Submit your review without proofreading it and checking everything one more time.

Before and After: Sample Reviewer Comments

Keeping in mind the guidelines above, how do you put your thoughts into words? Here are some sample “before” and “after” reviewer comments

✗ Before

“The authors appear to have no idea what they are talking about. I don’t think they have read any of the literature on this topic.”

✓ After

“The study fails to address how the findings relate to previous research in this area. The authors should rewrite their Introduction and Discussion to reference the related literature, especially recently published work such as Darwin et al.”

“The writing is so bad, it is practically unreadable. I could barely bring myself to finish it.”

“While the study appears to be sound, the language is unclear, making it difficult to follow. I advise the authors work with a writing coach or copyeditor to improve the flow and readability of the text.”

“It’s obvious that this type of experiment should have been included. I have no idea why the authors didn’t use it. This is a big mistake.”

“The authors are off to a good start, however, this study requires additional experiments, particularly [type of experiment]. Alternatively, the authors should include more information that clarifies and justifies their choice of methods.”

Suggested Language for Tricky Situations

You might find yourself in a situation where you’re not sure how to explain the problem or provide feedback in a constructive and respectful way. Here is some suggested language for common issues you might experience.

What you think : The manuscript is fatally flawed. What you could say: “The study does not appear to be sound” or “the authors have missed something crucial”.

What you think : You don’t completely understand the manuscript. What you could say : “The authors should clarify the following sections to avoid confusion…”

What you think : The technical details don’t make sense. What you could say : “The technical details should be expanded and clarified to ensure that readers understand exactly what the researchers studied.”

What you think: The writing is terrible. What you could say : “The authors should revise the language to improve readability.”

What you think : The authors have over-interpreted the findings. What you could say : “The authors aim to demonstrate [XYZ], however, the data does not fully support this conclusion. Specifically…”

What does a good review look like?

Check out the peer review examples at F1000 Research to see how other reviewers write up their reports and give constructive feedback to authors.

Time to Submit the Review!

Be sure you turn in your report on time. Need an extension? Tell the journal so that they know what to expect. If you need a lot of extra time, the journal might need to contact other reviewers or notify the author about the delay.

Tip: Building a relationship with an editor

You’ll be more likely to be asked to review again if you provide high-quality feedback and if you turn in the review on time. Especially if it’s your first review for a journal, it’s important to show that you are reliable. Prove yourself once and you’ll get asked to review again!

Getting started as a reviewer
Responding to an invitation
Reading a manuscript
Writing a peer review

The contents of the Peer Review Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

The contents of the Writing Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

There’s a lot to consider when deciding where to submit your work. Learn how to choose a journal that will help your study reach its audience, while reflecting your values as a researcher…

Have a language expert improve your writing

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Knowledge Base

Methodology

What Is Peer Review? | Types & Examples

What Is Peer Review? | Types & Examples

Published on December 17, 2021 by Tegan George . Revised on June 22, 2023.

Peer review, sometimes referred to as refereeing , is the process of evaluating submissions to an academic journal. Using strict criteria, a panel of reviewers in the same subject area decides whether to accept each submission for publication.

Peer-reviewed articles are considered a highly credible source due to the stringent process they go through before publication.

There are various types of peer review. The main difference between them is to what extent the authors, reviewers, and editors know each other’s identities. The most common types are:

Single-blind review
Double-blind review
Triple-blind review

Collaborative review

Open review.

Relatedly, peer assessment is a process where your peers provide you with feedback on something you’ve written, based on a set of criteria or benchmarks from an instructor. They then give constructive feedback, compliments, or guidance to help you improve your draft.

What is the purpose of peer review, types of peer review, the peer review process, providing feedback to your peers, peer review example, advantages of peer review, criticisms of peer review, other interesting articles, frequently asked questions about peer reviews.

Many academic fields use peer review, largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the manuscript. For this reason, academic journals are among the most credible sources you can refer to.

However, peer review is also common in non-academic settings. The United Nations, the European Union, and many individual nations use peer review to evaluate grant applications. It is also widely used in medical and health-related fields as a teaching or quality-of-care measure.

Peer assessment is often used in the classroom as a pedagogical tool. Both receiving feedback and providing it are thought to enhance the learning process, helping students think critically and collaboratively.

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Depending on the journal, there are several types of peer review.

Single-blind peer review

The most common type of peer review is single-blind (or single anonymized) review . Here, the names of the reviewers are not known by the author.

While this gives the reviewers the ability to give feedback without the possibility of interference from the author, there has been substantial criticism of this method in the last few years. Many argue that single-blind reviewing can lead to poaching or intellectual theft or that anonymized comments cause reviewers to be too harsh.

Double-blind peer review

In double-blind (or double anonymized) review , both the author and the reviewers are anonymous.

Arguments for double-blind review highlight that this mitigates any risk of prejudice on the side of the reviewer, while protecting the nature of the process. In theory, it also leads to manuscripts being published on merit rather than on the reputation of the author.

Triple-blind peer review

While triple-blind (or triple anonymized) review —where the identities of the author, reviewers, and editors are all anonymized—does exist, it is difficult to carry out in practice.

Proponents of adopting triple-blind review for journal submissions argue that it minimizes potential conflicts of interest and biases. However, ensuring anonymity is logistically challenging, and current editing software is not always able to fully anonymize everyone involved in the process.

In collaborative review , authors and reviewers interact with each other directly throughout the process. However, the identity of the reviewer is not known to the author. This gives all parties the opportunity to resolve any inconsistencies or contradictions in real time, and provides them a rich forum for discussion. It can mitigate the need for multiple rounds of editing and minimize back-and-forth.

Collaborative review can be time- and resource-intensive for the journal, however. For these collaborations to occur, there has to be a set system in place, often a technological platform, with staff monitoring and fixing any bugs or glitches.

Lastly, in open review , all parties know each other’s identities throughout the process. Often, open review can also include feedback from a larger audience, such as an online forum, or reviewer feedback included as part of the final published product.

While many argue that greater transparency prevents plagiarism or unnecessary harshness, there is also concern about the quality of future scholarship if reviewers feel they have to censor their comments.

In general, the peer review process includes the following steps:

First, the author submits the manuscript to the editor.
Reject the manuscript and send it back to the author, or
Send it onward to the selected peer reviewer(s)
Next, the peer review process occurs. The reviewer provides feedback, addressing any major or minor issues with the manuscript, and gives their advice regarding what edits should be made.
Lastly, the edited manuscript is sent back to the author. They input the edits and resubmit it to the editor for publication.

In an effort to be transparent, many journals are now disclosing who reviewed each article in the published product. There are also increasing opportunities for collaboration and feedback, with some journals allowing open communication between reviewers and authors.

It can seem daunting at first to conduct a peer review or peer assessment. If you’re not sure where to start, there are several best practices you can use.

Summarize the argument in your own words

Summarizing the main argument helps the author see how their argument is interpreted by readers, and gives you a jumping-off point for providing feedback. If you’re having trouble doing this, it’s a sign that the argument needs to be clearer, more concise, or worded differently.

If the author sees that you’ve interpreted their argument differently than they intended, they have an opportunity to address any misunderstandings when they get the manuscript back.

Separate your feedback into major and minor issues

It can be challenging to keep feedback organized. One strategy is to start out with any major issues and then flow into the more minor points. It’s often helpful to keep your feedback in a numbered list, so the author has concrete points to refer back to.

Major issues typically consist of any problems with the style, flow, or key points of the manuscript. Minor issues include spelling errors, citation errors, or other smaller, easy-to-apply feedback.

Tip: Try not to focus too much on the minor issues. If the manuscript has a lot of typos, consider making a note that the author should address spelling and grammar issues, rather than going through and fixing each one.

The best feedback you can provide is anything that helps them strengthen their argument or resolve major stylistic issues.

Give the type of feedback that you would like to receive

No one likes being criticized, and it can be difficult to give honest feedback without sounding overly harsh or critical. One strategy you can use here is the “compliment sandwich,” where you “sandwich” your constructive criticism between two compliments.

Be sure you are giving concrete, actionable feedback that will help the author submit a successful final draft. While you shouldn’t tell them exactly what they should do, your feedback should help them resolve any issues they may have overlooked.

As a rule of thumb, your feedback should be:

Easy to understand
Constructive

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Below is a brief annotated research example. You can view examples of peer feedback by hovering over the highlighted sections.

Influence of phone use on sleep

Studies show that teens from the US are getting less sleep than they were a decade ago (Johnson, 2019) . On average, teens only slept for 6 hours a night in 2021, compared to 8 hours a night in 2011. Johnson mentions several potential causes, such as increased anxiety, changed diets, and increased phone use.

The current study focuses on the effect phone use before bedtime has on the number of hours of sleep teens are getting.

For this study, a sample of 300 teens was recruited using social media, such as Facebook, Instagram, and Snapchat. The first week, all teens were allowed to use their phone the way they normally would, in order to obtain a baseline.

The sample was then divided into 3 groups:

Group 1 was not allowed to use their phone before bedtime.
Group 2 used their phone for 1 hour before bedtime.
Group 3 used their phone for 3 hours before bedtime.

All participants were asked to go to sleep around 10 p.m. to control for variation in bedtime . In the morning, their Fitbit showed the number of hours they’d slept. They kept track of these numbers themselves for 1 week.

Two independent t tests were used in order to compare Group 1 and Group 2, and Group 1 and Group 3. The first t test showed no significant difference ( p > .05) between the number of hours for Group 1 ( M = 7.8, SD = 0.6) and Group 2 ( M = 7.0, SD = 0.8). The second t test showed a significant difference ( p < .01) between the average difference for Group 1 ( M = 7.8, SD = 0.6) and Group 3 ( M = 6.1, SD = 1.5).

This shows that teens sleep fewer hours a night if they use their phone for over an hour before bedtime, compared to teens who use their phone for 0 to 1 hours.

Peer review is an established and hallowed process in academia, dating back hundreds of years. It provides various fields of study with metrics, expectations, and guidance to ensure published work is consistent with predetermined standards.

Protects the quality of published research

Peer review can stop obviously problematic, falsified, or otherwise untrustworthy research from being published. Any content that raises red flags for reviewers can be closely examined in the review stage, preventing plagiarized or duplicated research from being published.

Gives you access to feedback from experts in your field

Peer review represents an excellent opportunity to get feedback from renowned experts in your field and to improve your writing through their feedback and guidance. Experts with knowledge about your subject matter can give you feedback on both style and content, and they may also suggest avenues for further research that you hadn’t yet considered.

Helps you identify any weaknesses in your argument

Peer review acts as a first defense, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process. This way, you’ll end up with a more robust, more cohesive article.

While peer review is a widely accepted metric for credibility, it’s not without its drawbacks.

Reviewer bias

The more transparent double-blind system is not yet very common, which can lead to bias in reviewing. A common criticism is that an excellent paper by a new researcher may be declined, while an objectively lower-quality submission by an established researcher would be accepted.

Delays in publication

The thoroughness of the peer review process can lead to significant delays in publishing time. Research that was current at the time of submission may not be as current by the time it’s published. There is also high risk of publication bias , where journals are more likely to publish studies with positive findings than studies with negative findings.

Risk of human error

By its very nature, peer review carries a risk of human error. In particular, falsification often cannot be detected, given that reviewers would have to replicate entire experiments to ensure the validity of results.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

Normal distribution
Measures of central tendency
Chi square tests
Confidence interval
Quartiles & Quantiles
Cluster sampling
Stratified sampling
Thematic analysis
Discourse analysis
Cohort study
Ethnography

Research bias

Implicit bias
Cognitive bias
Conformity bias
Hawthorne effect
Availability heuristic
Attrition bias
Social desirability bias

Peer review is a process of evaluating submissions to an academic journal. Utilizing rigorous criteria, a panel of reviewers in the same subject area decide whether to accept each submission for publication. For this reason, academic journals are often considered among the most credible sources you can use in a research project– provided that the journal itself is trustworthy and well-regarded.

In general, the peer review process follows the following steps:

Reject the manuscript and send it back to author, or
Send it onward to the selected peer reviewer(s)
Next, the peer review process occurs. The reviewer provides feedback, addressing any major or minor issues with the manuscript, and gives their advice regarding what edits should be made.
Lastly, the edited manuscript is sent back to the author. They input the edits, and resubmit it to the editor for publication.

Peer review can stop obviously problematic, falsified, or otherwise untrustworthy research from being published. It also represents an excellent opportunity to get feedback from renowned experts in your field. It acts as a first defense, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process.

Peer-reviewed articles are considered a highly credible source due to this stringent process they go through before publication.

Many academic fields use peer review , largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the published manuscript.

A credible source should pass the CRAAP test and follow these guidelines:

The information should be up to date and current.
The author and publication should be a trusted authority on the subject you are researching.
The sources the author cited should be easy to find, clear, and unbiased.
For a web source, the URL and layout should signify that it is trustworthy.

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Student Peer Assessment

Student peer assessments are structured opportunities for students to provide and receive meaningful feedback on their work from their classmates. Engaging in peer assessment (also called peer review) fosters important skills for both the student doing the review and the one receiving the review. By serving as a reviewer, students learn how to provide constructive feedback. Moreover, students receiving feedback can gain a fresh perspective on their work and make improvements prior to their final submission. By helping students learn how to give and receive constructive feedback, peer assessments provide students with valuable skills that transfer to real-world settings where collaborative work is common. This is especially the case for students in STEM disciplines, where peer review is an important component of the publication process. Partaking in a collaborative process to improve each other’s work also promotes higher engagement with the course material, better understanding evaluation criteria and increases a sense of belonging among students, all of which are known to improve student academic success (Cho and MacArthur, 2010; Gilken and Johnson, 2019).

Best Practices to Incorporate Peer Feedback in Assessments

Peer assessments can improve student work without a proportionate increase in instructor workload. Nonetheless, instructors need to prepare students for peer review with adequate instruction and examples to be effective. Expand the boxes below to learn more about best practices and resources to incorporate student peer assessments in your courses.

Before Peer Review

Instructors should identify a particular assignment or task that could benefit from peer-review in the course. This includes multi-step projects and formative assessments (e.g., low-stakes homeworks or 5-minute essays). Ideally, use peer review for formative feedback, and not as a basis for grades since students may sometimes be inconsistent in how the rubric is applied. Instead, consider those assessments on which students have ample time to improve their work in response to the feedback received before a future higher-stakes submission or summative assessment. Some examples of summative assessments which can include a component of peer review on initial drafts include: written essays, storyboards, project reports or presentations. Another way to incorporate peer review is to allow students to reflect on and evaluate the contribution of each group member to a project/presentation, what worked well and what could be done better.

Clearly explain why peer review is important and how it connects to the learning objectives of the course.

Anticipate what tools will be used for the peer-review process, and provide students with instruction and support for using these tools. For example, students can be taught to use the suggesting or track changes feature in Google Docs or MS Word to provide feedback. Certain settings in MS word allow for double-blind review of documents in which the name of the student or commenter is not known, limiting potential biases in review. You may also ask students to bring in a named copy and an unnamed copy of their work to class for engaging in double-blind peer-review. You can create a peer review assignment in Canvas that is associated with a rubric for students to use to evaluate individual or group assignments . Alternatively, you may adopt a template to use Qualtrics or google forms for peer review .

Consider in advance what process you will use to assign peer reviewers to students. Peer-review groups can be directly assigned or set up randomly in Canvas . Always leave room for flexibility in changing assigned groups depending on student needs.

Set expectations around the timeline for providing feedback and if this will be done as an in-class activity or will be completed outside of the classroom. If the assignment for review is shorter than 4 pages, does not require detailed written feedback and the class sizes are small (< 40 students), consider allocating time in class itself. If assigned outside the classroom, provide students with guidelines regarding the time they should spend to review an assignment. You may also assign points for completing the review, to ensure all students receive feedback on their assignment.

Construct a rubric that allows students to provide detailed feedback–for example, a checklist rubric (docx) or single-point rubric (docx) with space for comments. Alternatively, you may create a feedback form that contains specific questions to guide the peer review process accompanied by a detailed analytic rubric. Co-creating rubrics with students may also provide an additional avenue for students to engage with the material because it requires students to identify and consider on what criteria their work should be evaluated.

Train students on the rubric so that they can apply it effectively and consistently. For example, you may set aside time in class for students to practice applying the rubric to a sample of work. Then, facilitate a discussion on how students used the rubric and what are ways to provide effective feedback. Consider using at least one class session to discuss best practices in providing feedback, the distinction between reviewing and editing. Remind students that they are evaluating the work and not the person. At the same time, remind them of the vulnerability of the person in sharing their work and avoiding value judgements.

Model the type of feedback students should expect to receive or provide in assessments.This may include providing a short summary of the work, along with what aspects work well and what could be improved on. If needed, take time in class to discuss what good feedback looks like. Some sample prompts include (Bean, 2009):

Write out at least two things that you think are particularly strong about this draft.
Identify two or three aspects of the draft where there is room for growth or improvement.
Make two or three directive statements recommending the most important changes that the writer should make in the next draft.

After Peer Review

The review work has been done; now what? How can you help students integrate what they have learned in the review process and improve their work?

Here are a few options for how to proceed:

Before receiving peer feedback, students do a self-assessment using a rubric or based on embedded prompts. Then, they compare their observations to the peer feedback.
Instead of directly sharing all feedback with individuals or groups of students, as an instructor you may summarize quantitative and qualitative feedback and address common themes during class.
Students discuss the peer feedback with the instructor to help develop strategies for improvement.
In a non-blind review process, students could discuss the feedback with their peer reviewer to seek clarification and prioritize the comments to address.
After revising their work in response to peer feedback, students can summarize the feedback they received, describe the changes they made in response to the feedback or provide a justification for not incorporating suggested changes.
After revising their work, students can conduct a self-assessment in the form of a memo that describes the changes they made in response to peer review and their reflection on how review improved their work.

References:

Bean, John C. (2011). Engaging ideas: The professor’s guide to integrating writing, critical thinking, and active learning in the classroom (second edition). San Francisco: Jossey-Bass.

Center for Teaching Innovation. (n.d.). Peer Assessment . Cornell University

Center for Teaching Innovation. (n.d.). Teaching students to evaluate each other . Cornell University

Cho, K., & MacArthur, C. (2010). Student revision with peer and expert reviewing . Learning and Instruction, 20 (4), 328–338.

Gilken, J.M. & Johnson, H.L. (2021). Implementing a Peer Feedback Intervention within a Community of Practice Framework . Community College Journal of Research and Practice , 45:3, 155-166.

Stearns Center Writing Across the Curriculum (n.d.). How to Help Students Give Effective Peer Response . George Mason University.

Stearns Center Writing Across the Curriculum (n.d.). Tips for Commenting on Student Writing . George Mason University.

WAC Clearinghouse. (2006, April). Creating effective peer review groups to improve student writing . Colorado State University.

10 Strategies to Make Peer Review Meaningful for Students

EdTech , Teaching | 0 comments

“A peer review can be a very mysterious process, and certainly a scary one, which is why we need to talk more about how it’s done.”- Wyn Kelley, Lecturer, Literature, MIT

One of the most powerful means of encouraging student engagement and learning is through peer review, or guiding students to both critique and encourage each other as they develop speeches, presentations, and paper drafts. Peer review activities enable students to seek guidance from others, and to gain an objective idea of the quality of their thinking and their ability to organize and present their own thoughts. Peer review, effectively, is what enables students to become better thinkers and communicators.

For some students, it can be difficult to provide concrete, actionable, and descriptive feedback to their peers. As Thomas Levenson, Professor in Writing and Humanistic Studies, MIT notes, many students are uncomfortable critiquing peers. To make sure students know that peer assessment should be constructive, he tells students that “they only get to say, ‘I liked it’ once per class.” It’s important that instructors give students a set of prompts that guide students, and enable them to see how they can be most productive and explicit in giving feedback. Grant Wiggins of Authentic Education , suggests that helpful feedback follows the following 7 criteria. It is 1) goal-referenced; 2) transparent; 3) actionable; 4) user-friendly; 5) timely; 6) ongoing; and 7) consistent. Peer feedback should, above all, provide students with a sense of closure as to where to go next.

Video: “No One Writes Alone” from MIT Video

At Acclaim, instructors from Communication and Public Speaking, as well as Entrepreneurship, Science and Digital Storytelling courses, have shared some of the prompts they send to students as they ask them to give peer evaluations of presentations. The following are 10 prompts for peer review, compiled from assignments across the disciplines; with 5 prompts on content and presentation skills, and 5 on technology:

CONTENT AND PRESENTATION:

1. What is the speaker’s main point?

2. How is the speech structured? Does the speaker have a distinct introduction and conclusion? Where does he signpost his argument?

3. How does the speaker use evidence and analysis? Do examples elaborate on facts? Can you tell the difference between broad ideas and details?

4. Is the amount of time the speaker spends on each point proportional to its importance to his argument?

5. How does the speaker engage the audience? Some things to comment on: voice level, tone, level of interest/excitement in subject, eye contact, responses/attitudes towards questions, approachability. How did his movement and gestures coordinate with content?

VISUALS/TECHNOLOGY

1. How well did the speaker coordinate his timing with the visuals?

2. Were the visuals relevant to the speech, and if so, how did they enhance it? Did the speaker adequately explain them?

3. Were the visuals clear, independently of the speaker? Voice any ideas about animations or graphics.

4. Did the speaker seem comfortable with the technology he/she used? How does the speaker respond to technological difficulties (if there were any?)

5. Are there any additional visuals that might have helped to enhance the speakers point?

While these prompts can be used in any context, real or online, they can be especially effective when both the presenters, as well as the reviewers, have the “the time to adequately reflect on the content presented and technology used before delivering feedback,” according to Robin Cooper , Professor of Biology and Neuroscience, University of Kentucky. Student feedback, when delivered in written form online, can take the pressure and discomfort off of class communication. Moreover, we’ve found that when students have the chance to review their own recorded presentations, the suggestions of their peers become increasingly actionable. For more great reading and suggestions on peer review and assessment, check out the following resources:

Annie Murphy Paul: “ From the Brilliant Report: How to Give Good Feedback .”

Cynthia C. Choi and Hsiang-ju Ho: “ Exploring New Literacies in Online Peer-Learning Environments ”

Gale Morris, “ Using Peer Review to Improve Student Writing .”

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41 Essential Peer Review Questions for Effective Employee Evaluations

Looking for best employee peer review questions for effective evaluations? We bring to you 20 top questions to ask during the peer review process.

Most important employee peer review questions

20 Adds employee peer review questions

Peer review questions to give feedback

Tips for preparing employee peer review questions

Frequently asked questions (faqs).

Employee peer reviews can be a powerful tool for improving team performance and creating a more engaged and productive workforce. When done correctly, peer reviews provide a valuable opportunity for team members to offer feedback and identify areas for growth and development.

However, crafting effective peer review questions can be a challenge. It's important to ask the right questions that will elicit honest, constructive feedback that can be used to drive meaningful change.

In this blog, you will find 41 employee peer review questions that cover a range of topics, from communication and collaboration to leadership and work quality.

Whether you're a manager or team leader looking to improve your team's performance, or an employee seeking to provide feedback to your colleagues, these questions will provide a useful starting point for your peer review process.

12 Most important employee peer review questions

1.What are this employee's strengths?

2. What should this employee do?

3. [To all people in leadership roles] If you were that leader, what would be the first thing you would do?

4. What three or four words would you use to describe this employee?

5. How well does this person adapt to changing priorities?

6. In what area do you want this person to improve?

“This person effectively prioritizes their workload and meets deadlines.”
“This person communicates clearly and effectively with me and other colleagues.”

9. What should this employee stop doing?

“This person has strong leadership skills.”
“This person has strong communication skills and helps everyone feel welcome in the team.”

10. Give an example of the business value this person brought to life.

“This person always gives feedback in a timely and efficient manner.”
“This person prefers teamwork above all else.”

11. What should this employee continue to do?

“This person always finds creative solutions and is proactive in solving problems.”
“This employee is always open to both negative and positive feedback.”

12. How well does this person manage their time and workload?

“This person strongly embodies our company values.”
“This person appreciates different points of view, even if they differ from his own.”

13.How effectively did your colleague contribute to team projects and goals?

14. Was your colleague dependable in meeting deadlines and completing assigned tasks?

15. How well did your colleague communicate with team members and other departments?

16. Did your colleague collaborate effectively with others, or did they work independently?

17. Did your colleague demonstrate strong problem-solving skills?

18. Was your colleague proactive in seeking feedback and improving their work?

19. Did your colleague take ownership of their work and take responsibility for their mistakes?

20. How well did your colleague adapt to change and handle challenging situations?

21. Did your colleague provide constructive feedback and support to their peers?

22. Did your colleague demonstrate a positive attitude and contribute to a positive work environment?

23. Was your colleague respectful and professional in their interactions with others?

24. Did your colleague demonstrate strong leadership skills when necessary?

25. How well did your colleague manage their time and workload?

26. Did your colleague exhibit strong attention to detail and produce high-quality work?

27. Was your colleague open to learning new skills and taking on new challenges?

28. Did your colleague demonstrate a commitment to their personal and professional growth?

29. Did your colleague actively seek to develop and maintain positive relationships with team members and managers?

30. Did your colleague demonstrate strong organizational skills?

31. Did your colleague demonstrate a strong work ethic and commitment to the organization's goals and values?

32. Did your colleague contribute to a culture of innovation and creativity in the workplace?

9 Peer review questions to give feedback

33. What am I doing well right now, and where can I improve?

34. Do you believe I interact with my team mates enough?

35. How can I assist you in your job more effectively?

36. What abilities can I hone to make myself a better employee?

37. Can you give me a particular illustration of where I excel?

38. Can you give me a concrete illustration of where I can improve?

39. What distinguishes me from the other squad members?

40. Do you see any holes in my professionalism?

41. Do you have any extra thoughts?

Here are some tips for forming effective employee peer review questions for a survey:

1.Keep it specific

Avoid vague or general questions that could lead to ambiguous or unhelpful responses. Instead, focus on specific areas of performance or behavior that you want to evaluate.

2. Make it objective

Ensure that the questions are objective and measurable. Avoid questions that are based on subjective opinions or personal bias.

3. Ask open-ended questions

While closed-ended questions (yes/no questions) can be useful, open-ended questions allow for more detailed and thoughtful responses that can provide more insight.

4. Tailor the questions to the role

Different roles require different skills and responsibilities, so make sure that your questions are tailored to the specific job or department.

5. Avoid leading questions

Avoid questions that could lead to bias or influence the respondent's answer. Keep the questions neutral and avoid leading the respondent to a particular answer.

6. Keep it relevant

Ensure that the questions are relevant to the employee's job and responsibilities. Ask questions that are meaningful and useful for both the employee and the organization.

7. Keep it short

Avoid making the survey too long, as this can lead to survey fatigue and reduce response rates. Keep the questions concise and to the point.

8. Pilot test the questions

Before launching the survey, pilot test the questions with a small group of employees. This can help you identify any potential issues with the questions and make adjustments before sending the survey out to the wider team.

Final thoughts

Employee peer reviews can be helpful for organizations to gather feedback and improve the performance of their employees. By utilizing the right questions, managers and team leaders can gain valuable insights into their team's strengths and weaknesses, while also identifying areas for improvement.

The 41 employee peer review questions outlined in this article cover a range of topics, including communication, teamwork, leadership, and work quality.

These questions can be adapted to suit the specific needs of any organization, and can be used to facilitate constructive conversations between team members.

Ultimately, the success of employee peer reviews depends on a culture of trust, transparency, and open communication within the organization. When employees feel comfortable providing feedback and receiving feedback, everyone benefits.

By incorporating peer reviews into your performance management process, you can create a more engaged, motivated, and productive team.

Here are some frequently asked questions that people ask about employee peer review.

What is an employee peer review?

An employee peer review is a process in which colleagues evaluate each other's performance, skills, and contributions to the organization. This type of review is often used as a supplement to traditional manager-led performance evaluations.

Why is conducting employee peer reviews important?

Conducting employee peer reviews is important because it provides a more comprehensive view of an employee's performance, including how they work with others on the team. It can also help identify strengths and weaknesses that may not be immediately apparent to a manager.

What are some common employee peer review questions?

Some common employee peer review questions include:

How well does the employee communicate with others on the team?
How effectively does the employee collaborate and work with others?
How reliable and dependable is the employee?
How does the employee handle stress and pressure?
What areas of the employee's performance could be improved?

How can I prepare for an employee peer review?

To prepare for an employee peer review, you should:

Review your job description and performance goals
Reflect on your strengths and weaknesses
Consider specific examples of your accomplishments and challenges over the past year
Identify areas for improvement and any training or support you need to achieve your goals
Be open to constructive feedback from your colleagues.

How can managers ensure that employee peer reviews are effective?

To ensure that employee peer reviews are effective, managers should:

Provide clear guidelines and expectations for the review process
Encourage honest and constructive feedback
Provide training and support to employees on how to give and receive feedback effectively
Use the feedback to inform decisions about performance, training, and development opportunities
Ensure that the feedback is kept confidential and not used for punitive purposes.

62 Vital Employee Performance Review Questions for Optimizing Your Workforce

20 employee recognition survey questions to empower your employees in 2024, unlock the biggest secret of engagement to retain your top performers., -->guest contributor -->.

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9 Examples of Peer Feedback Questions

What do I do well now, and what can I improve on in the future?
Do you think I interact enough with my team members?
How can I better support you in your work?
What skills can I improve to be a better employee?
Can you provide a specific example of an area in which I excel?
Can you provide a specific example of an area in which I can improve?
What sets me apart from other team members?
Have you noticed any gaps in my professionalism?
Do you have any additional feedback?

Our best thoughts and ideas can often come from peer feedback . While a performance review can often allow us to self-reflect on our own performance, they can also be incredibly stressful and intimidating. That's why peer feedback sessions are so important.

As a team member, how do you ask for peer feedback? Today we'll be covering 9 peer feedback questions you can ask your fellow peer.

By asking these review questions to a peer, you should be able to have a better idea of how you're doing as an employee, and also have a better idea of how to improve yourself as a worker.

1. What do I do well now, and what can I improve on in the future?

This question is an important one to ask early on in a peer feedback session, as it's meant to be a very general self-evaluation question that directly asks your peer how they think you are performing. It allows your peer to be honest and up-front about your performance, hopefully give you effective and meaningful feedback , and will help set the tone for the rest of the peer review.

2. Do you think I interact enough with my team members?

As your fellow coworker, your peer reviewer might be able to notice patterns with who you collaborate best with at work and who you don't necessarily get along with as well. This question may prove valuable as another person's perspective may help you realize which peers you have a lower engagement with as well.

3. How can I better support you in your work?

A peer review session is not just about improving yourself; it's also about improving the relationship between yourself and your peer. This question shows that you care about your peer and that you're able to help them achieve their goals while performing their own duties.

4. What skills can I improve to be a better employee?

Sometimes our peers may notice gaps we didn't even know existed! Being aware of your own skill gaps will help you to better understand how to improve in these areas, and can prove to be very valuable feedback.

5. Can you provide a specific example of an area in which I excel?

Often, we focus on what we can improve, not realizing that maybe what is seen as a flaw to us is actually something highly valued by our peer and the company. So it's important to take note of the skills and behaviors your peer values and wants you to continue doing!

6. Can you provide a specific example of an area in which I can improve?

Just because we've been told we do something well doesn't mean we shouldn't try to get better. This peer feedback question allows your peer to provide some guidance on where they see room for improvement within the company or yourself personally. It will also provide you with the chance to ask additional questions on how to improve in these areas.

7. What sets me apart from other team members?

As a peer review session is not just about improving ourselves, it's also about understanding how we can support our peers in a way that nobody else can. This peer feedback question helps us understand what strengths we have that make us unique and provide value to the company.

8. Have you noticed any gaps in my professionalism?

It's important to always be conscious of your workplace behavior! This peer feedback question will allow your peer to identify any gaps they see within your performance at work (i.e., timeliness, dress code etc.), or even extra-curricular behavior (i.e., arriving late, taking personal phone calls etc.). While this can sometimes be tough to hear, remember that constructive feedback is meant to better improve yourself as an employee.

9. Do you have any additional feedback?

The peer review session is a time for your peer to be open and honest about what they think of you as a peer! This open ended question will help them feel comfortable telling you anything else they feel the need to say before ending the feedback process.

Now it's time for you to ask your peers these 9 peer feedback questions! And while these are excellent sample questions, it's also fine to create new questions as well to ask. Ask for peer feedback today and get some valuable insight into how well your peers see you working within the company, and where there might be an opportunity for improvement that would benefit both yourself and your team. Best of luck in utilizing this peer feedback strategy in helping improve within your role at work!

For more information, feel free to take a look at our comprehensive guide to peer feedback . And if you got anything of value out of this article then consider trying out Matter, a free Slack app that allows for peers to give one another Kudos and constructive criticism. Try it out today for free.

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160 Questions to Ask After a Presentation

Asking questions after a presentation is not just about seeking clarity on what was discussed. It’s a golden opportunity to delve deeper, engage with the speaker, and enhance your understanding of the subject matter. But knowing which questions to ask isn’t always straightforward.

In this piece, we’re about to break down the art of crafting impactful questions post-presentation that will not only benefit you but also add value to the entire audience’s experience.

Table of Contents

Questions to Ask After a Presentation for Feedback

Questions to ask after a presentation interview, questions to ask students after a presentation, questions to ask after a research presentation, questions to ask after a business presentation, questions to ask after a marketing presentation, questions to ask after a book presentation, reflection questions to ask after a presentation, frequently asked questions, final thoughts.

Can you summarize the key points of the presentation?
What aspect of the presentation did you find most engaging?
Were there any areas that were unclear or confusing? If so, what were they?
How would you rate the overall organization and flow of the presentation?
Did the visual aids (such as slides or charts) enhance your understanding of the topic? Why or why not?
Did the presenter maintain good eye contact and use body language effectively?
Was the presenter’s tone and pace suitable for the content and audience?
Were there any statistics or facts presented that stood out to you? Why?
Did the presenter address potential counter-arguments or opposing views adequately?
Were the objectives of the presentation clearly stated and met?
How well did the presenter handle questions or interruptions during the presentation?
Was there anything in the presentation that seemed unnecessary or redundant?
What would you suggest to improve the presentation for future audiences?
How did the presentation change or influence your thinking about the subject?
Did the presentation feel tailored to the audience’s knowledge and interest level?
Was there a clear and compelling call to action or concluding statement?
Did the presentation feel too short, too long, or just the right length?
What was your overall impression of the presenter’s credibility and expertise on the subject?
How would you rate the relevance and importance of the topic to the audience?
Can you identify any biases or assumptions in the presentation that may have influenced the message?
How did you determine what content to include in your presentation?
Can you explain the rationale behind the structure and flow of your presentation?
What challenges did you face while preparing this presentation, and how did you overcome them?
Were there any points in the presentation where you felt you could have elaborated more or less? Why?
How did you decide on the visual elements and design of your presentation?
Can you describe your intended audience and how you tailored the content to engage them?
How did you ensure that the information presented was accurate and up-to-date?
Were there any counter-arguments or opposing views on this topic that you considered including?
How would you adapt this presentation for a different audience or context?
How do you handle unexpected questions or interruptions during a presentation?
Can you give an example of how you’ve handled negative feedback on a presentation in the past?
How do you measure the success of a presentation? What metrics or feedback do you seek?
What techniques do you use to engage an audience that may not be familiar with the topic?
How do you balance the need to entertain and inform in a presentation?
How do you prioritize information when you have a limited time to present?
What strategies do you employ to ensure that your main points are memorable?
How do you deal with nerves or anxiety before or during a presentation?
Can you describe a situation where a presentation did not go as planned and how you handled it?
How do you keep up with the latest trends and best practices in presenting?
Is there anything you would change about this presentation if you were to do it again?
How did you feel about the presentation? Were you confident or nervous, and why?
What was the main message or goal of your presentation, and do you think you achieved it?
How did you decide on the structure of your presentation?
What research methods did you use to gather information for this presentation?
Were there any challenges you encountered while preparing or presenting, and how did you address them?
How did you ensure that your visual aids or multimedia elements supported your key points?
What part of the presentation are you most proud of, and why?
Were there any areas where you felt uncertain or that you would like to improve upon for next time?
How did you tailor your presentation to fit the knowledge level and interest of your audience?
What techniques did you use to engage the audience, and how do you think they worked?
How did you practice your presentation, and what adjustments did you make as a result?
Did you feel the time allotted for your presentation was sufficient? Why or why not?
How did you decide what to emphasize or de-emphasize in your presentation?
What feedback did you receive from peers during the preparation, and how did you incorporate it?
Did you have a clear conclusion or call to action, and why did you choose it?
How do you think your presentation style affects the way your audience receives your message?
What would you do differently if you were to present this topic again?
Can you reflect on a piece of feedback or a question from the audience that made you think?
How has this presentation helped you better understand the subject matter?
How will the skills and insights gained from this presentation experience benefit you in the future?
Can you elaborate on the research question and what prompted you to investigate this topic?
How did you choose the methodology for this research, and why was it the most suitable approach?
Can you discuss any limitations or constraints within your research design and how they might have affected the results?
How do your findings align or contrast with existing literature or previous research in this field?
Were there any unexpected findings, and if so, how do you interpret them?
How did you ensure the reliability and validity of your data?
Can you discuss the ethical considerations involved in your research, and how were they addressed?
What are the practical implications of your findings for practitioners in the field?
How might your research contribute to theoretical development within this discipline?
What recommendations do you have for future research based on your findings?
Can you provide more details about your sample size and selection process?
How did you handle missing or inconsistent data within your research?
Were there any biases that could have influenced the results, and how were they mitigated?
How do you plan to disseminate these findings within the academic community or to the broader public?
Can you discuss the significance of your research within a broader social, economic, or cultural context?
What feedback have you received from peers or advisors on this research, and how has it shaped your work?
How does your research fit into your long-term academic or professional goals?
Were there any particular challenges in conveying complex research findings to a general audience, and how did you address them?
How does this research presentation fit into the larger project or research agenda, if applicable?
Can you provide more insight into the interdisciplinary aspects of your research, if any, and how they contributed to the depth or breadth of understanding?
Can you elaborate on the primary objectives and expected outcomes of this business initiative?
How does this strategy align with the overall mission and vision of the company?
What are the key performance indicators (KPIs) that you’ll be monitoring to gauge success?
Can you discuss the risks associated with this plan, and how have you prepared to mitigate them?
How does this proposal fit within the current market landscape, and what sets it apart from competitors?
What are the potential financial implications of this plan, including both investments and projected returns?
Can you provide more detail about the timeline and milestones for implementation?
What internal and external resources will be required, and how have you planned to allocate them?
How did you gather and analyze the data presented, and how does it support your conclusions?
How does this proposal take into account regulatory compliance and ethical considerations?
What are the potential challenges or roadblocks, and what strategies are in place to overcome them?
Can you explain how this initiative aligns with or affects other ongoing projects or departments within the company?
How will this plan impact stakeholders, and how have their interests and concerns been addressed?
What contingency plans are in place if the initial strategy doesn’t achieve the desired results?
How will success be communicated and celebrated within the organization?
What opportunities for collaboration or partnership with other organizations exist within this plan?
How does this proposal consider sustainability and the potential long-term impact on the environment and community?
How have you incorporated feedback or lessons learned from previous similar initiatives?
What are the key takeaways you’d like us to remember from this presentation?
How can we get involved or support this initiative moving forward?
Can you elaborate on the target audience for this marketing campaign, and how were they identified?
What are the main objectives and key performance indicators (KPIs) for this campaign?
How does this marketing strategy align with the overall brand values and business goals?
What channels will be utilized, and why were they chosen for this particular campaign?
Can you discuss the expected return on investment (ROI) and how it will be measured?
What are the creative concepts driving this campaign, and how do they resonate with the target audience?
How does this campaign consider the competitive landscape, and what sets it apart from competitors’ efforts?
What are the potential risks or challenges with this marketing plan, and how will they be mitigated?
Can you provide more details about the budget allocation across different marketing channels and activities?
How have customer insights or feedback been integrated into the campaign strategy?
What contingency plans are in place if certain elements of the campaign do not perform as expected?
How will this marketing initiative be integrated with other departments or business functions, such as sales or customer service?
How does this campaign consider sustainability or social responsibility, if at all?
What tools or technologies will be used to execute and monitor this campaign?
Can you discuss the timeline and key milestones for the launch and ongoing management of the campaign?
How will the success of this campaign be communicated both internally and externally?
How does this marketing strategy consider potential regulatory or compliance issues?
How will the campaign be adapted or customized for different markets or segments, if applicable?
What lessons from previous campaigns were applied in the development of this strategy?
How can we, as a team or as individuals, support the successful implementation of this marketing plan?
What inspired the main theme or concept of the book?
Can you describe the intended audience for this book, and why they would find it appealing?
How did the characters’ development contribute to the overall message of the book?
What research was conducted (if any) to ensure the authenticity of the setting, characters, or events?
Were there any challenges or ethical considerations in writing or presenting this book?
How does this book fit into the current literary landscape or genre? What sets it apart?
What do you believe readers will find most engaging or thought-provoking about this book?
Can you discuss any symbolic elements or literary devices used in the book and their significance?
How does the book’s structure (e.g., point of view, chronological order) contribute to its impact?
What were the emotional highs and lows during the writing or reading of this book, and how do they reflect in the story?
How does the book address or reflect contemporary social, cultural, or political issues?
Were there any parts of the book that were particularly difficult or rewarding to write or read?
How does this book relate to the author’s previous works or the evolution of their writing style?
What feedback or responses have been received from readers, critics, or peers, and how have they influenced the presentation?
What are the main takeaways or lessons you hope readers will gain from this book?
How might this book be used in educational settings, and what age group or courses would it be suitable for?
Can you discuss the process of editing, publishing, or marketing the book, if applicable?
How does the book’s cover art or design reflect its content or attract its target readership?
Are there plans for a sequel, adaptation, or related works in the future?
How can readers stay engaged with the author or the book’s community, such as through social media, book clubs, or events?
How do you feel the presentation went overall, and why?
What part of the presentation are you most proud of, and what made it successful?
Were there any moments where you felt challenged or uncertain? How did you handle those moments?
How did you perceive the audience’s engagement and reaction? Were there any surprises?
What feedback have you received from others, and how does it align with your self-assessment?
Were there any technical difficulties or unexpected obstacles, and how were they addressed?
How well did you manage your time during the presentation? Were there areas that needed more or less focus?
How did you feel before the presentation, and how did those feelings change throughout?
What strategies did you use to connect with the audience, and how effective were they?
Were there any points that you felt were misunderstood or could have been communicated more clearly?
How did the preparation process contribute to the overall success or challenges of the presentation?
What did you learn about yourself as a communicator or presenter through this experience?
Were there any ethical considerations in the content or delivery of the presentation, and how were they handled?
How does this presentation align with your long-term goals or professional development?
How would you approach this presentation differently if you had to do it again?
How has this presentation affected your confidence or skills in public speaking or presenting?
What resources or support would have enhanced your preparation or performance?
How will you apply what you’ve learned from this presentation to future projects or presentations?
How did your understanding of the topic change or deepen through the process of preparing and presenting?
What steps will you take to continue improving or building on the skills demonstrated in this presentation?

What if I disagree with a point made during the presentation?

It’s important to frame disagreement in a constructive and respectful way. You might say, “ I found your point on X intriguing. From a different perspective, could Y also be considered…? ” This opens up a dialogue without dismissing the presenter’s viewpoint.

How can I formulate my questions to encourage a more detailed answer?

Use open-ended questions that start with “ how ,” “ why, ” or “ could you explain… ” as these require more than a yes or no answer and encourage the presenter to provide depth. For example, “ Could you explain the process behind your research findings in more detail? “

By asking insightful questions, you’re not only cementing your understanding of the material presented but also opening doors to further knowledge and collaboration. Remember, the quality of your questions reflects the depth of your engagement and willingness to learn.

So, the next time you find yourself in the audience, seize the opportunity to ask meaningful questions and watch as simple presentations transform into dialogues that inspire and illuminate.

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Bea Mariel Saulo

Bea is an editor and writer with a passion for literature and self-improvement. Her ability to combine these two interests enables her to write informative and thought-provoking articles that positively impact society. She enjoys reading stories and listening to music in her spare time.

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Effective Peer Review: Who, Where, or What?

Peer review is widely viewed as one of the most critical elements in assuring the integrity of scientific literature ( Baldwin, 2018 ; Smith, 2006 ). Despite the widespread acceptance and utilization of peer review, many difficulties with the process have been identified ( Hames, 2014 ; Horrobin, 2001 ; Smith, 2006 ). One of the primary goals of the peer review process is to identify flaws in the work and, by so doing, help editors choose which manuscripts to publish. It is surprising that one of the persistent problems in peer review is assessing the quality of the reviews. Both authors and journal editors expect peer review to detect errors in experimental design and methodology and to ensure that the interpretation of the findings is presented in an objective and thoughtful manner. In traditional peer review, two or more reviewers are asked to evaluate a manuscript on the basis of the expectation that if the two reviewers agree on the quality of the submission, the likelihood of a high-quality review is increased. Unfortunately, studies have not consistently confirmed a high degree of agreement among reviewers. Rothwell and Martynn (2000) evaluated the reproducibility of peer review in neuroscience journals and meeting abstracts and found that agreement was approximately what would be expected by chance. Similarly, Scharschmidt et al. (1994) found similar results in the evaluation of 1,000 manuscripts submitted to the Journal of Clinical Investigation, where clustering of grades in the middle resulted in an agreement being “…only marginally…” better than chance. These observations suggest that we cannot rely on the agreement of reviewers to be an indication of the quality of the reviews. Another potential way to evaluate the quality of reviews would be to assess the ability of reviewers to detect errors in submissions. It is generally accepted that detection of intentional fraud is beyond the scope of typical peer review, but we do expect reviewers to detect major and minor errors as a primary function of the traditional peer review system ( Hwang, 2006 ; Weissman, 2006 ). Schroter et al. (2008) evaluated the ability of reviewers to detect major and minor errors by introducing errors into three previously published papers describing randomized controlled clinical trials. Reviewers detected approximately three of the nine errors introduced in each manuscript. Unfortunately, reviewers who had undergone training in how to conduct a high-quality peer review were not significantly better than untrained reviewers. Similar results have been reported by Godlee et al. (1998) and Baxt et al. (1998) . Baxt et al. (1998) did report that reviewers who rejected or suggested revision of a manuscript identified more errors than those who accepted the manuscript (decision: 17.3% of major errors detected [accept], 29.6% of major errors detected [revise], and 39.1% of major errors detected [reject]). It is almost certainly true that the extent of the failure to recognize errors in submitted manuscripts may differ among scientific disciplines and journals. It also however seems likely that these observations do have some applicability to journals such as JID Innovations . It is critical that both authors and editors are cognizant of these limitations of peer review in their assessment of reviews. These findings compel journals to continue to work to develop new strategies to train and evaluate reviewers. The findings also suggest that factors beyond the failure to detect objective mistakes in a manuscript may be playing a role in the discrepancy in reviewers’ evaluations. One area of ongoing concern in the peer review process is the role of reviewer bias in assessing the scientific work of colleagues ( Kuehn, 2017 ; Lee et al, 2013 ; Tvina et al, 2019 ).

Bias in the peer review process can take many forms, including collaborator/competitor bias, affiliation bias based on an investigator’s institution or department, geographical bias based on the region or country of origin, racial bias, and gender or sex bias ( Kuehn, 2017 ; Lee et al, 2013 ; Tvina et al, 2019 ). All of these forms of bias present the risk that a decision of the reviewer will not be based solely on the quality or merit of the work but rather be influenced by a bias of the reviewer. We and other journals routinely seek to avoid selecting individuals to review work from their own institutions and ask all reviewers to declare any potential personal conflicts of interest. All these methods require either the editor or the reviewer to identify a bias and fail to address the issue of implicit or unconscious reviewer bias. The dominant method currently utilized for peer review is the so-called single-blind review, in which the identity and affiliations of the authors are known to the reviewers, whereas the identity of reviewers remains unknown to the authors. This has led to concern that knowledge of the identity of the authors and their institutions may be the source of significant reviewer bias, especially implicit bias, in the evaluation of manuscripts. Double anonymized peer review (DAPR), also known as double-blind peer review, has been suggested as a way to address this issue ( Bazi, 2020 ; Lee et al, 2013 ). Studies have compared single-blind with double-blind reviewing and reported that there is no significant difference in the quality of the reviews ( Alam et al, 2011 ; Godlee et al, 1998 ; Justice et al, 1998 ; van Rooyen et al, 1998 ). Although these studies looked at measures such as the number of errors detected, acceptance rate, and distribution of initial reviewer scores, they were not designed to address specific sources of bias such as authors’ gender, institution, or geographic location. Other studies have been undertaken to directly address the issue of bias in the peer review process. Ross et al (2006) compared the acceptance of abstracts submitted to the American Heart Association’s annual scientific meeting during a period when the reviewers knew the identity and origin of the authors (i.e., single-blind review) with when this information was not known by the reviewers (i.e., double-anonymized peer review). They found a significant increase in acceptance of non‒United States abstracts and abstracts from non-English speaking countries when the reviewers were unaware of the country of origin of the abstracts ( Ross et al, 2006 ). They also found a significant decrease in the acceptance of abstracts from prestigious institutions when the reviewers were unaware of the institutions where the work was done. In a similar study, Tomkins et al. (2017) found that papers submitted to a prestigious computer science meeting were more likely to be accepted if they were from famous authors, top universities, and top companies. Okike et al. (2016) documented similar results for manuscripts submitted to the orthopedic literature. They submitted a fabricated manuscript that was presented as being written by two prominent orthopedic surgeons (past Presidents of the American Academy of Orthopedic Surgeons) from prestigious institutions. When reviewed in the traditional single-blind fashion, which included the identity of the authors, the manuscript was accepted by 87% of the reviewers. By contrast, when the identity of the authors was unknown, the manuscript was accepted by 68% of the reviewers ( P = 0.02) ( Blank, 1991 ). A study conducted at The American Economic Review found that authors at near-top-ranked universities experienced lower acceptance rates when authorship was anonymized ( Blank, 1991 ). Of interest, they also found that for women, there was no difference in the acceptance rate between the double-anonymized and single-blinded reviews; however, for men, the acceptance rate was lower with double-anonymized reviews.

These studies provide strong evidence that knowledge of who and where the study was performed can impact the acceptance of abstracts and manuscripts. This conflicts with the goal of the review process to base our judgments on the quality of what the results demonstrate. It is difficult to estimate how much this may affect the fate of a manuscript at JID Innovations . We do not have evidence that our review process has been impacted by bias as is reported in the studies discussed. However, neither can we state with certainty that such bias is not a factor in the reviews we receive. One of the goals of JID Innovations is to be a truly open-access journal available to all investigators in skin science from around the world. We have sought to be an outlet for studies that challenge existing paradigms or that may report negative results. We want to be seen as providing fair and objective reviews for all authors, regardless of where they work or who they are. If we are to achieve this goal, it is imperative that the who and where of a specific manuscript do not negatively impact the evaluation of the what. We want young investigators, investigators at less prestigious institutions or from less well-known laboratories, and investigators from any country around the world to be confident that their work will be judged by what they report and not by the who and the where.

To be true to this mission, JID Innovations will be initiating DAPR starting in October 2022. This is not being done because we are aware of any issues of bias with our current process of peer review but because we realize that the absence of proof is not proof of absence. As a part of this process, authors will be asked to remove identifying material from manuscripts at the time of submission in preparation for the review process ( https://www.jidinnovations.org/content/authorinfo ). As a result, primary reviewers will see only the what of the manuscript. We realize that this process involves extra work for both the authors and our staff, but we feel the benefits will outweigh this small cost. Indeed, in other journals that have taken this step, surveys have shown that both authors and reviewers ultimately prefer double-anonymized reviews ( Bennett et al, 2018 ; Moylan et al, 2014 ). We realize that achieving 100% anonymization of a manuscript is nearly impossible. Studies have shown that the rate of successful anonymizing, where the reviewers cannot discern the authorship of a manuscript, ranged from 47 to 73%. It is however interesting that even with this rate of success in the anonymizing process, a meta-analysis of trials of double- versus that of single-blind peer review has suggested an impact, with lower acceptance rates with double-anonymized peer review ( Ucci et al, 2022 ). More work clearly needs to be done to assess the value of the DAPR process, and we will be monitoring our results carefully.

The institution of DAPR in JID Innovations will assure our authors that the what of their manuscript is our focus. It does not matter who you are or where you are from. It will also emphasize to our reviewers that our focus is on the what. We will be carefully monitoring the results of this new policy and plan to report back on our experience. We also welcome your feedback on your experience as a reviewer and author for JID Innovations ; send your comments to us at [email protected] .

Finally, this decision should be seen not as the end of our efforts to improve the peer review process but merely as a first step. We will continue to work to improve all aspects of the peer review process for JID Innovations . We firmly believe that the use of double-blind -anonymized peer review will bring us closer to ensuring to our authors and readers that the work that is published by JID Innovations has been selected on the basis of what the paper reports and not on who performed the studies or where they were located.

Conflict of Interest

The author states no conflicts of interest.

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Open access
Published: 16 April 2024

Protocol for a systematic review and meta-analysis of the prevalence of mental illness among nursing home residents

Jared Holt ORCID: orcid.org/0000-0002-0421-1759 1 ,
Sunil Bhar 1 ,
Penelope Schofield 1 , 2 , 3 , 4 ,
Deborah Koder 1 ,
Patrick Owen 5 , 6 ,
Dallas Seitz 7 &
Jahar Bhowmik 8

Systematic Reviews volume 13 , Article number: 109 ( 2024 ) Cite this article

Metrics details

There is a high prevalence of mental illness in nursing home residents compared to older adults living in the community. This was highlighted in the most recent comprehensive systematic review on the topic, published in 2010. In the context of a rapidly aging population and increased numbers of older adults requiring residential care, this study aims to provide a contemporary account of the prevalence of mental illness among nursing home residents.

This protocol was prepared in line with the PRISMA-P 2015 Statement. Systematic searches will be undertaken across six electronic databases: PubMed, Embase, Web of Science, PsycNET, CINAHL, and Abstracts in Social Gerontology. Peer-reviewed studies published from 2009 onwards which report the prevalence of mental illness within nursing home populations will be included. Database searches will be supplemented by forward and backward citation searching. Titles and abstracts of records will be screened using a semi-automated process. The full text of selected records will be assessed to confirm inclusion criteria are met. Study selection will be recorded in a PRISMA flowchart. A pilot-tested form will be used to extract data from included studies, alongside the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. A study characteristics and results table will be prepared to present key details from each included study, supported by a narrative synthesis. Random-effects restricted maximum likelihood meta-analyses will be performed to compute pooled prevalence estimates for mental illnesses represented in the identified studies. Heterogeneity will be assessed using Cochran’s Q and Higgins’ I 2 statistics. A Funnel plot and Egger’s test will be used to assess publication bias. The GRADE approach will be used to assess the quality of the body of evidence identified.

The study will provide a comprehensive and contemporary account of the prevalence of mental illness among nursing home residents. Meta-analyses will provide robust prevalence estimates across a range of presentations. Key insights will be highlighted, including potential sources of heterogeneity. Implications for residents, researchers, care providers, and policymakers will be noted.

Systematic review registration

PROSPERO: CRD42023456226.

Peer Review reports

The world’s population is aging at an increasing rate. The number of individuals aged 60 and over is predicted to double by 2050 and the population aged 80 and over is expected to triple [ 1 ]. While longer lifespans afford additional opportunities to individuals and societies, they also introduce challenges in managing the burden of disease associated with aging.

Nursing homes are residential facilities that provide care for older adults and other disabled individuals whose care needs are unable to be met in their own homes. Understanding the needs of nursing home residents is a necessary precondition to ensure systems are appropriately designed and resourced. This becomes even more important considering the number of nursing homes (and residents) will inevitably increase alongside the aging population.

Unfortunately, relatively little is known about the prevalence of mental illness among nursing home residents. The last comprehensive systematic review on the topic was published in 2010 [ 2 ]. The authors found dementia, depression, and anxiety disorders to be the most common mental illnesses among older adults in long-term care. However, the authors did not undertake meta-analyses to compute pooled prevalence estimates for the illnesses and reported median figures only. A dearth of prevalence studies addressing other common mental illnesses (e.g., anxiety disorders, schizophrenia, and bipolar disorder) in the nursing home population was also noted by Seitz and colleagues. The authors further commented that many of the studies included in their paper may not accurately reflect present-day prevalence rates due to their age (more than half of the studies were published prior to 2000). This issue has only been exacerbated given the ever-changing landscape of an aging population [ 1 ], as well as advancements in how mental illnesses are understood and related refinements to diagnostic criteria and instruments [ 3 ]. Furthermore, there has been considerable methodological progress regarding the conduct of systematic reviews since the early 2000s and updated guidance to ensure greater robustness, reliability, and transparency [ 4 , 5 , 6 ].

Elias [ 7 ] and Fornaro and colleagues [ 8 ] both carried out more recent targeted reviews. The former included loneliness, anxiety, and depression, while the latter considered major depressive disorder, bipolar disorder, and schizophrenia. However, neither study provided a rationale for the selection of the chosen disorders, nor the exclusion of others. Fornaro and colleagues [ 8 ] further restricted their inclusion criteria to only consider studies investigating nursing home residents without dementia. This decision acts to critically limit the external validity of their findings. A recent meta-analysis of the prevalence of dementia in long-term care institutions found that more than half of all residents live with dementia [ 9 ]. Given dementia appears to be the rule rather than the exception in this population, residents with comorbid dementia must be considered if prevalence estimates are to be of use to decision-makers.

The present study builds on and expands the previous reviews to provide a contemporary and comprehensive account of the prevalence of mental illness among nursing home residents. It is not merely intended as an update of Seitz and colleagues’ paper [ 2 ]. This study will leverage the considerable methodological progress and guidance on conducting systematic reviews that have been published since Seitz and colleagues released their study in 2010. In doing so, it aims to generate rigorous and reliable estimates of mental illness prevalence in nursing homes.

As compared to recent reviews (e.g., [ 7 , 8 ]), this study will address a much broader range of mental illnesses. It will also better reflect the realities and complexities of the nursing homes, particularly through ensuring dementia co-morbidities are duly considered. In doing so, we hope to provide nursing home organizations, researchers, and governments with the necessary evidence to inform planning efforts and ensure the mental health needs of this vulnerable population can be met.

Methods/design

This protocol is for a systematic review and meta-analysis of mental illness among nursing home residents. It was registered on PROSPERO on 01 September 2023 (CRD42023456226). Any future updates to the protocol will be reflected in the PROSPERO registration. The protocol has been informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) 2015 Statement [ 10 ] and used the PRISMA-P 2015 checklist (see Additional file 1 ). The systematic review and meta-analyses will be undertaken in alignment with the relevant chapter of the JBI Manual for Evidence Synthesis [ 4 ].

Eligibility criteria

The systematic review and meta-analysis will consider studies measuring the prevalence of mental illness among nursing home residents, published from 01 January 2009. The publication date of these studies aligns with the end-point of the last comprehensive systematic review of the topic [ 2 ] and ensures a focus on the modern-day nursing home experience. Non-English publications will be considered where abstracts are available in English and the information required for data extraction is provided.

The ‘CoCoPop’ mnemonic (Condition, Context, and Population; [ 4 ]) has been used to guide inclusion requirements. That is, for studies to be included they must consider the relevant condition (mental illness), be presented in the appropriate context (prevalence rates), and apply to the target population (nursing home residents).

Condition (mental illness)

Studies investigating at least one mental disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders [ 11 , 12 , 13 , 14 ] or the International Classification of Diseases and Related Health Problems [ 15 , 16 ] will be considered for this review. Studies investigating clinically significant mental disturbances or symptoms will also be included where measures have been validated for target conditions and cut-off scores have been established to indicate clinical significance (e.g., scores of eight or more on the Cornell Scale for Depression in Dementia; [ 17 ]). Noting the prevalence of dementia in nursing homes has been addressed in a recent systematic review [ 9 ], dementia diagnoses will not be separately considered in this study. However, comorbid dementia will be considered where study authors have reported this information in the context of additional mental disorder diagnoses or clinically significant symptomology.

Context (prevalence)

The systematic review and meta-analyses will include peer-reviewed observational epidemiological studies that focus on identifying the prevalence of mental illness (mental disorders or clinically relevant symptoms), including cross-sectional studies, retrospective cohort studies, and prospective longitudinal cohort studies. For longitudinal studies, point/period prevalence estimates will be taken from the first reported time-period. Validation studies will also be considered where tools with established validity have been used as comparators and relevant statistics have been reported. Other study designs not mentioned above, including intervention studies, systematic reviews, case studies, case–control studies, opinion pieces, editorials, etc., will not be considered.

Population (nursing homes)

The systematic review will include studies relating to residents of nursing homes, which are variously referred to in the literature as homes for the aged, long-term care, aged care homes, residential aged care facilities, specialized nursing facilities, institutionalized elderly, or institutionalized older adults. Despite nursing homes being largely associated with older adult populations, they are increasingly being used to care for younger individuals [ 18 ]. Accordingly, and to ensure a comprehensive and contemporaneously relevant review, no age-based restrictions will be applied. Studies investigating older adults living in the community, retirement homes, or hospital in-patient settings will not be considered. Studies involving mixed populations (e.g., older adults from both community and nursing home settings) will also be excluded unless the groups are separately reported. Additionally, studies focusing on sub-populations or specifically targeted samples will be excluded. For example, this may be samples of nursing home residents who have been ‘pre-screened’ for mental illness, samples of residents suffering from comorbid primary disorders, or studies conducted in psychiatric nursing homes.

Search strategy

Searches will be conducted across six databases, including PubMed, Embase (Ovid), Web of Science (Clarivate), PsycINFO (APA PsycNet), CINAHL (EBSCOhost), and Abstracts in Social Gerontology (EBSCOhost). The databases were selected based on guidance from Bramer et al. [ 19 ] regarding optimal database combinations for literature searches in systematic reviews. Searches will be undertaken in August 2023 and will be re-run in April 2024, ahead of final analyses.

Search queries were developed to operationalize the CoCoPop elements outlined above. As the present study is interested in all mental disorders and clinically relevant symptomology, a broad range of terms were derived from diagnoses contained in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR; [ 14 ]). Acknowledging the variation in terminology used to describe nursing homes in the literature, search terms also include ‘homes for the aged’, ‘long-term care’, ‘residential aged care’, ‘skilled nursing facilities’, and ‘institutionalized older people’, as well as grammatical variants. ‘Incidence’ and ‘epidemiology’ are similarly included as likely alternatives to prevalence. Search queries require the presence of all three CoCoPop elements, effected through the application of the Boolean ‘AND’ operator. Individual search queries use a combination of MeSH/index terms and text-string searches, depending on the available functionality of each database. Search queries for each of the six databases are provided in Additional file 2 . The search strategy was developed in collaboration with and was peer-reviewed by, an information specialist located at the Swinburne University of Technology, Melbourne, Australia.

Forward and backward citation searches will be carried out on previously published reviews to detect additional potentially relevant studies.

Data management

An online tool will be used to manage the selection and review process. Rayyan is a web-based application for managing systematic reviews which can be accessed for free [ 20 ]. Rayyan has been found to have high useability ratings and superior performance in deduplication and software-assisted screening processes [ 21 ]. Results from database searches will be imported into Rayyan using compatible file types (.ris or.nbib). Deduplication of records will be undertaken in Rayyan, given its demonstrated accuracy in this process [ 22 ]. Extracted data from included studies will be collated in Microsoft Excel and meta-analyses performed in IBM SPSS Statistics (Version 28). Grading of Recommendations Assessment, Development and Evaluation (GRADE; [ 23 ]) tables will be prepared using the web-based application, GRADEpro ( https://www.gradepro.org/ ).

Study selection

Following deduplication, a semi-automated process for screening titles and abstracts will be conducted. Semi-automated processes have been found to have reached maturity with respect to abstract screening in systematic reviews [ 24 ]. They offer the potential for significant savings in time and effort while retaining acceptable specificity and sensitivity [ 24 ]. However, there remains a lack of consensus regarding recommended ‘stopping rules’. That is, the point at which duplicate human screening can be discontinued and the remaining records subjected to a more streamlined review process [ 25 , 26 , 27 ]. Acknowledging this limitation, recent guidance suggests the application of multiple conservative approaches to stopping rules to ensure reliable performance [ 28 ].

Rayyan has built-in capability to facilitate semi-automated title and abstract screening (20). Once enough manual decisions have been recorded (at least 50), Rayyan uses machine learning and artificial intelligence to predict the likelihood that each remaining article should be included in the systematic review. The computed likelihoods are presented through a five-star rating system. Each record is assigned either 0.5, 1.5, 2.5, 3.5, or 4.5 stars, with 4.5 stars representing the greatest likelihood of inclusion and 0.5 stars the least. Each subsequent decision made by reviewers provides further guidance for Rayyan’s algorithm and star ratings can be recomputed periodically to generate updated predictions. Records can be sorted from highest to lowest ratings, allowing reviewers to manually screen those records predicted as the most likely to fit inclusion criteria. The process continues until a pre-defined stopping rule is met. This type of approach has been adopted in several recent systematic reviews considering the experiences of older adults [ 29 , 30 , 31 ], as well as broader populations [ 32 , 33 ]. Compared to these recent publications, this study will apply more conservative stopping rules to minimize the risk of missing potentially relevant studies.

Rayyan allows reviewers to assign the labels of ‘include’, ‘exclude’, or ‘maybe’ to each record. Reviewers will be blinded to each other’s decisions until all required records have been reviewed in duplicate. Any disagreements and ‘maybes’ will be resolved via adjudication from a third independent team member. In the present study, the titles and abstracts of records will be independently reviewed by at least two reviewers until both of the following stopping rules have been met: (i) a minimum of 50% of records have been reviewed, and (ii) 100 consecutive articles have been excluded (see [ 28 ]). All remaining records will be screened by one reviewer only.

In practice, 10% of retrieved records will be randomly selected and screened by two independent reviewers, at which point Rayyan star ratings will be computed. Records will then be sorted by their star ratings, from highest to lowest. The screening will continue sequentially, starting with the highest-rated record. Ratings will be recomputed when 20% and 40% of records have been screened by two independent reviewers. Records will be re-ordered by rating, from highest to lowest, following each computation. Screening will continue until at least 50% of records have been screened and 100 consecutive records have been excluded. All remaining records will be screened by one reviewer only.

In the next phase, the full text of all records selected to progress (i.e., those ‘included’ during title/abstract review) will be independently reviewed by at least two reviewers, who are blinded to each other’s decisions. This phase will also be facilitated by Rayyan, which again provides reviewers the option to assign the labels of ‘include’, ‘exclude’, or ‘maybe’ to each record. Any disagreements and ‘maybes’ will be resolved via adjudication from a third independent team member.

Data extraction

Data will be extracted from studies that are confirmed to meet the inclusion criteria via full-text review. A pre-piloted form has been developed, based largely on the Data Extraction Form for Prevalence Studies from Munn et al. ([ 4 ]; see Additional file 3 ). Extracted data items will include general information about the study (e.g., author details, study title, publication year, location); information about the study methods (e.g., study design, sample size, population, inclusion/exclusion criteria, diagnostic criteria/instrument used); and the results (prevalence rates, confidence intervals and/or standard errors, etc.). Data extraction will be undertaken in duplicate by two independent extractors. Any disagreements between the two reviewers will be resolved via adjudication from a third independent team member.

Attempts will be made to obtain any missing data by directly contacting the relevant studies’ investigators. Three attempts will be made to contact each author over a 2-week period. If no response is received, the related study will be excluded from further analysis.

Risk of bias in individual studies

The JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data [ 4 ] will be used to undertake quality and bias assessments of included studies. It is the most recent and methodologically rigorous assessment tool for prevalence studies [ 34 , 35 ]. Each study will be independently evaluated by at least two reviewers. Any disagreements between the two reviewers will be resolved via adjudication from a third independent team member.

Data synthesis

A study characteristics and results table will be prepared to present key details from each study that satisfies the inclusion criteria. A narrative synthesis will be undertaken to summarise the relevant studies. This will be supported by meta-analyses to compute pooled prevalence estimates for each mental disorder represented in the identified studies. Specifically, random-effects restricted maximum likelihood meta-analyses will be undertaken given the expected heterogeneity (e.g., study samples will be drawn from different national populations; see [ 36 , 37 ]). Where meta-analyses include less than five studies, the Hartung-Knapp-Sidik-Jonkman method will be employed per recommendations [ 38 ].

Consistent with previous reviews, findings will be presented by disorder subgroups contained in the DSM-5-TR (e.g., depressive disorders, anxiety disorders, personality disorders, feeding and eating disorders; [ 14 ]). Findings will also report comparisons between groups with and without dementia, where such comorbidity information is available. Subgroup analyses will apply a series of random-effects models as described above and Cochran’s Q and Higgins’ I 2 will be used to test for heterogeneity among different subgroups [ 39 , 40 ]. The subgroup analyses will consider possible differences based on age (less than 65; 65 to 74; 75 to 84; over 85), gender (male; female; non-binary), location (by continent), study design (cross-sectional; prospective longitudinal; retrospective; validation study), and diagnostic tools applied (e.g., for depression this will consider the Geriatric Depression Scale [ 41 ]; Cornell Scale for Depression in Dementia [ 42 ]; Patient Health Questionnaire [ 43 , 44 ]; Other). Reflecting concerns regarding underpowered subgroup analyses in meta-analyses [ 45 ], subgroup analyses will be undertaken only if 10 or more studies are available and each subgroup contains a minimum of three studies [ 46 ].

Meta-bias(es)

Cochran’s Q and Higgin’s I 2 statistics will be used to assess statistical heterogeneity [ 39 , 40 ]. When three or more studies are available, the heterogeneity of observed effects will be evaluated by prediction interval [ 47 ]. When 10 or more studies are available, publication bias will be assessed via visual inspection of funnel plots and Egger’s P [ 48 ].

Confidence in cumulative evidence

The overall quality of the body of evidence identified through this systematic review will be summarized and assessed using the Grade approach [ 23 ]. Although specific guidance is lacking on the application of GRADE to systematic reviews of prevalence, it remains the recommended approach, noting some translatable guidance is available [ 5 , 49 ].

The present proposed review provides an opportunity to update the literature on the prevalence of mental illness in one of the most vulnerable populations: nursing home residents. This is long overdue with the most recent comprehensive review published in 2010 [ 2 ]. It found the population experiences mental illness at significantly higher rates compared to older adults in community settings. The present review will consider the substantial literature published in the intervening period to provide an up-to-date account of the prevalence of mental illness among nursing home residents. The review’s eligibility criteria include all mental disorders and clinically relevant symptoms, allowing for a broad consideration of mental illness in the target population. Restrictions are placed on study design and the measurement tools applied to ensure the highest quality evidence is identified. Meta-analyses will be undertaken to provide robust prevalence estimates across a range of presentations and assess potential sources of heterogeneity. Key insights will be highlighted, including any observed changes in the prevalence of mental illnesses in nursing home residents since the last comprehensive systematic review. Implications for researchers, care providers, and policymakers will be noted.

Availability of data and materials

Not applicable.

Abbreviations

American Psychological Association

Cumulated Index to Nursing and Allied Health Literature

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision

Grading of Recommendations, Assessment, Development, and Evaluations

Joanna Briggs Institute

Medical Subject Headings

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Preferred Reporting Items for Systematic review and Meta-Analysis Protocols

The International Prospective Register of Systematic Reviews

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Acknowledgements

The authors would like to thank Annette Steere, Library Liaison Team Leader, Swinburne University of Technology, for her assistance in developing the database search strategy for this review.

This research is supported by an Australian Government Research Training Program (RTP) Scholarship.

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JH, SB, DK, and PS defined the research question. JH developed the search strategy and determined inclusion and exclusion criteria. PO, DS, and JB provided methodological support. JH created the first draft of this manuscript and all authors reviewed and approved the final draft. JH is the guarantor of this review. All authors read and approved the final manuscript.

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Supplementary Information

Additional file 1..

PRISMA-P 2015 Checklist.Checklist for the reporting of systematic review and meta-analysis protocols.

Additional file 2.

Database Search Queries for a Systematic Review into the Prevalence of Mental Illness Among Nursing Homes Residents. Search queries for databases for a systematic review and metal-analysis of the prevalence of mental illness among nursing homes residents.

Additional file 3.

Data Extraction Template. Data extraction template for a systematic review and metal-analysis of the prevalence of mental illness among nursing homes residents, adapted from the JBI Data Extraction Form for Prevalence Studies.

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Holt, J., Bhar, S., Schofield, P. et al. Protocol for a systematic review and meta-analysis of the prevalence of mental illness among nursing home residents. Syst Rev 13 , 109 (2024). https://doi.org/10.1186/s13643-024-02516-1

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Acute care models for older people living with frailty: a systematic review and taxonomy

Thomas Knight 1 ,
Vicky Kamwa 1 ,
Catherine Atkin 1 ,
Catherine Green 2 ,
Janahan Ragunathan 3 ,
Daniel Lasserson 4 &
Elizabeth Sapey 1

BMC Geriatrics volume 23 , Article number: 809 ( 2023 ) Cite this article

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The need to improve the acute care pathway to meet the care needs of older people living with frailty is a strategic priority for many healthcare systems. The optimal care model for this patient group is unclear.

A systematic review was conducted to derive a taxonomy of acute care models for older people with acute medical illness and describe the outcomes used to assess their effectiveness. Care models providing time-limited episodes of care (up to 14 days) within 48 h of presentation to patients over the age of 65 with acute medical illness were included. Care models based in hospital and community settings were eligible.

Searches were undertaken in Medline, Embase, CINAHL and Cochrane databases. Interventions were described and classified in detail using a modified version of the TIDIeR checklist for complex interventions. Outcomes were described and classified using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy. Risk of bias was assessed using RoB2 and ROBINS-I.

The inclusion criteria were met by 103 articles. Four classes of acute care model were identified, acute-bed based care, hospital at home, emergency department in-reach and care home models. The field is dominated by small single centre randomised and non-randomised studies. Most studies were judged to be at risk of bias. A range of outcome measures were reported with little consistency between studies. Evidence of effectiveness was limited.

Acute care models for older people living with frailty are heterogenous. The clinical effectiveness of these models cannot be conclusively established from the available evidence.

Trial registration

PROSPERO registration (CRD42021279131).

Peer Review reports

Introduction

Population ageing and the increasing prevalence of long-term health conditions represent a significant challenge to many advanced health care systems [ 1 ]. Older people, particularly those living with frailty and multimorbidity, are at high risk of sudden health crisis necessitating urgent assessment to identify and treat causative conditions. The acute care pathway collectively defines the clinical processes employed to achieve this function. It typically comprises sequential assessment in community and hospital settings and culminates in emergency hospital admission when necessary.

Older people living with frailty are at high risk of adverse outcomes such as mortality [ 2 ] and have longer average lengths of hospital stay when accessing the acute care pathway [ 3 ]. The conversion rate from ED attendance to emergency admission is 3 times higher in people aged over 85 relative to people under 65 [ 4 ]. As older people represent a growing proportion of ED attendances the demand for hospital bed-based care is likely to rise [ 4 ]. This must be reconciled with downward trends in the number of acute hospital beds at the population level [ 5 ]. Improved integration between health and social care may help mitigate the impact of these changes to some degree but will not abrogate the need for hospital assessment and inpatient bed-based care in the context of sudden deterioration or severe illness [ 6 ]. Adaptations to the acute care pathway may improve the quality of care for older people while simultaneously reducing pressure on an increasingly congested acute care system.

These factors have collectively driven a rapid expansion of studies investigating models of care intended to mitigate the risk of hospital admission or avoid bed-based hospital care entirely [ 7 ]. Previous systematic reviews of acute care models for older people have focused on interventions located at specific points along the acute care pathway [ 8 , 9 , 10 ]. There has been a tendency to group interventions with different eligibility criteria and clinical processes. Differentiating models of care able to manage acute illness from those primarily engaged with rehabilitation and the functional consequence of resolving acute illness is not straightforward. This distinction is important as policy makers and commissioners look to maximise the efficiency of acute hospital bed use and find credible alternatives to acute inpatient care in the community.

It is possible that a more granular classification of the interventions may foster a greater understanding of which elements of the model drive effectiveness and highlight areas of best practice.

A systematic review was undertaken to describe and classify the range of acute care models designed to manage acute medical illness in older people with the objective of deriving a taxonomy of care models. The review also aimed to describe and classify the outcome measures used in studies investigating these models. A secondary objective was to determine whether the proposed taxonomy was useful in understanding any differences in observed outcomes between studies. We took the novel approach of including acute care models operating in hospital and community settings.

Study design

The systematic review was conducted using a two-step process. The first step was undertaken to describe and classify acute care models for older people and the outcome measures used to demonstrate their clinical effectiveness within the current literature. This information was used to create a taxonomy of care models accompanied by a narrative summary. No restrictions were placed on study design at this stage of the process.

The second step looked to describe the effectiveness of each model and restricted analysis to randomised controlled trials or observational studies with an experimental design (including non-randomised trials, cohort studies with comparator groups, before and after longitudinal studies). Previous systematic reviews and meta-analyses were not used to inform the taxonomy. Primary studies from relevant systematic reviews were included if they met the inclusion criteria. The systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. The study protocol was registered with PROSPERO (CRD42021279131).

Eligibility criteria and study selection

Inclusion and exclusion criteria were designed to incorporate interventions operating within the hospital and the community. An age threshold of 65 years was used to define care models for older people (mean age of study participants > 65 years. Mean age as opposed to a strict age threshold was employed to ensure care models accepting younger patients with frailty identified using alternative measures, such as validated frailty scores or multi-morbidity were not excluded.

The intervention needed to target acute medical illness or acute exacerbation of chronic disease. There is no consensus definition of acute care. To ensure a focus on acute care, study participants needed to be recruited within 48 h of presentation and the care model had to provide time limited episodes of care (up to 14 days). The requirement for time limited episodes of care was used as a criterion to exclude care models delivering ongoing chronic disease management after resolution of acute illness which were felt likely to employ different care processes and focus on different clinical outcomes. Recruitment direct from the ED was used as a proxy for recruitment within 48 h in studies where this metric was not reported. Community interventions were only included if they were able to provide a credible alternative to hospital bed-based care. This was defined as the capability to provide face-to-face review alongside access to hospital level treatments (eg intravenous treatments) and hospital level diagnostics (eg blood tests, imaging) at home.

A full list of inclusion and exclusion criteria is provided in Table 1 .

Data sources and searches

The search strategy comprised both MeSH terms and keyword text and was performed on 30 th September 2021 with no date restrictions. The search strategy is provided in Supplementary Table 1 . The search was undertaken in 5 electronic databases (Ovid MEDLINE, Ovid Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of systematic reviews, Cochrane Central Register of Controlled Trials). Hand reference list screening was carried out of all included articles. Systematic reviews were not included directly. All individual studies meeting the inclusion criteria contained within systematic reviews identified by the search were included.

Titles and abstracts were reviewed by two reviewers. (TK reviewed each and at-least one further review from CA, VK, CG, JR). Full-text records were obtained and reviewed against the eligibility criteria. Disagreements were resolved by a third reviewer (DL). Data extraction was undertaken by 1 reviewer (TK). A bespoke data extraction tool was adapted from the TIDIeR checklist to characterise each intervention [ 11 ]. Outcome measurements were classified using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy [ 12 ].

Data extraction and quality assessment

Risk of bias was assessed using criteria from the Cochrane Handbook. Randomised controlled trials were assessed using RoB-2 tool [ 13 ] and observational studies were assessed using the ROBINS-I tool [ 14 ]. Risk of bias was assessed by 1 reviewer (TK).

Data synthesis

Finding from included articles were grouped and summarised. Due to clinical heterogeneity between studies meta-analysis was not appropriate. A narrative synthesis of the results was undertaken. Visualisations were created using R statistical software (Version 1.3.1093, Vienna. Austria). The geographical location of included studies was mapped using the ggmap package. Source maps were obtained from © Stamen Design, under a Creative Commons Attribution (CC BY 3.0) license. Outcome areas and domains were plotted using the treemap package.

The initial search returned 13,102 relevant articles. Title and abstract screening identified 340 relevant articles for full text review. A total of 90 articles met the eligibility criteria. Hand searching of references identified 13 further articles. Therefore, 103 articles were included in the analysis (see Fig. 1 ). Identified articles were published between April 1991 and April 2021. This comprised 20 randomised controlled trials reported across 26 articles), 6 study protocols (results for 2 had been reported and were included), 38 observational studies with a comparator group reported across 51 articles, and 20 descriptive studies without a comparator group. The search identified 101 conference abstracts which did not contain sufficient information to adequately describe the model of care delivered. These abstracts were not used to inform the taxonomy.

A PRISMA flow diagram for the studies screened and included in the systematic review. Legend: Studies were screened against the inclusion and exclusion criteria described in Table 1 . Reasons for exclusion are provided

The articles could be broadly categorised into four groups based on the model of care they described. These included: bedded acute frailty units (AFU), Hospital at Home models (HaH), ED based in-reach models and acute care home models, see Fig. 2 . A detailed description of the interventions described in each individual study is provided in Supplementary Table 2 . The geographical location of included studies is provided in Fig. 3 .

The Proposed taxonomy of acute care models for older people. Legend: The taxonomy was defined using key features of the care models; Care models were initially differentiated based on location. Acute bedded frailty units operated from a fixed bed base or offering consultation to general medical wards. Hospital at home models were differentiated based on their use of telemedicine. Physician intensive models used face to face review at home as standard. Remote oversight models were primarily delivered by specialist nurses with care supported provided remotely by physicians on a selective basis. Emergency Department in reach models could be differentiated by their staffing model. Nurse led care coordination without direct input from a dedicated geriatrician or care delivered by geriatricians within the Emergency Department. Care home models were differentiated by their primary location of activity, either services offered within the care home or adaptations to the care pathway following transfer to the Emergency Department

A map identifying the countries where the included studies were based. Legend. The map shows the location of included studies identifying: Colours to denote the care model type as defined by the taxonomy. Brown dots represent Hospital at Home models, Violet dots represents bedded Acute Frailty Units. Purple dots Emergency Department in-reach models. Green dots care models. Source maps were obtained from © Stamen Design, under a Creative Commons Attribution (CC BY 3.0) license

Bedded acute frailty units models

The provision of tailored bed-based in-patient care for frail adults as a direct alternative to treatment on a general medical ward was described in 32 articles derived from 24 studies. This included 8 articles [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] reporting results from 6 randomised controlled trials, 1 trial protocol without results [ 23 ], 11 observational studies with a comparator group reported across 15 articles [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] and 8 descriptive studies without a comparator [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ]. A detailed description of the care models is provided in Supplementary Table 2 A.

The AFU care model has a strong focus on maintaining and restoring function, but in contrast to a rehabilitation ward intervenes prior to full resolution of acute illness. A range of names were used to identify care models with similar underlying approaches, including Acute Frailty units (AFU), Acute Care for Elders (ACE) units and CGA units. Generic descriptions of the model frequently reference four core components, patient centred care, specifically designed environments, review of medical care and early discharge planning as key characteristics of the model. There was considerable variation in how these shared high-level objectives were operationalised within individual care models.

Treatment was delivered within a geographically distinct bedded unit in 20 studies [ 15 , 16 , 17 , 18 , 19 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 34 , 35 , 38 , 39 , 42 , 44 , 45 , 46 ], of which 7 specifically reported adaptations to optimise the environment for older people [ 15 , 17 , 18 , 23 , 24 , 39 , 41 ]. The mean number of beds in each unit was 18 (SD 8). The number of beds was not reported in 3 studies [ 25 , 41 , 46 ]. A mobile model providing specialist consultations to patients within general medical bed was described in 3 studies [ 20 , 33 , 36 ] (and an integrated service with variable bed capacity operating within an acute medical unit in 1 study [ 45 ].

Eligibility criteria were heterogenous. Age criteria were reported in studies describing 20 care models [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 38 , 39 , 41 , 42 , 44 , 45 ]. Descriptions of the process of patient referral and how eligibility criteria were implemented in practice were uncommon. The presence of additional criteria such as functional impairment or specific geriatric conditions were frequently reported, but it was not possible to establish how these criteria were operationalised. The use of validated frailty assessment tools to define eligible patients were reported in 1 study (reported across 5 articles) [ 26 , 28 , 29 , 30 , 31 ]. Patients from residential care homes were excluded in 2 studies [ 18 , 21 ]. Bed availability was cited as a common determinant of receiving treatment on the AFU.

Hospital at home models

Hospital at home (HaH) models describe the provision of acute medical care within a person’s usual place of residence. The care model aims to replicate acute bed-based care and operate under the assumption that care would be delivered in an acute hospital setting if the model were absent. HaH models were described in 37 articles derived from 27 studies. This included 16 articles [ 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ] reporting results from 12 randomised controlled, 2 protocols (of which 1 had reported results and was included) [ 63 , 64 ], 9 observational studies with a comparator group reported across 15 articles [ 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ] and 4 descriptive studies without a comparator group [ 79 , 80 , 81 , 82 ]. A detailed description of the care models is provided in Supplementary Table 2 B.

There was significant clinical heterogeneity between included HaH models. The model accommodated patients with unselected acute medical illness in 31 studies and specific disease groups in 7 studies (decompensated heart failure = 3 [ 57 , 58 , 62 ], COPD = 4 [ 47 , 51 , 52 , 70 , 79 ]).

Eligibility criteria to define suitability for HaH care were heterogenous. All included studies made the intention to act as an alternative to hospital bed-based care explicit. Clinical discretion exercised by the HaH team was the arbiter of the appropriateness and safety of HaH care in all the identified studies. No standardised approach to assessment was identified and it was not possible to reliably determine the acuity of included patients from the reported data. The majority of HaH studies specifically targeted adults over the age of 65. In models open to adults of all ages, the mean age of participants was over 65 in all cases. Care home residents were excluded in 9 studies [ 53 , 58 , 59 , 63 , 67 , 73 , 74 , 75 , 80 ].

Care was led by a geriatrician in 6 studies, [ 47 , 59 , 61 , 62 , 73 , 78 ] by a general internal medicine physician in 29 studies and a primary care physician in 2 studies [ 60 , 83 ]. The intensity of physician and nursing involvement varied substantially. Physician involvement ranged from multiple daily physical home visits to remote oversight without direct physical assessment. Specific out-of-hours arrangements were reported in 12 studies reported across 19 articles [ 47 , 53 , 54 , 55 , 61 , 62 , 65 , 67 , 68 , 69 , 71 , 72 , 74 , 75 , 76 , 77 , 81 , 82 , 83 ]. The use of telemedicine was described in 5 studies reported across 11 articles [ 47 , 65 , 66 , 68 , 69 , 71 , 72 , 74 , 75 , 76 , 77 ]. Reporting of the study intervention was often restricted to a description of standardised operating procedure. The frequency of assessment achieved in practice was reported in 6 studies [ 52 , 53 , 58 , 74 , 75 , 81 ] and the proportion of patients receiving specific treatments was reported in 3 studies [ 47 , 53 , 80 ].

ED in-reach models

ED in-reach models aim to optimise processes of care for older people in the ED. The care models typically provide care coordination and elements of CGA to reduce the likelihood of admission to acute-bed based care. ED in-reach models were described in 28 studies describing 27 care models. This included 2 randomised controlled trials, [ 84 , 85 ] 1 randomised controlled trial protocol without results [ 86 ], 12 observational studies with a comparator group [ 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 ] and 13 descriptive studies without a comparator group [ 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 ]. A detailed description of the care models is provided in Supplementary Table 2 C.

Two distinct approaches to the operational design of services were evident. One approach, described in 11 studies, involved the use of bedded areas located within ED clinical decision units (alternatively referred to as ED short stay units) to provide elements of CGA to older patients who required additional assessment and investigation before a decision regarding acute medical admission could be reached [ 87 , 89 , 90 , 91 , 94 , 96 , 104 , 105 , 107 , 109 , 111 ].

An alternative approach, described in 20 studies, involved the provision of elements of CGA directly within the ED. CGA was undertaken by a geriatrician in 10 care models [ 84 , 88 , 97 , 100 , 101 , 102 , 103 , 108 , 110 ] and by specially trained nurses in 7 care models [ 85 , 86 , 92 , 93 , 95 , 98 , 99 , 106 ]. Studies of this care model frequently cited a reduction in the number of avoidable medical admissions as the primary motivation for the service. The distinction between avoidable and unavoidable admissions was poorly defined.

Eligibility criteria were heterogenous. Age criteria were reported in 13 care models [ 84 , 88 , 91 , 93 , 94 , 95 , 98 , 99 , 102 , 103 , 104 , 106 , 108 , 112 ]. The use of validated frailty assessment tools to define eligible patients were reported in 5 care models [ 84 , 86 , 92 , 99 , 106 ]. Care home residents were excluded in 3 studies [ 86 , 91 , 94 ]. Eligibility criteria were not reported in 5 studies [ 87 , 89 , 91 , 109 , 110 ]. A variety of approaches were adopted to identifying potentially eligible patients in the ED. Screening of all patients attending the ED was reported in 3 studies [ 84 , 88 , 93 ]. The service was accessed by a referral from the ED team in 11 care models [ 89 , 90 , 92 , 95 , 98 , 99 , 100 , 101 , 104 , 109 , 110 ]. The process of referral and patient selection were not consistently reported.

Acute care home models

Models targeting care home residents were reported in 5 studies. All 5 studies had an observational design [ 113 , 114 , 115 , 116 , 117 ]. Two categories of intervention were described. The first involved the presence of dedicated staff trained in acute care present with the care home [ 113 , 117 ]. These staff had the ability to deliver acute interventions in the care home. Privileged access was given to the on-call ED physician in both models (augmented by telemedicine in one study) [ 117 ]. The process which triggered assessment by the on-site team were not defined. A detailed description of the care models is provided in Supplementary Table 2 D.

An alternative model involved a hospital-based team providing out-reach to care homes and early assessment of care home resident presenting to ED. Both care models in this category also had the capability to provide ongoing acute care in the care home when required. This was achieved by a geriatrician-led team with the option to provide daily visits in one model [ 116 ] and a specialist ED nursing team in the other [ 114 , 115 ].

Outcome measurements

Outcomes were classified using the COMET taxonomy. Outcomes were reported across 6 core areas and 15 domains. Mortality was reported (in isolation or as part of a composite outcome) in 35 studies, the reporting time horizon ranged from in-hospital mortality to 1 year. Life impact was reported 27 studies, this included measurement of physical function in 21 studies and cognitive function in 6 studies. The tools used to measure physical function and the time horizons of assessment varied.

Resource use was the most reported core outcome measure. Studies frequently described multiple outcome domains related to resource use. The average length of stay was reported in 34 studies and re-admission rate in 39 studies. Readmission rates were reported over a range of time horizons 30 days to 1 year. Care home admission were reported (in isolation of as part of a composite outcome) in 14 studies over a time horizon of 30 days to 6 months. Economic analysis was reported in 19 studies. Adverse events were reported in 22 studies. A detailed summary of the outcome domains, methods of measurement and associated time horizons is provided in Supplementary Table 3 .

The relative frequency with which the outcome domains were reported across all studies is provided in Fig. 4 A and stratified by care model in Fig. 4 B. Outcomes reported by bedded AFU and HaH were broadly similar, although AFU more commonly reported outcomes related to physical function. Economic analysis was less prevalent in studies investigating ED in-reach models. A focus on aspects of care delivery, such as disposition from the ED and analysis of clinical processes relevant to the quality and adequacy of intervention were more common in studies evaluating ED in-reach.

Tree diagrams: A tree diagrams representing the relative proportion of outcomes reported in all studies. B Tree diagrams representing the relative proportion of studies by study group. Legend. * Treemap representing hierarchical outcome data using nested rectangles. Large rectangle represent core outcome areas, smaller rectangular tiles within each core outcome area represent outcome domains. Each rectangle has an area proportional to the frequency reported within included studies. All studies n = 103, Bedded acute frailty unit n = 32, Hospital at Home n = 38, ED in reach models n = 28, Care home n = 5

Effectiveness

Clinical heterogeneity amongst the care models identified and disparity in the outcomes measured used to evaluate the care models precluded meta-analysis. Risk of bias was assessed for each study. Aggregated results of the domain-based risk of bias assessment tools are provided in Fig. 5 and the results of individual study assessments are provided in Supplementary Table 4 .

Summary of bias assessments. A Summary of randomised controlled studies using RoB2 tool. B Summary of non-randomised studies using ROBINS-I tool

The nature of the intervention precluded blinding of participants or personnel to group allocation in all included randomised controlled trials. Partial blinding of outcome assessment was reported in one study investigating the effectiveness of bedded AFUs [ 17 ] and assessment was unblinded in the remainder. Blinding during outcome assessment was reported in 4 randomised controlled trials investigating HaH [ 47 , 52 , 59 , 60 ]. Outcome assessment was unblinded in both randomised controlled trials investigating ED in-reach models [ 84 , 85 ]. All the studies investigating bedded AFUs were undertaken in single sites which may have led to contamination of the control arm. This would be anticipated to favour the null hypothesis [ 15 , 16 , 18 , 19 , 20 , 21 , 22 ]. Contamination of the control arm was less likely in HaH models delivered by distinct clinical teams.

All included observational studies were at serious or critical risk of confounding. The decision to manage patients in the intervention arm is likely to have been selective, based on clinical judgment informed by pre-intervention clinical characteristics. Only 5 studies employed robust statistical techniques to control for confounding [ 65 , 67 , 69 , 78 , 92 ]. Residual confounding from unmeasured prognostic factors posed at risk of bias all included observational studies.

Effectiveness of acute care models

Bedded acute frailty unit models.

No statistical difference in primary outcome was observed in 2 randomised controlled trials (reported across 3 articles) of specialist bed-based care for unselected older medical patients, 1 study measured the composite outcome of death, severe dependence and psychological well-being [ 15 ] and the other physical function at 3 months following discharge [ 19 ]. A planned cost-analysis demonstrated no difference in the total cost of admission between groups [ 16 ]. A single centre randomised controlled trial comparing a specialist unit for acutely unwell patients with cognitive impairment with usual care demonstrated no statistical difference in the composite outcome of days at home [ 17 ]. All included observational studies were judged to be at critical or serious risk of bias.

The largest randomised controlled trial included 1055 participants [ 59 ]. The study was designed to recruit to the HaH intervention at a ratio of 2:1. A significant number of participants moved from the control to the intervention arm due to operational pressures within the hospital. The study found no difference in the primary outcome of living at home at 6 months (the inverse of death or long-term residential care) [ 59 ]. The remaining 11 trials (reported across 15 articles) had smaller sample sizes (mean 81 participants, SD 33). One randomised controlled trial (2 articles) reported a statistically significant reduction in the rate of adverse events [ 50 ] and favourable functional outcomes in the group allocated to HaH care [ 49 ].

HaH care for older people with decompensated heart failure was investigated in 2 randomised controlled trials, 1 reported no difference in mortality or readmission at 6 months [ 62 ] and 1 no difference in mortality or readmission at 12 months [ 57 ]. HaH care for older people with an acute exacerbation of COPD was investigated in 2 randomised controlled trials, 1 reported a statistically significant reduction in readmissions at 6 months and no difference in mortality at 6 months [ 47 ] and 1 reported lower costs at 90 days, driven by shorted length of stay in the HaH group, with no difference in mortality or readmission rate at 90 days [ 52 ]. Economic analysis determined HaH was associated with lower costs in 1 randomised controlled trial of participants with unselected medical-illness [ 53 ]. Nested analysis of patient and carer satisfaction was included in 5 trials [ 47 , 52 , 53 , 59 , 62 ] in 3 trials the findings were reported in separate articles [ 51 , 55 , 66 ]. All showed an increase in measures of patient satisfaction in the HaH intervention group.

One randomised trial compared two contrasting models of HaH. The study arms compared HaH care led by primary care physicians with care led by hospital specialists [ 60 ]. Those in the hospital specialist arm were initially assessed in the ED and discharged within 4 h of assessment with a home-based care plan. The hospital specialist team did not undertake home visits. Those in the primary care physician arm received care exclusively at home. In both arms the plan care was delivered by a dedicated HaH nursing team. The primary care physician model was a associated with a statistically significant reduction in hospital admission at 7 days. A series of articles published as part of a non-randomised controlled trial [ 75 ] reported a reduction in length of admission, [ 75 ] reduced levels of carer stress [ 71 ] and no difference in physical function [ 72 ] in the HaH group.

ED in reach models

No statistical difference in the primary outcome measure was observed in 2 randomised controlled trials investigating ED in-reach models. In one study the provision of geriatrician lead CGA to patients aged over 75 with a clinical frailty scale (CFS) of 4 or above did not affect cumulative length of stay over a 1 year follow up period [ 84 ]. A randomised controlled trial investigating provision of nurse-led care coordination in the ED found no significant effect on the rate of hospital admission [ 85 ]. Uncontrolled before and after studies were a common methodological approach to the assessment of ED in-reach models, employed in 5 studies. All included observational studies were judged to be at serious risk of bias.

This systematic review provides a summary and classification of acute care models for older people living with frailty and an assessment of effectiveness based on current published evidence. The care models identified could be broadly differentiated by the location within the acute care pathway at which they operate. This generic classification provides a degree of structure to a large and complicated field of research, sensitive to the fact that relevant interventions have emerged across hospital and community settings. The spectrum of outcomes reported and differing approaches to measurement suggest consensus on how best to determine the effectiveness of these care models has yet to emerge.

The clinical effectiveness of acute care models for older people was difficult to determine from the available studies. The number of participants within each trial was small. The risk of confounding by indication was pervasive amongst observational studies and statistical techniques to control for cofounding were generally absent or inadequate. These methodological limitations prevented meaningful comparisons of the impact on outcomes between care models. There is a paucity of contemporary data on the effectiveness of acute care models for older people. Some of the most influential studies were conducted over two decades ago. This raises the concern that the clinical processes employed may now be obsolete.

Complex interventions, such as acute care models for older people are often difficult to characterise. The detailed summary of individual interventions provided within this review highlights the contrasting approaches adopted by services under the same umbrella.

Few studies adopted a structured approach to defining the intervention under investigation and the descriptions provided varied in depth and quality. The nature of care provided in the usual care arm of comparative studies was equally difficult to define. The absence of consistent inclusion and exclusion criteria or knowledge of how criteria were operationalised makes it difficult to discern the population targeted by each intervention. Assignment often incorporated a subjective assessment by an individual clinician acting as gatekeeper. Thresholds for admission and discharge are not standardised and risk tolerance may vary at the individual, hospital and system level. This is particularly pertinent to studies investigating the role of HaH and ED in-reach models, predicated on the assumption that care would inevitably require in-patient bed-based care if the intervention was absent. This assumption is inherently difficult to substantiate. All the HaH models included in this systematic review had access to hospital level diagnostics and interventions but the proportion of patients receiving these interventions were inconsistently reported. This obfuscates an objective assessment of acuity and whether hospital admission was warranted.

Comparison with previous literature

Clinical heterogeneity in the studies included in previous systematic reviews and the absence of universally accepted definitions for the care models investigated cloud interpretation of the existing literature. The diverse range of approaches to patient selection, operational design and outcome measurement highlighted in this review suggests caution is warranted when pooling studies in this subject area.

Several systematic reviews investigating acute care models for older people have focused the delivery of comprehensive geriatric assessment (CGA) [ 8 ]. CGA involves multidimensional assessment with particular attention on the functional consequences of illness [ 118 ]. CGA has been shown to increase the likelihood of being alive or returning to home at 3 to 12 months follow up amongst older patients admitted to hospital with acute illness [ 8 ]. Meta-analysis of CGA delivered in bed-based frailty units found a lower risk of functional decline, a higher likelihood of living at home after discharge and no differences in mortality [ 119 ]. CGA delivered in bed-based frailty units may also reduce the incidence of adverse events such as falls, delirium and pressure sores at discharge [ 10 ]. The inclusion of interventions delivered on rehabilitation wards, and patients with surgical and orthopaedic presentations in previous systematic reviews limits generalisation to care models employed at earlier time points in the acute care pathway. The available literature suggests alternatives to usual bed-based care incorporating CGA may be of benefit but offers little to guide how these services should be designed and implemented. When inclusion is limited to interventions employed within 48 h of presentation the evidence of effectiveness is less compelling. This is important given the benefit of CGA is cited as the primary motivation for operational models located upstream in the acute care pathway [ 120 ].

HaH models have also been the subject of systematic review and meta-analysis. A Cochrane review of admission avoidance HaH identified ten randomised controlled trials including 1333 participants of which 850 were included in individual patient level meta-analysis [ 121 ]. The analysis demonstrated a significant reduction in mortality at 6 months (adjusted HR 0.62, 95% CI 0.45–0.87). A more recent systematic review and meta-analysis found patients managed in HaH following discharge from the ED had a lower risk of admission to institutional care (RR 0.16 95% CI 0.03–0.74) and no difference in mortality (RR 0.84 95% CI 0.6–1.2) [ 122 ]. These systematic reviews pooled results from studies investigating HaH in the context of a diverse range of conditions including stroke, cellulitis, fractures and respiratory illness which would be expected to employ very different clinical processes. Applying a more restrictive approach to study inclusion, by only including HaH models with access to hospital level diagnostics and treatments allows greater confidence in the assertion that the HaH models included in the current review offered a true alternative to hospital admission.

Implications for policy and future research

The provision of acute care models for older people are predicated on a logic model rather than empirical evidence of benefit. Further large and rigorously constructed randomised controlled trials may strengthen the evidence base but may not be the most effectual method of influencing local decisions on service provision or the direction of policy.

Research in acute care delivery is complicated by a need to maintain operational performance. Amongst the studies identified, bed availability and restricted operational hours frequently resulted in a large differential between the number of potentially eligible participants and the number of patients ultimately included. Practical considerations aside, the outcomes of interventional studies are likely to be highly dependent on local context and external factors which influence generalisability.

Knowledge in this subject area may be enhanced by developing a consistent approach to outcome reporting and measurement, ideally incorporating the priorities and preferences of patients. Mortality may not be the most appropriate metric of effectiveness given a significant proportion of older people living with frailty requiring acute care for medical illness are entering the last 12 months of life [ 123 ]. Current models of acute care infrequently establish and record individual preferences in relation to location of care in the event of acute medical illness or preferred location of death amongst older people [ 124 ]. A narrow focus on clinical and operational outcomes may simplify study design, facilitate comparisons and provide reassurance around safety but risks ignoring other aspects of care, such as quality of life, which may be more meaningful from the patient perspective.

Given the complexity of the intervention, an understanding of the processes and behaviours which drive successful models may be best approached from a qualitative research paradigm.

Strength and limitations

The primary objective of this systematic review was to describe and categorise acute care models for older people and highlight variation in the outcome measures used to assess them. An extensive search strategy inclusive of the grey literature and indifferent to methodological design was purposefully employed in order to capture a comprehensive representation of the range of models in operation. Every acute hospital encounters older people living with frailty and the potential for variation in approach is vast. Only a small fraction of care models delivered in practice are reported in the literature. The practice of publishing multiple articles from the same original study was relatively common, particularly in literature pertaining to acute bed-based care and HaH models. The account provided is therefore susceptible to both publication and outcome reporting bias.

Availability of data and materials

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

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Knight, T., Kamwa, V., Atkin, C. et al. Acute care models for older people living with frailty: a systematic review and taxonomy. BMC Geriatr 23 , 809 (2023). https://doi.org/10.1186/s12877-023-04373-4

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Case report
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Published: 17 April 2024

Pneumoperitoneum, pneumoretroperitoneum and pneumomediastinum: rare complications of perforation peritonitis: a case report

H. Hafiani ORCID: orcid.org/0000-0002-3198-1783 1 ,
N. Bouknani 1 ,
E. M. Choukri 1 ,
R. Charif Saibari 1 &
A. Rami 1

Journal of Medical Case Reports volume 18 , Article number: 187 ( 2024 ) Cite this article

Metrics details

Gas extravasation complications arising from perforated diverticulitis are common but manifestations such as pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum happening at the same time are exceedingly rare. This case report explores the unique presentation of these 3 complications occurring simultaneously, their diagnosis and their management, emphasizing the importance of interdisciplinary collaboration for accurate diagnosis and effective management.

Case presentation

A 74-year-old North African female, with a medical history including hypertension, dyslipidemia, type 2 diabetes, goiter, prior cholecystectomy, and bilateral total knee replacement, presented with sudden-onset pelvic pain, chronic constipation, and rectal bleeding. Clinical examination revealed hemodynamic instability, hypoxemia, and diffuse tenderness. After appropriate fluid resuscitation with norepinephrine and saline serum, the patient was stable enough to undergo computed tomography scan. Emergency computed tomography scan confirmed perforated diverticulitis at the rectosigmoid junction, accompanied by the unprecedented presence of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum. The patient underwent prompt surgical intervention with colo-rectal resection and a Hartmann colostomy. The postoperative course was favorable, leading to discharge one week after admission.

Conclusions

This case report highlights the clinical novelty of gas extravasation complications in perforated diverticulitis. The unique triad of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum in a 74-year-old female underscores the diagnostic challenges and the importance of advanced imaging techniques. The successful collaboration between radiologists and surgeons facilitated a timely and accurate diagnosis, enabling a minimally invasive surgical approach. This case contributes to the understanding of atypical presentations of diverticulitis and emphasizes the significance of interdisciplinary teamwork in managing such rare manifestations.

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Introduction

Potential sources of gas extravasation include the respiratory tract, the gastrointestinal tract or infections with gas-generating germs [ 1 ]. While pneumoperitoneum is a classic complication of diverticulitis, pneumomediastinum [ 2 ] and pneumoretroperitoneum are very rare complications of perforated diverticulitis [ 3 ]. Imaging studies can help to diagnose such diseases, their complications and even sometimes, their own etiology. While abdominal X-ray alone can help diagnose air outside the peritoneum, CT scan remains the gold standard today with fine localisation of air bubbles, eventual ascites and other things such as perforation location. We present the unusual case of a 74 years old female with peritonitis from perforated diverticulitis at the rectosigmoid junction that resulted in pneumoperitoneum, pneumoretroperitoneum and even pneumomediastinum.

The patient of the case is a 74 years old North African female with hypertension, dyslipidemia, type 2 diabetes, goiter, prior cholecystectomy, and bilateral total knee replacement. The patient's symptoms began with sudden onset of cramp-like pelvic pain, accompanied by chronic constipation and scant rectal bleeding. Notably, there were no associated vomiting or urinary symptoms, but the presentation occurred within a febrile and altered general condition.

Clinical examination showed hemodynamic and respiratory instability with low blood pressure and hypoxemia associated with diffuse tenderness and hypogastric guarding, while rectal examination didn’t show any rectal bleeding or melena. After appropriate resuscitation done with appropriate quantities of norepinephrine and saline serum, the patient was stable enough to undergo imaging. A CT scan was ordered at the emergency room and the final diagnosis was perforated diverticulitis but what caught our attention was that the patient had both pneumoperitoneum (Fig. 1 ) and pneumoretroperitoneum (Fig. 2 ) and pneumomediastinum (Fig. 3 ) that suggested perforation at the rectosigmoid junction.

CT scan axial view showing pneumoperitoneum. Arrow points to pneumoperitoneum

CT scan axial view showing pneumoretroperitoneum. Arrow points to pneumoretroperitoneum

CT scan axial view showing pneumomediastinum. Arrow points to pneumodiastinum

Our patient was sent to the operating room for surgery on that same day and had laparoscopic colo-rectal resection with a Hartmann colostomy. The postoperative course was favorable and the patient was discharged from the hospital 1 week afterward.

Perforation of the colic wall can happen due to diverticulitis, neoplasm, iatrogenic or traumatic mechanisms. Colonic diverticulosis is common in the western countries affecting nearly 50% of the population [ 4 ] with approximately 20% of them that may develop inflammation of the diverticula [ 5 ]. This inflammation can lead to perforation which is a serious complication that requires urgent intervention. Extradigestive air secondary to perforated diverticula can help localize the site of the perforation on CT scan, whether it is in the peritoneum, behind it, or in the mediastinum. While pneumoperitoneum is a classic localisation of air after perforation, pneumoretroperitoneum is less usual.

Pneumomediastinum secondary to colonic perforation is extremely rare and only 20 cases of spontaneous perforation (not iatrogenic or traumatic) were reported before 2019 [ 6 ]. Diverticulitis was the most common cause of mediastinal emphysema [ 6 ].

In our case, the air was localized in the 3 parts (Fig. 4 ) and made us immediately think that the perforation occurred at the rectosigmoid junction, near the Douglas, where the peritoneum folds (Fig. 2 ). The mechanism of the pneumomediastinum is not fully understood but a few theories emerged: it could either come from extravasation of air through the fascial planes or the esophagus and its perivascular spaces or come directly from the retroperitoneum [ 7 ].

CT scan sagittal view showing pneumoperitoneum [ 1 ], pneumoretroperitoneum [ 3 ] and pneumomediastinum [ 2 ]. Arrow 1 points to pneumoperitoneum, arrow 2 points to pneumomediastinum, arow 3 points to pneumoretroperitoneum

Another theory includes the foramina of Morgagni and Bochdalek, which are responsible for diaphragmatic hernias when they are weak. These 2 visceral peritoneal folds could constitute air passage from the peritoneum to the mediastinum.

In our particular scenario, the radiologist readily established the diagnosis due to clear manifestations of diverticulitis in addition to the presence of extradigestive air. However, in certain instances, the detection of air may serve as the sole indicator, necessitating extensive paraclinical investigations. This underscores the rationale behind the diagnostic algorithm proposed by Wang et al. [ 8 ] for situations where air constitutes the sole available information.

Following the diagnosis, the patient promptly underwent laparoscopic colorectal resection, during which the surgeons validated the radiologist's diagnosis of peritonitis resulting from diverticulitis perforation (Additional file 1 : Video S1). Peritoneal lavage was done, and a Hartmann colostomy was performed by the surgeon. Subsequently, the patient was discharged without any complications after a 10-day hospitalization period.

The question of the origin of the extradigestive air remains, and this case highlights the fact that the collaboration between radiologists and surgeons should be optimal. With a good and clear diagnosis, the surgeon chose the laparoscopic approach (less harmful for the patient) and could cure a potentially fatal disease with a minimalist approach, sending the patient back home 10 days after admission.

In conclusion, our case report underscores the complexity and rarity of gas extravasation complications resulting from perforated diverticulitis. The presentation of a 74-year-old female with peritonitis at the rectosigmoid junction led to the unique occurrence of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum. This very unusual manifestation necessitated a prompt and collaborative effort between radiologists and surgeons for accurate diagnosis and timely intervention. The effective coordination between radiologists and surgeons, coupled with advanced imaging techniques, not only facilitated a timely and accurate diagnosis but also enabled a minimally invasive surgical approach with a favorable outcome.

Availability of data and materials

The data that support the findings of this study are available from the corresponding author, Hafiani Hamza, upon reasonable request.

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H. Hafiani, N. Bouknani, E. M. Choukri, R. Charif Saibari & A. Rami

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Hamza Hafiani—Conception of the work, Design of the work, Acquisition of data, Analysis of data, Interpretation of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Nawal Bouknani—Conception of the work, Design of the work, Acquisition of data, Analysis of data, Interpretation of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. El Mehdi Choukri—Conception of the work, Design of the work, Acquisition of data, Analysis of data, Interpretation of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Rayhana Charif Saibari—Conception of the work, Design of the work, Acquisition of data, Analysis of data, Interpretation of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Amal Rami—Conception of the work, Design of the work, Acquisition of data, Analysis of data, Interpretation of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

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Additional file 1. Video of the laparoscopic surgery showing the perforation.

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Hafiani, H., Bouknani, N., Choukri, E.M. et al. Pneumoperitoneum, pneumoretroperitoneum and pneumomediastinum: rare complications of perforation peritonitis: a case report. J Med Case Reports 18 , 187 (2024). https://doi.org/10.1186/s13256-024-04488-1

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Received : 22 January 2024

Accepted : 01 March 2024

Published : 17 April 2024

DOI : https://doi.org/10.1186/s13256-024-04488-1

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Pneumomediastinum
Pneumoperitoneum
Pneumoretroperitoneum
Perforation
Peritonitis
Diverticulitis

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1. How well does the employee collaborate with team members on projects and tasks?

2. Can you provide an example of when the employee demonstrated strong problem-solving skills?

3. How would you rate the employee’s communication skills, particularly in stressful situations?

4. Has the employee taken the initiative to lead any projects or initiatives? If so, how successful were they?

5. Can you comment on the quality and timeliness of the employee’s work?

6. How well does the employee handle constructive criticism and feedback?

7. Does the employee contribute to a positive and inclusive work environment?

8. Can you cite an instance where the employee showed adaptability to sudden changes in projects or priorities?

9. How effectively does the employee manage their time and resources?

10. How consistently does the employee demonstrate ethical behavior and integrity in their work?

11. How well does the employee handle conflict within the team?

12. Can you identify a skill or area in which the employee has shown significant improvement?

13. How well does the employee balance individual tasks with team responsibilities?

14. Does the employee exhibit a strong understanding of the company’s mission and objectives?

15. How approachable is the employee for help or discussions related to work?

16. How proactive is the employee in identifying challenges and proposing solutions?

17. Can you comment on the employee’s reliability and dependability in fulfilling commitments?

18. How respectful is the employee of diverse opinions and perspectives?

19. How effectively does the employee prioritize tasks and manage stress?

20. How receptive is the employee to new ideas and innovative approaches?

21. How well does the employee maintain client or customer relationships?

22. Is the employee effective in sharing knowledge and expertise with the team?

23. Does the employee actively seek feedback from peers or superiors?

24. How frequently does the employee volunteer for additional responsibilities?

25. Can you provide an example of when the employee successfully navigated a complex situation?

26. How well does the employee articulate their thoughts and ideas in meetings?

27. Does the employee display a willingness to mentor or guide less experienced team members?

28. How effectively does the employee manage remote work and virtual collaborations?

29. Can you comment on the employee’s ability to focus on long-term goals while managing short-term tasks?

30. How active is the employee in participating in company-wide initiatives or events?

31. How adept is the employee at handling confidential or sensitive information?

32. Can you describe the employee’s effectiveness in cross-departmental collaboration?

33. How attentive is the employee to details in their work?

34. Does the employee consistently meet deadlines without compromising on quality?

35. How resourceful is the employee when encountering obstacles or limited resources?

36. How would you rate the employee’s adaptability to rapidly changing situations?

37. Does the employee display ethical behavior and integrity in their professional interactions?

38. How well does the employee contribute to a positive workplace culture?

39. How willing is the employee to take ownership of both successes and failures?

40. Can you provide an example of a project where the employee demonstrated excellent project management skills?

41. How well does the employee respond to constructive criticism?

42. Does the employee show a genuine interest in the professional development of their peers?

43. Can you comment on the employee’s crisis management skills?

44. How skilled is the employee in using technology tools relevant to their job?

45. Does the employee make data-driven decisions when applicable?

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