Introduction:
This study examined digital self- and peer-assessment in dental education, in a formative clinical assessment called the Unseen Clinical Case (UCC). This assessment enhances critical thinking and treatment planning skills by asking students to review a patient’s history and findings from their clinical examination. Students use this information to develop and present a treatment plan. An interdisciplinary patient case was designed for this UCC to simulate real-world clinical scenarios which effectively integrates theoretical knowledge with practical skills to promote holistic, patient-centred care. The research explores the validity and reliability of audio-video-supported digital self- and peer-assessment within the complex UCC framework.

Methods:
Third-year Doctor of Dental Medicine (DMD) students participated in a prospective cohort study in 2023 and 2024. The UCC is specifically designed to assess critical thinking across dental disciplines. Students attended a three-hour training session focused on interdisciplinary case analysis and the use of a standardised marking rubric, calibrated with a benchmarking video presentation. The assessment was then administered with students reviewing case documentation and preparing a PowerPoint presentation outlining their diagnosis and treatment plan which they recorded as an audio-video presentation using Zoom. Asynchronous self- and peer-assessments of the recorded presentations were then completed, using the rubric provided. A calibrated expert independently evaluated the students' video recordings. Following the intervention, students compared self, peer, and expert feedback and completed a questionnaire. Self, peer and examiner marks were analysed using descriptive statistics, t-tests, and correlation analysis. Inferential analysis used Hmisc and corrplot packages in R (v 4.4.0). Qualitative data were analysed thematically.

Results:
A total of 192 students completed the UCC exam. Quantitative analysis revealed that peer-assessment marks were highest (mean 92%). Self-assessment marks (mean 80%) were higher than expert-assigned marks (mean 69%, p < 0.01). Self- or peer-assessment scores did not predict expert marks. Self-assessment aligned more with examiner standards than peer assessment (p < 0.001), but peer feedback was perceived as more motivating (p < 0.001). Qualitative survey results indicated that self-assessment inspired metacognitive reflection. Peer-assessment enhanced perspective-taking. Expert feedback was regarded as crucial for anchoring assessments with clinical standards and ensuring a triangulated feedback loop.

Conclusion:
The results of this study indicate that digital self- and peer-assessment play a role in enhancing critical thinking and clinical decision-making within the UCC framework. Self-assessment scores were higher than examiner assessments, and students perceived self-assessment as more aligned with examiner standards than peer assessment. However, peer feedback was perceived as more motivating. Notably, expert feedback was crucial for ensuring both self- and peer-assessments adhere to clinical standards, fostering a comprehensive learning environment that supports reflective and analytical capacities essential for effective dental clinical decision-making.

Keywords: Digital technology, higher education, dentistry, self-assessment, peer assessment.