Introduction Peer evaluation is the final practical element of TBL that may be used to promote interpersonal and team skills essential for future success. To our knowledge, there is limited information on medical students’ perceptions of peer feedback, both in terms of its value and how it has affected them as they move forward in their careers. In an effort to improve peer feedback implementation and long-term utility, the goal of this study was to gain a deeper understanding of students’ perceptions about the effectiveness of giving and receiving peer feedback. Methods This study utilized an exploratory qualitative research design using focus groups. A total of six focus groups were conducted, each comprised of medical students in their first through fourth years, and medical residents who graduated from the same institution. Discussions were transcribed verbatim and thematic analyses were completed by five independent reviewers. Themes were identified by consensus and any differences were resolved by careful re-reading of the transcripts. Results Four key themes and several interconnected subthemes were identified. Subthemes for the first key theme, preparation and training, included the importance of peer feedback instruction and the clarification of what constructive feedback involves. With the second key theme, procedure and implementation, noteworthy subthemes included providing oral versus written peer feedback and the use of self-reflection. Faculty role modeling was a notable subtheme identified under the third theme, evaluation of student feedback. Significant subthemes for the fourth key theme, student considerations, included student maturity and evolution through medical school as well as the stresses of grading, and anxiety about faculty perceptions. Conclusion Our analysis raised awareness about several potential areas of concern and difficulty for students in regards to the TBL peer feedback process. Quality improvement initiatives may include the addition of self-reflection and use of oral instead of written feedback.