Written assessments are essential components of higher education practices. However, faculty members encounter common pitfalls when designing questions intended to evaluate student-learning outcomes. The objective of this project was to determine the impact of a mandatory examination peer review process on question accuracy, alignment with learning objectives, use of best practices in question design, and language/grammar.A mandatory peer review process was implemented for all midterm (before phase) and final (after phase) examinations. Peer review occurred by two reviewers and followed a pre-defined guidance document. Non-punitive feedback given to faculty members served as the intervention. Frequencies of flagged questions according to guidance categories were compared between phases.A total of 21 midterm and 21 final exam reviews were included in the analysis. A total of 637 questions were reviewed across all midterms and 1003 questions were reviewed across all finals. Few questions were flagged for accuracy and alignment with learning outcomes. The median total proportion of questions flagged for best practices was significantly lower for final exams versus midterm exams (15.8 vs. 6.45%, p = 0.014). The intervention did not influence language and grammar errors (9.68 vs. 10.0% of questions flagged before and after, respectively, p = 0.305).A non-punitive peer review process for written examinations can overcome pitfalls in exam creation and improve best practices in question writing. The peer-review process had a substantial effect at flagging language/grammar errors but error rate did not differ between midterm and final exams.