Introduction <p>PeerWise is a tool where students generate, answer, and rate peers’ multiple-choice questions. This study aims to explore the use of PeerWise in three foundational sciences courses in an occupational and physical therapy curriculum.</p> Subjects <p>Doctor of physical therapy students enrolled in a neuroscience course in 2021 (<i>n</i> = 64) and 2022 (<i>n</i> = 59), masters and doctoral level occupational (OT) therapy students enrolled in an anatomy and kinesiology course in 2021 (<i>n</i> = 74) and 2022 (<i>n</i> = 77), and masters and doctoral level OT students enrolled in a neuroscience course in 2022 (<i>n</i> = 66) and 2023 (<i>n</i> = 73).</p> Methods <p>Students (<i>n</i> = 413) were assigned to write, answer, and rate multiple-choice questions using PeerWise. The impact on exam performance was analyzed through Kruskal-Wallis H Tests, post-hoc Bonferroni, and multiple linear regression. Student satisfaction was assessed through survey.</p> Results <p>Data on student participation in question writing, answering, and rating from six courses were analyzed. Statistically significant results were found in three courses. Authoring questions that other students rated highly resulted in a statistically significant difference in exam performance in the 2022 OT neuroscience (<i>p</i> = 0.001) and 2021 OT anatomy and kinesiology course (<i>p</i> = 0.002). Exam grade performance improved by 0.092 points for every 1-point increase in the score for authoring highly rated questions (<i>p</i> = 0.007) in the 2022 PT Neuroscience course.</p> Discussion/Conclusion <p>Authoring higher-quality questions was the most consistent variable associated with higher exam performance. Student satisfaction with PeerWise was high. PeerWise is a no-cost tool with a low administrative burden for faculty. PeerWise can be considered a tool to support student performance.</p>