Abstract Case-based learning immerses students in real-world scenarios, prompting observation, action, and reflection to enhance cognitive skills. The open-ended nature of such learning can challenge students to reach greater levels of critical thinking; however, we have noticed that without guidance, students often do not know how to approach these types of questions. Therefore, the objective of this study was to investigate how two low-input interventions strategies may help train cognitive skills and improve student performance. Three semesters of an undergraduate physiology course employed a case-based assessment strategy, which included three-unit case studies and one cumulative final case study. Semester 1 (S1; n = 48) represented no intervention, Semester 2 (S2; n = 59) included two dedicated class periods of instructor led guidance on approaching case studies, and Semester 3 (S3; n = 95) utilized an online peer evaluation platform, where students evaluated and provided feedback to each other. For S2 and S3 the interventions first took place between case study 1and case study 2. In all semesters, students also received individualized feedback from the instructor or teaching assistants after each case study. In S2 and S3 pre-semester and post-semester surveys were administered to understand changes in perceptions of their own cognitive skills. In S2 and S3, case study grades decreased and increased (P < 0.05), respectively, between the first and second case study. The average grade on case studies after intervention was greatest (P < 0.05) in S3 where peer intervention was employed, compared with S1 or S2, which did not differ. When comparing changes in perceptions between the beginning and end of the semester, student confidence in their cognitive skills, determined by agreeance with Likert scale statements, tended to increase more (P < 0.10) in S3 compared with S2 (7.9% vs. 3.4%, respectively). The most notable change was agreeance with the statement “I can take multiple ideas from different concepts and combine them to create new understanding” which increased 7.0% and 16.5% in S2 and S3, respectively. Interestingly, free response questions indicated that students did not enjoy peer evaluation and felt that it was not beneficial to their learning. However, these data indicate that students benefited most from peer led intervention, when evaluated by student performance and perceptions of their cognitive skills. Peer evaluation provides a unique opportunity for students to actively engage in the learning process and to practice cognitive skills. This process holds dual benefit as reviewing peers requires students to reflect, analyze, and evaluate, which are cognitive skills also needed to solve the case studies.
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