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Abstract

Background

Peer-assisted learning (PAL) has been increasingly adopted in undergraduate medical education as a strategy to enhance the acquisition of clinical skills. Its potential to promote collaborative learning, cost-effectiveness, and professional development makes it an attractive pedagogical approach. However, the evidence surrounding its implementation and outcomes in clinical skills teaching remains scattered.

Methods

We conducted a scoping review following the PRISMA-ScR guidelines to map the extent, range, and nature of the literature on PAL in undergraduate clinical skills education. Relevant studies were identified through searches of PubMed, Scopus, Web of Science, and ERIC from inception to 17 September 2024. Articles were included if they examined PAL interventions involving undergraduate medical students in clinical skills training. Data were extracted on study characteristics, implementation strategies, outcomes, and reported challenges.

Results

A total of 95 studies met the inclusion criteria. PAL was applied across a range of clinical skills including history taking, physical examination, procedural skills, and communication training. Reported benefits included improved student confidence, enhanced skill acquisition, and positive perceptions of peer tutors and learners. Challenges included variability in tutor training, assessment methods, and sustainability of programs. Evidence gaps were noted in long-term outcomes and standardization of evaluation tools.

Conclusions

PAL is a valuable educational approach for teaching clinical skills in undergraduate medical education, with benefits for both tutors and learners. Further research is needed to establish standardized frameworks, assess long-term impact, and guide integration into formal curricula.

Keywords

Peer-assisted learning clinical skills undergraduate medical education scoping review medical curriculum

Introduction

Peer-assisted learning (PAL) has been defined as “people from similar social groupings who are not professional teachers helping each other to learn and learning themselves by teaching”.¹ It is derived from Vygotsky's social constructivist theory of learning which emphasizes that the knowledge synthesized in the mind of the learner interplays with the external community in which the learning process is happening.² Stemming from this theory, the theory of “cognitive congruence” hypothesized that the more the tutors and learners share a common knowledge base, the better the learning outcomes will be.³ Schmidt and Moust expanded the theory by stating that sharing a social role with the learners helps the tutor in the knowledge transfer process, they called this concept “social congruence”.⁴

Since the 1990s, PAL has been incorporated into different teaching activities and disciplines with mostly positive outcomes.⁵ It has demonstrated a number of benefits to student-learners, student-teachers and educational institutions.⁶ Reported benefits for student-learners include increased satisfaction, reduction in anxiety in clinical encounters, more opportunities for learning, more chances for participation in clinical activities, and better development of cognitive and psychomotor skills.⁷ Likewise, student-teachers benefit from PAL. Researchers have identified three reasons why medical students should learn and practice teaching skills.⁸ First, they are the future doctors and faculty members who will teach the new generation. Second, they will be better educators to their patients, which improve doctor–patient relationship and lead to better patient outcomes. Third, they will be able to learn better by understanding the concepts of learning and teaching. To support the last point, evidence has shown that student–teachers gain a lot of pedagogical and professional benefits from being involved in PAL activities.⁹ Such benefits include deeper understanding of the topic being taught,¹⁰ better academic performance,¹¹ increased confidence,⁷ enhanced self-learning skills,¹² and development of leadership qualities.¹³ Teaching institutions stand to benefit from PAL as well. Evidence suggests that PAL can help address the worldwide educator shortage and reduce the teaching load on faculty.⁹ Although important, it is essential not to consider these logistical concerns in isolation from the student-related outcomes of such intervention.⁶

PAL has been analysed in the context of cognitive, psychomotor and affective learning outcomes.⁷ The authors approached this topic from the perspective of educators engaged in undergraduate clinical skills training. One of the author's teaching experience centres on supporting junior students in developing history-taking and physical examination skills, while another author focuses on introducing surgical skills to more senior learners. Through their involvement in these activities, the authors have observed a growing interest in the potential role of PAL within clinical skills education and recognized the need for clearer evidence on how PAL has been structured, delivered, and evaluated across institutions. Thus, the specific focus of this review will be the utilization of PAL in teaching clinical skills, in which psychomotor development is the main measurable outcome.⁵ Evidence indicates that PAL is particularly effective when applied to the teaching of practical skills.¹⁴ The definition of a clinical skill that will be applied in this review is “any action, performed by a healthcare worker involved in direct patient care, which impacts on clinical outcome in a measurable way”.¹⁵ Most published reviews on this topic focused on the outcomes and benefits of PAL.^16–18 However, no identified review discussed the details of PAL-approaches, including their characteristics and the context in which they were applied.

To address this gap in the characterization of PAL-approaches within undergraduate clinical skills education, this scoping review was conducted guided by the methodological framework of Arksey and O’Malley¹⁹ and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.²⁰ In their paper, Arksey and O’Malley have identified four reasons to carry out a scoping review, namely to investigate the extent of research activity in a specific field, to summarize research findings, to analyse the possibility of running a systematic review, and to pinpoint gaps in literature.¹⁹ This review aims to scope the literature for different PAL-approaches in the teaching of clinical skills in undergraduate medical education (UME). The main objectives will be matched to the first two reasons mentioned earlier, specifically to identify the different approaches in which PAL was applied in these studies, and to summarize the characteristics of these PAL-approaches and of the students participating in them.

Methods

This review was conducted as part of a postgraduate Master's programme at the University of Warwick. Academic approval for the study proposal was granted on 16 September 2024. There is no published protocol for this scoping review. As the study involved no interaction with human participants and relied solely on the analysis of previously published literature, it fell under the category of literature-based research. According to the University of Warwick's Research Integrity and Ethics Policy, literature-based studies that do not involve human participants, identifiable personal data, or biological samples do not require formal ethical approval²¹; therefore, no ethical review was sought for this scoping review.

This review followed the PRISMA-ScR guidelines at every stage to ensure the quality of the reported findings.²⁰ Moreover, a full PRISMA-ScR checklist, including section numbers, is attached (Appendix 2).²² It was conducted using the framework developed by Arksey and O’Malley, which has five essential steps (the “optional” sixth step will not be covered due to time constraints).¹⁹ These are:

Step 1 (Identifying the Research Question): the research question was constructed using the Population-Concept-Context (PCC) framework.²³ The question is “how can PAL (concept) be incorporated in the teaching of clinical skills (context) for undergraduate medical students (population)?”.

Step 2 (Identifying relevant studies): the search strategy was developed iteratively by the authors in consultation with an academic librarian experienced in systematic and scoping review methodology. An initial exploratory search of Medline was conducted to identify keywords and index terms commonly used to describe PAL. As no relevant Medical Subject Headings (MeSH) for PAL were identified, the final search strategy relied on a combination of free-text terms and Boolean operators. Table 1 shows the complete Boolean search string used. The same search strategy was adapted in three other databases: Web of Science, Scopus, Education Resources Information Centre (ERIC). All databases were searched from inception to 17 September 2024. The only limit applied was the availability of the full text in English. No filters were applied for study design, publication type, or publication year. All results were extracted to the synthesis review management software Rayyan for duplicate removal and blinded screening.²⁴

Step 3 (Study Selection): First, Rayyan software was used to detect the duplicate articles. All screening was conducted using Rayyan's blinded review and conflict-detection features. Prior to formal screening, both reviewers completed a calibration exercise by jointly reviewing a sample of articles to refine the definitions of the eligibility criteria and ensure consistent application during abstract and full-text screening. Although Rayyan facilitates blinded dual screening, it does not provide a built-in function for calculating Cohen's κ,²⁵ and the pre-resolution decision matrix required for such a calculation was not preserved during conflict resolution. Nonetheless, the review process incorporated two independent reviewers, systematic conflict identification, and resolution by consensus, thereby ensuring a rigorous and reproducible approach to study selection. Table 2 details the Inclusion and exclusion criteria. Only studies published as full-text articles in English were included. This decision was made to ensure adequate methodological detail and feasibility of analysis. Non-English full texts, abstracts without accessible full manuscripts, conference proceedings, theses, and other gray literature were excluded. This decision was made to ensure adequate methodological detail for data extraction and comparability across studies. For the purpose of this review, undergraduate medical students, including those undertaking clinical rotations or designated as “clinical clerks,” were considered eligible. In contrast, studies relying solely on postgraduate trainees or faculty as instructors were excluded from the review. Studies employing blended teaching models (ie students co-teaching with interns, residents, faculty or other experts) were included.

Step 4 (Charting the data): a “data charting form” was used to extract the relevant details from the selected articles.²² Extracted information was divided into three categories: literature, population, and PAL-approach characteristics, including the type of skills being taught. Outcome measures were not extracted or synthesized, as the objective of this scoping review was to map PAL-approach characteristics rather than evaluate intervention effectiveness. MS Excel, version 16.93 (Microsoft Corporation) was used to organize and chart the data.²⁶

Step 5 (Collating, summarising, and reporting results): the extracted data was collated and analysed under each of the three categories. A quantitative summary of important data points is presented in a table format, along with a narrative analysis. Significant findings are discussed further in the “Discussion” section.

Table 1.

Search Strategy.

Databases	Search Date	Search String (Boolean Phrase)	Limits Applied
Medline (via PubMed), Scopus, Web of Science, Education Resources Information Centre (ERIC)	17 Sept 2024	(medical OR preclinical) AND (student* OR undergraduate* OR education)	Full text available in English
		AND
		(“near-peer” OR “peer-assisted” OR “peer-supported” OR “peer-led” OR “peer-to-peer” OR “student-led”) AND (teach* OR learn* OR tutor* OR educat*))
		AND
		(clinical OR practical OR technical OR medical OR surgical OR physical OR communication) AND (skill* OR competenc* OR exam* OR train*)

Table 2.

Inclusion and Exclusion Criteria.

Included	Excluded
Published full-text primary research	Literature synthesis
	Commentaries, editorials, letters to editors
	Gray literature (ie conference abstracts, theses, and unpublished reports)
Full text published in English	Full text not available in English
Population
Undergraduate medical students and clerks	Postgraduate students
	Postgraduate trainees (Residents, Interns)
	Dentistry students
	Allied health professions (eg nurses, physician assistants, physiotherapists)
	Veterinary students
Concept
Peer-assisted learning: a teaching method based on students being involved in the teaching of other students from the same or a different educational level. Blended methods (students and experts, students and residents/interns) are included	Experts (eg faculty, consultants, technicians) teaching students
	Residents teaching students
Context
Teaching clinical skills of any kind	A solely theory-based approach

Results

The process of article search and selection, along with article counts, is detailed in the PRISMA-ScR flowchart (Figure 1).²⁰

Figure 1.

Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) flowchart.

Appendix 1 details all included studies, and the data extracted from them. Table 3 summarizes the publication characteristics of the 95 included studies.

Table 3.

Characteristics of Included Studies.

No	Authors	Year	Country	Data Type	Sample Size
1	Perkins, Hulme and Bion²⁷	2002	United Kingdom	Quantitative	122
2	Nestel and Kidd²⁸	2005	United Kingdom	Both	NS*
3	Glynn et al²⁹	2006	Ireland	Qualitative	14
4	Leeper et al³⁰	2007	United States	Quantitative	92
5	Field et al³¹	2007	United Kingdom	Quantitative	86
6	Burke et al³²	2007	United Kingdom	Quantitative	28
7	Hudson and Tonkin ³³	2008	Australia	Both	131
8	Heckmann et al³⁴	2008	Germany	Quantitative	122
9	Graham, Burke and Field³⁵	2008	United Kingdom	Quantitative	45
10	Nikendei et al³⁶	2009	Germany	Quantitative	168
11	Weyrich et al³⁷	2009	Germany	Quantitative	89
12	Hughes et al³⁸	2010	United Kingdom	Quantitative	NS
13	Perry et al³⁹	2010	United Kingdom	Quantitative	159
14	Raupach et al⁴⁰	2010	Germany	Quantitative	335
15	Knobe et al⁴¹	2010	Germany	Quantitative	151
16	Schauseil-Zipf et al⁴²	2010	Germany	Quantitative	109
17	Fujiwara et al⁴³	2011	Japan	Quantitative	74
18	Graziano⁴⁴	2011	United States	Quantitative	60
19	Knobe et al⁴⁵	2012	Germany	Quantitative	292
20	Silbert and Lake⁴⁶	2012	Australia	Quantitative	321
21	Blank et al⁴⁷	2013	Germany	Quantitative	48
22	Büscher et al⁴⁸	2013	Germany	Quantitative	123
23	Meller et al⁴⁹	2013	United States	Quantitative	24
24	Mutwali and Hassan⁵⁰	2013	Sudan	Quantitative	144
25	Gainor et al⁵¹	2014	United States	Quantitative	98
26	Krautter et al⁵²	2014	Germany	Qualitative	168
27	Grove and Løfgren⁵³	2014	Denmark	Quantitative	146
28	Blohm et al⁵⁴	2014	Germany	Quantitative	135
29	Pean et al⁵⁵	2015	Haiti	Quantitative	115
30	Sarwar and Tarique⁵⁶	2016	Pakistan	Quantitative	152
31	Preece et al⁵⁷	2015	United Kingdom	Quantitative	35
32	Liew et al⁵⁸	2015	Malaysia	Quantitative	985
33	Carr et al⁵⁹	2016	Australia	Both	41
34	Cash et al⁶⁰	2017	United Kingdom	Quantitative	NS
35	Seifert et al⁶¹	2015	Germany	Quantitative	50
36	Lam, Barker and Sepdham⁶²	2016	United States	Quantitative	14
37	Shinnick, Spelke and Martinez⁶³	2016	United States	Quantitative	66
38	Khaw and Raw⁶⁴	2016	Australia	Quantitative	327
39	Shah, Mahboob and Shah⁶⁵	2017	Pakistan	Quantitative	120
40	Flynn et al⁶⁶	2017	United States	Quantitative	46
41	Nomura, Onishi and Kato⁶⁷	2017	Japan	Both	116
42	Keifenheim et al⁶⁸	2017	Germany	Quantitative	42
43	Pelloux et al⁶⁹	2017	France	Quantitative	84
44	Dickerson et al⁷⁰	2017	United Kingdom	Quantitative	102
45	O’Leary et al⁷¹	2018	Canada	NA†	NS
46	Rotzoll et al⁷²	2018	Germany	Quantitative	148
47	Bennett, Morris and Mirza⁷³	2018	United Kingdom	Quantitative	70
48	Abbas et al⁷⁴	2018	Syria	Quantitative	72
49	Naeger et al⁷⁵	2013	United States	Quantitative	119
50	Tamachi et al⁷⁶	2018	United Kingdom	Qualitative	NS
51	Yoong et al⁷⁷	2019	United Kingdom	Quantitative	60
52	Nourkami-Tutdibi et al⁷⁸	2020	Germany	Quantitative	40
53	Gallagher et al⁷⁹	2019	United States	Quantitative	NS
54	Kewcharoen et al⁸⁰	2020	Thailand	Quantitative	80
55	Ong et al⁸¹	2020	Malaysia	Quantitative	35
56	Down et al⁸²	2020	United Kingdom	Quantitative	14
57	Ribeiro et al⁸³	2020	Portugal	Quantitative	104
58	Binkhorst et al⁸⁴	2020	Netherlands	Quantitative	213
59	Kachare et al⁸⁵	2020	United States	Quantitative	103
60	Cremerius et al⁸⁶	2021	Germany	Quantitative	88
61	Schwill et al⁸⁷	2020	Germany	Quantitative	1534
62	Kim et al⁸⁸	2023	United States	Quantitative	46
63	Roehr et al⁸⁹	2021	United States	Quantitative	25
64	Eimer et al⁹⁰	2020	Germany	Quantitative	77
65	Nisar et al⁹¹	2021	Saudi Arabia	Qualitative	22
66	Kumar et al⁹²	2021	United Kingdom	Quantitative	61
67	Pintér et al⁹³	2021	Hungary	Quantitative	60
68	Kronschnabl, Baerwald and Rotzoll⁹⁴	2021	Germany	Quantitative	89
69	Divya et al⁹⁵	2021	India	Quantitative	100
70	George et al⁹⁶	2021	India	Quantitative	57
71	Nourkami-Tutdibi et al⁹⁷	2021	Germany	Quantitative	75
72	Schaffer et al⁹⁸	2021	United Kingdom	Quantitative	31
73	Manolopoulos et al⁹⁹	2022	Cyprus	Quantitative	147
74	Gripay et al¹⁰⁰	2022	France	Quantitative	440
75	Li et al¹⁰¹	2022	United States	Quantitative	24
76	Avonts et al¹⁰²	2022	Belgium	Both	311
77	Rong, Lee and Herbst¹⁰³	2022	United States	Quantitative	73
78	Lu et al¹⁰⁴	2022	United States	Quantitative	21
79	Aydin et al¹⁰⁵	2022	Turkey	Quantitative	159
80	Loda et al¹⁰⁶	2022	Germany	Quantitative	128
81	Bedada et al¹⁰⁷	2022	Botswana	Quantitative	134
82	Spelde A et al¹⁰⁸	2023	United States	Quantitative	NS
83	J. Weimer et al¹⁰⁹	2023	Germany	Quantitative	217
84	Avonts et al¹¹⁰	2023	Belgium	Qualitative	NS
85	Hari, Kälin, et al¹¹¹	2024	Switzerland	Quantitative	152
86	Swallow, Wride and Donroe¹¹²	2023	United States	Both	104
87	Chen et al¹¹³	2023	Hong Kong	Both	24
88	Gillam et al¹¹⁴	2023	United Kingdom	Quantitative	208
89	Johannes Weimer et al¹¹⁵	2023	Germany	Quantitative	888
90	Zhao et al¹¹⁶	2023	United States	Quantitative	47
91	Aquino et al¹¹⁷	2024	United States	Quantitative	60
92	Hari, Caprez, et al¹¹⁸	2024	Switzerland	Quantitative	64
93	Iyer et al¹¹⁹	2024	United Kingdom	Both	90
94	Alt et al¹²⁰	2024	Switzerland	Both	64
95	Abdulrahman, Alkhateeb and Othman¹²¹	2024	Iraq	Quantitative	175

Literature Characteristics (Publication Trends)

The characteristics of the included literature, including publication year, geographic distribution, study design, and sample sizes, are summarized below. Publication dates for the included studies ranged from 2002 to August 2024. Only one study was published in each of the years 2002, 2005, and 2006 (3/95, 3.2%). After 2006, the number of publications increased steadily, reaching a peak of 11 studies in 2020 (11/95, 11.6%). A subsequent decline was observed in the following years, with 8 studies in 2021 (8/95, 8.4%), 9 in 2022 (9/95, 9.5%), and 9 in 2023 (9/95, 9.5%).

The three countries contributing the largest number of publications were Germany (23/95, 24.2%), the United States (19/95, 20%), and the United Kingdom (18/95, 18.9%). The remaining 24 countries each contributed four or fewer studies. Figure 2 summarizes the geographic distribution of studies by World Health Organization (WHO) region.¹²² The European region accounted for the largest proportion of publications (55/95, 57.9%), driven predominantly by contributions from Germany and the United Kingdom, followed by the Region of the Americas (21/95, 22.1%). The Western Pacific, Eastern Mediterranean, South-East Asia, and African regions contributed 9 (9/95, 9.5%), 6 (6/95, 6.3%), 3 (3/95, 3.2%), and 1 (1/95, 1.1%) study, respectively. These figures reflect the country in which the PAL intervention was conducted rather than the location of the publishing journal.

Figure 2.

Geographic distribution of studies by World Health Organization (WHO) region.

Table 4 provides an overview of the data types reported and the range of sample sizes used across the included studies. Most studies collected quantitative data (80/95, 84.2%), while only five studies (5/95, 5.3%) used a qualitative design. Nine studies employed mixed-methods approaches (9/95, 9.5%), and one study did not report collecting either qualitative or quantitative data (1/95, 1.1%). Sample sizes varied widely, with the largest cohort including 1534 participants across a five-year period.⁸⁷ The smallest sample size in a quantitative study was 14 participants.^62,82 Among studies collecting quantitative data, the median sample size was 91. Of the five qualitative-only studies, three reported their sample sizes: 16, 22, and 168.^29,52,91 In eight studies, sample size was not specified (8/95, 8.4%). Together, these patterns demonstrate a progressively increasing research interest in PAL for clinical skills training, with notable geographic and methodological clustering across the literature.

Table 4.

Literature Characteristics.

Data Type	Studies	Sample Size	Studies
Both	9	<50	21
Qualitative	5	50 - < 100	25
Quantitative	80	100 - < 150	21
Not applicable	1	>150	20
		Not Specified	8

Population Characteristics

The demographic and academic characteristics of the participating students, as well as the structure of peer- and near-peer tutor involvement, are detailed in this subsection. Near-peer assisted learning, in which senior students teach more junior learners,¹²³ was the most common approach and was used in 56 of the included studies (56/95, 58.9%). Approaches in which tutors and learners were at the same academic level were reported in 15 studies (15/95, 15.8%), while 10 studies (10/95, 10.5%) used both models concurrently. Reciprocal PAL, where students alternate between tutor and learner roles,⁹ was used in two studies (2/95, 2.1%).

Across the studies that reported tutor and learner levels, student-tutors were drawn from the three senior years of medical school (years 4-6) in 89 studies, while student-learners came from the three junior years (years 1-3) in 27 studies. These counts are not mutually exclusive, as several studies included students from more than one academic level. Figure 3 illustrates the distribution of participating students by undergraduate year, acknowledging that individual studies may contribute data to multiple levels. The specific difference in seniority between tutors and learners could be calculated in 18 studies (18/95, 18.9%). Among these 18 studies, the tutor–learner gap was one year in 10 studies (10/18, 55.6%), two years in five studies (5/18, 27.8%), three years in two studies (2/18, 11.1%), and four years in one study (1/18, 5.6%). In the remaining studies, the difference could not be determined because authors either did not specify learner levels or reported broad ranges.

Figure 3.

Distribution of participating students by undergraduate class (learners vs tutors).

The number of student-tutors involved in the PAL intervention was not specified in 28 studies. A comparable number of studies also did not report how tutors were selected for participation. Among the studies that did specify the number of student-tutors (67/95, 70.5%), 25 studies (25/67, 37.3%) involved five tutors or fewer, while 15 studies (15/67, 22.4%) reported more than 15 tutors. The largest number of peer-tutors in a single study was 78,¹⁰² whereas the smallest was one tutor,^62,94 With respect to tutor recruitment, 30 studies (30/95, 31.6%) selected or invited tutors to participate, whereas 35 studies (35/95, 36.8%) relied on volunteer participation. Two PAL programs were delivered as part of elective modules; one within a Medical Education elective and the other within a musculoskeletal system PAL module.^32,51 Table 5 summarizes the distribution of tutor types, the number of student-tutors involved, and the methods by which tutors were selected across the included studies. Overall, the included studies reveal considerable variation in learner levels, tutor seniority, and tutor recruitment methods, underscoring the heterogeneity of PAL implementation across institutions.

Table 5.

Population Characteristics (Student-Tutors).

Tutor Type	Studies	No. of Tutors	Studies	Tutor Selection	Studies
Near-peers	56	1–5	25	Volunteering	35
Peers	15	6–10	10	Selection / Invitation	30
Both	10	11–15	17	Elective module	2
Not Specified	14	16–20	5	Not Specified	28
		21–30	5
		>30	5
		Not Specified	28

PAL-Approach Characteristics

Variation in the design and delivery of PAL interventions is described below, including tutor training, program structure, comparison groups, group sizes, and assessment methods. In 38 studies, the analysed PAL intervention represented a subset of a larger, ongoing PAL program (38/95, 40%), whereas more than half of the studies (54/95, 56.8%) evaluated the full program. This information was unclear in three studies (3/95, 3.2%). Regarding tutor preparation, 31 studies (31/95, 32.6%) trained student-tutors exclusively in the clinical skills to be taught, while 13 studies (13/95, 13.7%) provided only pedagogical training. The majority of studies trained tutors in both domains (34/95, 35.8%). Only one study reported that no training was provided (1/95, 1.1%),⁸⁰ and 16 studies (16/95, 16.8%) did not specify the training approach.

Among the studies that used a controlled trial design (51/95, 53.7%), 36 trials (36/51, 70.6%) compared PAL to an expert-led teaching arm. The remaining controlled studies compared PAL to no additional intervention (8/51, 15.7%) or to alternative educational methods such as team-based learning (TBL) or virtual reality instruction.^86,89 Only five studies (5/95, 5.3%) compared different PAL-approach characteristics, including intervention duration,^97,115 delivery modality (online vs in-person PAL),^116,119 and learner level (pre-clinical vs clinical students).⁹⁸

Only a small subset of the included studies incorporated online, hybrid, or tele-enabled formats within their PAL interventions. Four studies explicitly reported technology-mediated delivery methods: one used tele-ultrasound as the primary instructional modality,¹²⁴ one implemented an online performance-scoring system within a near-peer basic life support program,¹¹⁴ one described a physical examination course combining in-person and remote components,¹¹² and the fourth compared online and in-person near-peer surgical teaching during the COVID-19 pandemic.¹¹⁹ These technology-supported approaches were exceptions within the broader dataset, in which the majority of PAL interventions were conducted entirely face to face.

Outcome evaluation methods varied across studies: 31 studies used surveys alone (31/95, 32.6%), 19 used student assessments alone (19/95, 20.0%), and 39 used a combination of both (39/95, 41.1%). Six studies (6/95, 6.3%) did not use either method. Of these six, five collected qualitative data through focus groups,^52,91 semi-structured interviews,^76,110 or both.²⁹ One study described the program without collecting empirical data.⁷¹

The number of sessions used to teach these skills also varied. Twenty-seven studies included only one session (27/95, 28.4%), while 19 studies reported “multiple” sessions without specifying the exact number (19/95, 20%). Among the 74 single-skill-group studies (see below), 26 (26/74, 35.1%) used a single session and 33 (33/74, 44.6%) used between two and nine sessions. None of the studies addressing three or four skill groups delivered them within a single session. The largest number of sessions reported in a single study was 21 one-hour sessions over four months, covering a single skill group.¹¹¹ The number of sessions was not specified in four studies (4/95, 4.2%).

Among the studies that reported student group size (69/95, 72.6%), most interventions (54/69, 78.3%) involved groups of no more than ten students. In contrast, two studies, both describing the same PAL program, reported group sizes as large as 50 students.^102,110 Table 6 summarizes key PAL-approach characteristics, including tutor training methods, comparator groups used in controlled studies, and the distribution of skill-group numbers and session structures across the included programs. These findings highlight substantial diversity in the design, duration, comparator groups, and assessment strategies of PAL interventions, reflecting the absence of a standardized approach in current practice.

Table 6.

PAL-Approach Characteristics.

Tutor Training	Studies	Second Arm of the Study	Studies*
Clinical skills	31	Not applicable	45
Pedagogical principles	13	Expert educators	36
Both types of training	34	No intervention	8
No training	1	Different Peer-Assisted Learning (PAL) characteristics (duration, method of delivery, students’ level)	5
Not specified	16	Other teaching methods (Team-Based Learning (TBL), virtual reality)	2

Number of skill groups	Studies	Number of sessions	Studies
1	74	1	27
2	11	2–5	30
3	5	6–21	15
4	4	Multiple (exact number not mentioned)	19
Not specified	1	Not specified	4

* The total here is 96. One study compared PAL to both expert-led teaching and team-based learning (TBL)⁸⁶

Skills Taught

The types of skills taught across the included studies varied considerably but were collated into nine categories, hereafter referred to as “skill groups”. An overview of these skill groups, along with their relative frequencies, is presented in Table 7. The most prevalent skill group was physical examination, represented in 37 of 92 programs that specified the skill taught (37/92, 40.2%). The remaining eight groups, in descending order of frequency, were surgical skills (19/92, 20.7%), ultrasound skills (17/92, 18.5%), procedural skills (16/92, 17.4%), history-taking skills (14/92, 15.2%), cardiopulmonary resuscitation skills (12/92, 13.0%), interpretation skills (6/92, 6.5%), communication skills (5/92, 5.4%), and spinal manipulative therapy (1/92, 1.1%).

Table 7.

Skill Groups, Number of Studies and Examples of Included Skills.

Skill Group	Studies	Example of Included Skills
Physical examination	37	Vital signs, including blood pressure measurement
		Focused examination
		Neonatal and paediatric examination
History taking (HT)	14	Focused-history taking (including system-oriented, sexual and psychosocial history)
Communication skills	5	Basic patient-interviewing skills
Communication skills	5	Patient-centred interviewing
Procedural skills	16	Venipuncture
		Cannulation
		Arterial blood collection
		Injections (intramuscular and subcutaneous)
		Urethral catheterization
		Lumbar puncture
		Intubation
		Splinting
		Nasogastric tube insertion
Surgical skills	19	Scrubbing-in, gowning and gloving
		Handling of surgical instruments
		Suturing and knot-tying skills
		Basic laparoscopy skills
Ultrasound skills	17	Point-of-Care Ultrasound (POCUS)
		Focused ultrasonography (eg abdominal, thoracic, musculoskeletal, …)
		Echocardiography
		Optic nerve sheath diameter (ONSD) measurement
		Abdominal aortic aneurysm (AAA) screening
Interpretation skills	6	ECG interpretation
Interpretation skills	6	CXR interpretation
Cardiopulmonary Resuscitation (CPR)	12	Basic Life Support (BLS) and defibrillator use
Cardiopulmonary Resuscitation (CPR)	12	Advanced Cardiac Life Support (ACLS)
Spinal manipulative therapy	1	Bimanual practical and diagnostic skills

Most studies incorporated only a single skill group, with 74 of 95 studies (74/95, 77.9%) focusing on one domain. Eleven studies addressed two skill groups (11/95, 11.6%), five addressed three groups (5/95, 5.3%), and four studies addressed four groups (4/95, 4.2%). One study referred broadly to “clinical skills” without specifying the exact skill taught.⁵⁶ The distribution of skill groups indicates that PAL is most frequently applied to physical examination and procedural domains, while more specialized or interpretive skills are represented less consistently.

Missing Information

Across the included studies, several key variables were incompletely reported. The number of student-tutors involved in the PAL intervention was not specified in 28 studies (28/95, 29.5%), while tutor recruitment or selection procedures were also unreported in 28 studies (28/95, 29.5%). Tutor training methods were not described in 16 studies (16/95, 16.8%). Sample size was not reported in eight studies (8/95, 8.4%), and the number of skill groups taught was unspecified in one study (1/95, 1.1%). The academic level of tutors or learners could not be determined in a substantial proportion of studies because authors either did not specify these details or reported broad ranges. With respect to intervention characteristics, the number of teaching sessions was not reported in four studies (4/95, 4.2%), and group size was not specified in 26 studies (26/95, 27.4%). These patterns of missing information underscore the variability in reporting PAL-program characteristics and highlight the need for more standardized and comprehensive reporting frameworks.

Discussion

Literature Characteristics

The limited number of qualitative studies suggests that many researchers in this area may be more comfortable collecting and analysing quantitative, ‘objective’ data than engaging with qualitative methods.¹²⁵ It may also reflect the lack of experience of most medical education researchers in the qualitative research methodology.¹²⁶ Nonetheless, this methodology is essential in providing us with deeper understanding of how, and why, different teaching approaches, including PAL, affect learners.¹²⁷ For example, the five studies included in this review that followed a qualitative methodology have provided more insight into the challenges facing the adoption of an online PAL-program,⁹¹ the experience of students with PAL,^52,76 the processes at work within a PAL program,²⁹ and the impact of PAL on student-tutors.¹¹⁰

Population Characteristics

The findings of this review demonstrate that the near-peer approach is the most commonly used method among researchers. It has been suggest that PAL works best when the student-tutors have an experience advantage over their colleagues.¹²³ The experience difference between learners and tutors is called the “educational distance” or “cognitive distance”, and there is still no consensus among researchers on the distance that yields the best educational outcomes.¹²⁸

Tutor recruitment is an essential aspect of any PAL program.⁹ In most of the included studies, tutor participation was voluntary. This was true whether the tutors were selected by the faculty, answered a volunteering call, or volunteered in their own right. Ethical considerations may have played a role, but one always has to be aware of the risk of “self-selection” bias when generalizing the outcomes of these interventions.⁵ Some programs were initiated, organized, and carried out by students themselves, with appropriate faculty supervision.^30,55,72

PAL-Approach Characteristics

This scoping review did not report on the outcomes of PAL interventions, nor did it perform any formal appraisal. Nonetheless, the synthesized findings suggest that several methodological issues should be considered when interpreting the existing effectiveness literature. Firstly, the context and specifics of the PAL-approaches varied greatly among the included articles. Previous literature-synthesis projects done in this topic have reported a similar observation.^5,18 Such heterogenicity has previously prevented researchers from systematically pooling the results of different studies to do a metanalysis.⁷ Secondly, the results of the studies analyzing a fraction of a larger program may not reflect the outcomes of the whole PAL-intervention. Program evaluation theories state that the “educational context” in which an educational intervention is applied has a direct impact on the evaluation results.¹²⁹ This indicates that selecting a different part of the program may have led to different reported outcomes. A third reason is the fact that some authors used subjective self-assessment questionnaires without the utilization of an objective assessment method. Subjective methods of evaluation do not always correlate with the results of objective assessment,⁵ and may lead to misleading conclusions regarding the efficacy of the intervention.

Providing student-tutors with formal pedagogical training is essential to ensure effective peer-assisted instruction.¹³⁰ In most medical education institutions, students receive no formal training in educational theory and methods, and may feel overwhelmed once they adopt the tutor role.¹²³ In the studies that provided aforesaid training, the selected topics varied. Examples included theoretical topics, such as adult learning principles,¹⁰⁸ small-group theory,³¹ and theories of skill-teaching.⁵⁰ Nonetheless, most authors chose to provide a more practical training, examples included teaching strategies,⁹² small-group work,²⁹ giving constructive feedback,^59,67,102 planning an educational intervention,⁴⁶ and learner assessment.¹¹⁴ Some interventions were part of a medical education elective, in which students spent several weeks learning about, and practicing, medical education.^44,51,64

In theory, PAL-interventions are more suited to the teaching of clinical skills than factual skills.⁹ Acquiring and improving such skills require a small-group setting, where learners get the chance to discuss, watch and practice the skills in a controlled setting.¹⁸ Bulte et al concluded that evidence supporting PAL in small-group settings is stronger than that available for other teaching formats.¹²³ The findings of this review show that most researchers opted for the small group setting in their interventions. However, the exact numerical cut-off point that separates a small-group from a large-group has long been debated among medical education scholars,¹³¹ with some even suggesting that small group-setting is rather a set of principles and skills that lead to a more useful communication between tutors and learners.¹³² In the studies that followed an educational trial methodology, the majority compared PAL to expert-led teaching or to no-intervention at all. Only one study compared the effectiveness of PAL to another similar small group setting intervention (ie TBL). More well-designed trials are needed to compare PAL to other such interventions like problem-based learning (PBL) and simulation-based learning.

Only a small number of studies used online or hybrid formats for PAL. These included tele-ultrasound teaching, an online performance-scoring system, and programs that delivered some sessions remotely. Because these studies were few and varied in their design, no firm observations can be made about how online PAL compares with in-person delivery. Most PAL programs in the literature continue to be delivered face to face, which likely reflects the practical, hands-on nature of clinical skills teaching. Further work is needed to better understand when online or hybrid PAL approaches are feasible and how they might complement traditional in-person sessions.

Limitations and Recommendations

This review did not report outcomes because its scope was limited to mapping PAL approaches and their contextual characteristics rather than evaluating intervention effectiveness. Given the marked heterogeneity and inconsistent reporting of outcomes across the included studies, neither a descriptive synthesis nor a critical appraisal would have been methodologically appropriate. Accordingly, the review focuses solely on the structure and implementation features of PAL interventions. Additionally, with the large number of studies fulfilling the inclusion criteria, the choice was made not to analyse some important data points, including the aims and objectives of the included studies. Other data points may also have benefited from deeper analysis, including PAL-tutors selection and training process, the role of the PAL intervention within the larger curriculum, and the descriptions of the sessions. Furthermore, the search methodology did not include any unpublished studies or gray literature. These decisions were made in response to time and manpower constraints. Hopefully, this paper will instigate more literature synthesis projects in this important field of medical education.

The findings of this review outline how PAL is currently being used to support clinical skills teaching and highlight the wide variation in how programs are designed and implemented. These observations may help curriculum planners identify which elements of PAL are most relevant to their own settings, such as tutor level, the type of skills taught, and the structure of training or sessions. The mapping also shows areas where reporting is inconsistent, which limits comparison across institutions. Other researchers reviewing the literature on PAL have come to the same conclusion.⁵ Together, these points indicate that PAL continues to be a flexible and commonly used approach in clinical skills education, but one that would benefit from more standardized reporting and purposeful integration into medical curricula.

Ross and Cameron proposed a 24-item framework to guide the planning and implementation of PAL interventions,⁹ and a reporting checklist adapted from this framework is provided in Appendix 3 to support clearer and more consistent descriptions of PAL activities. In addition, a taxonomy summarizing the core components of PAL interventions has been developed based on the findings of this scoping review. Together, these tools can improve reporting transparency and facilitate more robust data synthesis and analysis in future reviews.

Conclusion

This scoping review mapped how PAL has been used to support clinical skills teaching in undergraduate medical education. The findings show considerable variation in how programs are designed, particularly in tutor level, tutor preparation, group size, and the number of sessions delivered. Most programs used small-group formats with tutor-to-learner ratios commonly ranging between 1:5 and 1:10, and tutor preparation usually consisted of brief orientations covering both the skills to be taught and basic teaching principles. Assessment methods varied across studies, with written surveys and practical skills assessments used most frequently.

Reporting practices differed widely, making comparison across studies difficult. Clearer documentation of key components would support more consistent reporting and allow educators to better understand how PAL is implemented. A unified reporting framework would be beneficial, and a draft checklist has been included in Appendix 3 to guide future descriptions of PAL activities. In addition, more qualitative research is needed to explore how tutors and learners experience PAL and to identify the contextual factors that influence its applicability in different settings. Overall, PAL remains a flexible approach for teaching clinical skills, and its integration into curricula can be strengthened through clearer reporting and deliberate planning of core program elements. By clarifying how PAL has been structured and reported, this review provides a basis for educators to design more coherent PAL programmes and for researchers to undertake future comparative and outcome-focused studies.

Supplemental Material

sj-docx-1-mde-10.1177_23821205261422892 - Supplemental material for The Use of Peer-Assisted Learning in Teaching Clinical Skills in Undergraduate Medical Education: A Scoping Review

Supplemental material, sj-docx-1-mde-10.1177_23821205261422892 for The Use of Peer-Assisted Learning in Teaching Clinical Skills in Undergraduate Medical Education: A Scoping Review by Suhaib Mohamed Moamen, Abdulla Ismaeel Mohamed and Lynette Van Der Merwe in Journal of Medical Education and Curricular Development

Supplemental Material

sj-docx-2-mde-10.1177_23821205261422892 - Supplemental material for The Use of Peer-Assisted Learning in Teaching Clinical Skills in Undergraduate Medical Education: A Scoping Review

Supplemental material, sj-docx-2-mde-10.1177_23821205261422892 for The Use of Peer-Assisted Learning in Teaching Clinical Skills in Undergraduate Medical Education: A Scoping Review by Suhaib Mohamed Moamen, Abdulla Ismaeel Mohamed and Lynette Van Der Merwe in Journal of Medical Education and Curricular Development

Supplemental Material

sj-docx-3-mde-10.1177_23821205261422892 - Supplemental material for The Use of Peer-Assisted Learning in Teaching Clinical Skills in Undergraduate Medical Education: A Scoping Review

Supplemental material, sj-docx-3-mde-10.1177_23821205261422892 for The Use of Peer-Assisted Learning in Teaching Clinical Skills in Undergraduate Medical Education: A Scoping Review by Suhaib Mohamed Moamen, Abdulla Ismaeel Mohamed and Lynette Van Der Merwe in Journal of Medical Education and Curricular Development

Footnotes

ORCID iD

Suhaib Mohamed Moamen

Ethics Approval

Academic approval for the study proposal was granted on 16 September 2024. No human participants were directly involved.

Author Contributions

Conceptualization: Suhaib Mohamed Moamen

Methodology: Suhaib Mohamed Moamen, Abdulla Ismaeel Mohamed

Data Curation: Suhaib Mohamed Moamen, Abdulla Ismaeel Mohamed

Writing – Original Draft: Suhaib Mohamed Moamen

Writing – Review & Editing: Suhaib Mohamed Moamen, Abdulla Ismaeel Mohamed, Lynette Van Der Merwe

Supervision: Lynette Van Der Merwe

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Funding

No funding was obtained for this project.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

References

Topping

. The effectiveness of peer tutoring in further and higher education: a typology and review of the literature. High Educ. 1996;32(3):321–345.

Vygotsky

LS.

Mind in Society: The Development of Higher Psychological Processes. Vol 86. Harvard University Press; 1978.

Cornwall

Students as teachers: peer teaching in higher education. Published online 1979.

Schmidt

Moust

JH.

What makes a tutor effective? A structural equations modelling approach to learning in problem-based curricula. Published online 1995.

Wilson

Singh

Lemanu

Hawken

Hill

. Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school. Adv Med Educ Pract. 2011;2:157–172.

Burgess

Van Diggele

Roberts

Mellis

. Feedback in the clinical setting. BMC Med Educ. 2020;20(S2):460. doi:10.1186/s12909-020-02280-5

Secomb

. A systematic review of peer teaching and learning in clinical education. J Clin Nurs. 2008;17(6):703–716.

Dandavino

Snell

Wiseman

. Why medical students should learn how to teach. Med Teach. 2007;29(6):558–565.

Ross

Cameron

. Peer assisted learning: a planning and implementation framework: AMEE guide No. 30. Med Teach. 2007;29(6):527–545. doi:10.1080/01421590701665886

10.

Krych

March

Bryan

Peake

Pawlina

Carmichael

. Reciprocal peer teaching: students teaching students in the gross anatomy laboratory. Clin Anat. 2005;18(4):296–301.

11.

Cohen

Kulik

CLC

. Educational outcomes of tutoring: a meta-analysis of findings. Am Educ Res J. 1982;19(2):237–248.

12.

Burgess

Clark

Chapman

Mellis

. Senior medical students as peer examiners in an OSCE. Med Teach. 2013;35(1):58–62.

13.

Weyrich

Schrauth

Kraus

, et al. Undergraduate technical skills training guided by student tutors – analysis of tutors’ attitudes, tutees’ acceptance and learning progress in an innovative teaching model. BMC Med Educ. 2008;8(18):1–9.

14.

Williams

Reddy

. Does peer-assisted learning improve academic performance? A scoping review. Nurse Educ Today. 2016;42:23–29.

15.

Tolsgaard

. Clinical skills training in undergraduate medical education using a student-centered approach. Dan Med J. 2013;60(8):B4690.

16.

Tai

Molloy

Haines

Canny

. Same-level peer-assisted learning in medical clinical placements: a narrative systematic review. Med Educ. 2016;50(4):469–484. doi:10.1111/medu.12898

17.

Gelis

Cervello

Rey

, et al. Peer role-play for training communication skills in medical students: a systematic review. Simul Healthc. 2020;15(2):106–111. doi:10.1097/SIH.0000000000000412

18.

Brierley

Ellis

Reid

. Peer-assisted learning in medical education: a systematic review and meta-analysis. Med Educ. 2022;56(4):365–373. doi:10.1111/medu.14672

19.

Arksey

O’Malley

Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.

20.

Tricco

Lillie

Zarin

, et al. PRISMA Extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–473. doi:10.7326/M18-0850

21.

University of Warwick. Research Integrity and Ethics: Ethical Approval Guidance. University of Warwick; 2024. https://warwick.ac.uk/services/ris/research-integrity/ethical-approval/

22.

Pollock

Peters

MDJ

Khalil

, et al. Recommendations for the extraction, analysis, and presentation of results in scoping reviews. JBI Evid Synth. 2023;21(3):520–532. doi:10.11124/JBIES-22-00123

23.

Peters

Godfrey

Khalil

McInerney

Parker

Soares

. Guidance for conducting systematic scoping reviews. JBI Evid Implement. 2015;13(3):141–146.

24.

Ouzzani

Hammady

Fedorowicz

Elmagarmid

. Rayyan – a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. doi:10.1186/s13643-016-0384-4

25.

Cohen

. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20(1):37–46.

26.

Microsoft Corporation. Microsoft Excel for Mac, version 16.93 [computer program]. Microsoft Corporation; 2025.

27.

Perkins

Hulme

Bion

. Peer-led resuscitation training for healthcare students: a randomised controlled study. Intensive Care Med. 2002;28(6):698–700. doi:10.1007/s00134-002-1291-9

28.

Nestel

Kidd

. Peer assisted learning in patient-centred interviewing: the impact on student tutors. Med Teach. 2005;27(5):439–444. doi:10.1080/01421590500086813

29.

Glynn

MacFarlane

Kelly

Cantillon

Murphy

. Helping each other to learn – a process evaluation of peer assisted learning. BMC Med Educ. 2006;6(18). doi:10.1186/1472-6920-6-18

30.

Leeper

Chang

Cotter

, et al. A student-designed and student-led sexual-history-taking module for second-year medical students. Teach Learn Med. 2007;19(3):293–301. doi:10.1080/10401330701366770

31.

Field

Burke

McAllister

Lloyd

. Peer-assisted learning: a novel approach to clinical skills learning for medical students. Med Educ. 2007;41(4):411–418. doi:10.1111/j.1365-2929.2007.02713.x

32.

Burke

Fayaz

Graham

Matthew

Field

. Peer-assisted learning in the acquisition of clinical skills: a supplementary approach to musculoskeletal system training. Med Teach. 2007;29(6):577–582. doi:10.1080/01421590701469867

33.

Hudson

Tonkin

. Clinical skills education: outcomes of relationships between junior medical students, senior peers and simulated patients. Med Educ. 2008;42(9):901–908. doi:10.1111/j.1365-2923.2008.03107.x

34.

Heckmann

Dütsch

Rauch

Lang

Weih

Schwab

. Effects of peer-assisted training during the neurology clerkship: a randomized controlled study. Eur J Neurol. 2008;15(12):1365–1370. doi:10.1111/j.1468-1331.2008.02317.x

35.

Graham

Burke

Field

. Undergraduate rheumatology: can peer-assisted learning by medical students deliver equivalent training to that provided by specialist staff?. Rheumatology (Oxford). 2008;47(5):652–655. doi:10.1093/rheumatology/ken048

36.

Nikendei

Andreesen

Hoffmann

Jünger

. Cross-year peer tutoring on internal medicine wards: effects on self-assessed clinical competencies – a group control design study. Med Teach. 2009;31(2):32–35. doi:10.1080/01421590802464452

37.

Weyrich

Celebi

Schrauth

Möltner

Lammerding-Köppel

Nikendei

. Peer-assisted versus faculty staff-led skills laboratory training: a randomised controlled trial. Med Educ. 2009;43(2):113–120. doi:10.1111/j.1365-2923.2008.03252.x

38.

Hughes

Jiwaji

Lally

, et al. Advanced cardiac resuscitation evaluation (ACRE): a randomised single-blind controlled trial of peer-led vs expert-led advanced resuscitation training. Scand J Trauma Resusc Emerg Med. 2010;18(3). doi:10.1186/1757-7241-18-3

39.

Perry

Burke

Friel

Field

. Can training in musculoskeletal examination skills be effectively delivered by undergraduate students as part of the standard curriculum?. Rheumatology (Oxford). 2010;49(9):1756–1761. doi:10.1093/rheumatology/keq166

40.

Raupach

Hanneforth

Anders

Pukrop

ten Cate

Harendza

. Impact of teaching and assessment format on electrocardiogram interpretation skills. Med Educ. 2010;44(7):731–740. doi:10.1111/j.1365-2923.2010.03687.x

41.

Knobe

Münker

Sellei

, et al. Peer teaching: a randomised controlled trial using student-teachers to teach musculoskeletal ultrasound. Med Educ. 2010;44(2):148–155. doi:10.1111/j.1365-2923.2009.03557.x

42.

Schauseil-Zipf

Karay

Ehrlich

Knoop

Michalk

. Peer teaching in paediatrics – medical students as learners and teachers on a paediatric course. GMS Z Med Ausbild. 2010;27(5):Doc71. doi:10.3205/zma000708

43.

Fujiwara

Nishimura

Honda

, et al. Comparison of peer-led versus professional-led training in basic life support for medical students. Adv Med Educ Pract. 2011;2:187–191. doi:10.2147/AMEP.S22948

44.

Graziano

. Randomized surgical training for medical students: resident versus peer-led teaching. Am J Obstet Gynecol. 2011;204(6):542.e1–542.e4. doi:10.1016/j.ajog.2011.01.038

45.

Knobe

Holschen

Mooij

, et al. Knowledge transfer of spinal manipulation skills by student-teachers: a randomised controlled trial. Eur Spine J. 2012;21(5):992–998. doi:10.1007/s00586-011-2140-8

46.

Silbert

Lake

. Peer-assisted learning in teaching clinical examination to junior medical students. Med Teach. 2012;34(5):392–397. doi:10.3109/0142159X.2012.668240

47.

Blank

Blankenfeld

Vogelmann

Linde

Schneider

. Can near-peer medical students effectively teach a new curriculum in physical examination? BMC Med Educ. 2013;13(1):165. doi:10.1186/1472-6920-13-165

48.

Büscher

Weber

Büscher

, et al. Evaluation of the peer teaching program at the university children’s hospital essen – a single center experience. GMS Z Med Ausbild. 2013;30(2):Doc25. doi:10.3205/zma000868

49.

Meller

Chen

Haeseler

. Near-peer teaching in a required third-year clerkship. Yale J Biol Med. 2013;86(4):583–589.

50.

Mutwali

Hassan

. Skills training of junior medical students: can peer teaching be the solution? Afr J Health Prof Educ. 2013;5(2):84–87. doi:10.7196/AJHPE.235

51.

Gainor

Patel

George

MacNamara

Dollase

Taylor

. An intensive medical education elective for senior medical students. R I Med J. (2013). 2014;97(7):40–44.

52.

Krautter

Andreesen

Köhl-Hackert

Hoffmann

Herzog

Nikendei

. Cross-year peer tutoring on internal medicine wards: results of a qualitative focus group analysis. Adv Med Educ Pract. 2014;5:323–330. doi:10.2147/AMEP.S65479

53.

Grove

Løfgren

. Successful implementation of the European resuscitation council basic life support course as mandatory peer-led training for medical students. Eur J Emerg Med. 2014;21(2):142–144. doi:10.1097/MEJ.0b013e328360a0f4

54.

Blohm

Krautter

Lauter

, et al. Voluntary undergraduate technical skills training course to prepare students for clerkship assignment: tutees’ and tutors’ perspectives. BMC Med Educ. 2014;14(1):71. doi:10.1186/1472-6920-14-71

55.

Pean

Davis

Merrill

, et al. Near-peer emergency medicine for medical students in Port-au-Prince, Haiti: an example of rethinking global health interventions in developing countries. Ann Glob Health. 2015;81(2):276–282. doi:10.1016/j.aogh.2015.03.002

56.

Sarwar

Tarique

. Peer-assisted learning: who should be the tutor, fellow student or senior resident? J Coll Physicians Surg Pak. 2016;26(7):573–576.

57.

Preece

Dickinson

Sherif

, et al. Peer-assisted teaching of basic surgical skills. Med Educ Online. 2015;20(1):27579. doi:10.3402/meo.v20.27579

58.

Liew

Sow

Sidhu

Nadarajah

. The near-peer tutoring programme: embracing the “doctors-to-teach” philosophy – a comparison of the effects of participation between the senior and junior near-peer tutors. Med Educ Online. 2015;20(1):27959. doi:10.3402/meo.v20.27959

59.

Carr

Brand

Wei

, et al. Helping someone with a skill sharpens it in your own mind: a mixed method study exploring health professions students’ experiences of peer assisted learning (PAL). BMC Med Educ. 2016;16(1):48. doi:10.1186/s12909-016-0566-8

60.

Cash

Brand

Wong

Richardson

Athorn

Chowdhury

. Near-peer medical student simulation training. Clin Teach. 2017;14(3):175–179. doi:10.1111/tct.12558

61.

Seifert

Schaack

Jennewein

, et al. Peer-assisted learning in a student-run free clinic project increases clinical competence. Med Teach. 2015;38(5):515–522. doi:10.3109/0142159X.2015.1105940

62.

Lam

Barker

Sepdham

. Senior medical student-led interactive small-group module on acute fracture management. MedEdPORTAL. 2016;12:10463. doi:10.15766/mep_2374-8265.10463

63.

Shinnick

Spelke

Martinez

. Student-led training day increases student confidence in women’s primary care skills. Fam Med. 2016;48(7):551–555.

64.

Khaw

Raw

. The outcomes and acceptability of near-peer teaching among medical students in clinical skills. Int J Med Educ. 2016;7:188–194. doi:10.5116/ijme.5749.7b8b

65.

Shah

Mahboob

Shah

. Effectiveness of horizontal peer-assisted learning in physical examination performance. J Ayub Med Coll Abbottabad. 2017;29(4):559–565.

66.

Flynn

Williams

Colgan

Southall

Lewin

. Improving medical student confidence in clinical skills through a peer-facilitated workshop. Med Sci Educ. 2017;27(4):701–706. doi:10.1007/s40670-017-0465-6

67.

Nomura

Onishi

Kato

. Medical students can teach communication skills – a mixed methods study of cross-year peer tutoring. BMC Med Educ. 2017;17(1):103. doi:10.1186/s12909-017-0939-7

68.

Keifenheim

Petzold

Junne

, et al. Peer-assisted history-taking groups: a subjective assessment of their impact upon medical students’ interview skills. GMS J Med Educ. 2017;34(3):Doc35. doi:10.3205/zma001112

69.

Pelloux

Gregoire

Kirmizigul

, et al. Peripheral venous catheter insertion simulation training: a randomized controlled trial comparing performance after instructor-led teaching versus peer-assisted learning. Anaesth Crit Care Pain Med. 2017;36(6):397–402. doi:10.1016/j.accpm.2016.11.007

70.

Dickerson

Paul

Vila

Whiticar

. The role for peer-assisted ultrasound teaching in medical school. Clin Teach. 2017;14(3):170–174. doi:10.1111/tct.12541

71.

O’Leary

Goumeniouk

Cormier

Potter

Gilic

Brennan

. Competency in acute resuscitation through successive simulation (CARTSS): a mentor-based, near-peer learning initiative. Can J Emerg Med. 2018;20(6):952–954. doi:10.1017/cem.2018.28

72.

Rotzoll

Wiemer

Zimmermann

Alex

Meixensberger

International peer-teaching: the LernKlinik Leipzig “erasmus-week” for incoming erasmus students. GMS J Med Educ. 2018;35(5):Doc56. doi:10.3205/zma001202

73.

Bennett

Morris

Mirza

. Medical students teaching medical students surgical skills: the benefits of peer-assisted learning. J Surg Educ. 2018;75(6):1471–1474. doi:10.1016/j.jsurg.2018.03.011

74.

Abbas

Sawaf

Hanafi

, et al. Peers versus professional training of basic life support in Syria: a randomized controlled trial. BMC Med Educ. 2018;18(1):142. doi:10.1186/s12909-018-1241-z

75.

Naeger

Conrad

Nguyen

Kohi

Webb

. Students teaching students: evaluation of a “near-peer” teaching experience. Acad Radiol. 2013;20(9):1177–1182. doi:10.1016/j.acra.2013.04.004

76.

Tamachi

Giles

Dornan

Hill

EJR

. You understand that whole big situation they’re in”: interpretative phenomenological analysis of peer-assisted learning. BMC Med Educ. 2018;18(1):197. doi:10.1186/s12909-018-1291-2

77.

Yoong

Nagesh

Rye

Devaraj

. Consultant-led peer assisted learning model. Clin Teach. 2019;16(5):502–506. doi:10.1111/tct.12970

78.

Nourkami-Tutdibi

Tutdibi

Schmidt

Zemlin

Abdul-Khaliq

Hofer

. Long-term knowledge retention after peer-assisted abdominal ultrasound teaching: is PAL a successful model for achieving knowledge retention? Ultraschall Med. 2020;41(1):36–43. doi:10.1055/a-1034-7749

79.

Gallagher

Matevish

Neuzil

, et al. Peer-led surgical clerkship programming support through the general surgery interest group at the vanderbilt university school of medicine. J Surg Educ. 2019;76(6):1451–1455. doi:10.1016/j.jsurg.2019.04.012

80.

Kewcharoen

Charoenpoonsiri

Thangjui

Panthong

Hongkan

. A comparison between peer-assisted learning and self-study for electrocardiography interpretation in Thai medical students. J Adv Med Educ Prof. 2020;8(1):18–24. doi:10.30476/jamp.2019.81458.1006

81.

Ong

Lew

Cheong

, et al.

Can we use peer-assisted learning to teach basic surgical skills?

Malays J Med Sci. 2020;27(5):101–107. doi:10.21315/mjms2020.27.5.10

82.

Down

Morris

Kulkarni

Mohiuddin

. Effectiveness of a multi-session combined near-peer and faculty-led surgical skills course on self-perceived ability to perform basic surgical skills. Ann Med Surg (Lond). 2020;57:153–156. doi:10.1016/j.amsu.2020.07.045

83.

Ribeiro

Rosete

Teixeira

Conceição H da

Santos

. Peer assisted learning: a pedagogical alternative of teaching skills to medical students. Acta Med Port. 2020;33(11):742–752.

84.

Binkhorst

Draaisma

JMT

Benthem

van de Pol

EMR

Hogeveen

Tan

ECTH

. Peer-led pediatric resuscitation training: effects on self-efficacy and skill performance. BMC Med Educ. 2020;20(1):427. doi:10.1186/s12909-020-02359-z

85.

Kachare

Kapsalis

Yun

, et al. Students teaching students: a survey of a medical student-led surgical skills workshop – a prospective cohort study. Ann Med Surg (Lond). 2020;56:43–47. doi:10.1016/j.amsu.2020.05.034

86.

Cremerius

Gradl-Dietsch

Beeres

FJP

, et al. Team-based learning for teaching musculoskeletal ultrasound skills: a prospective randomised trial. Eur J Trauma Emerg Surg. 2021;47(4):1189–1199. doi:10.1007/s00068-019-01298-9

87.

Schwill

Hundertmark

Fahrbach-Veeser

, et al. The AaLplus near-peer teaching program in family medicine strengthens basic medical skills: a five-year retrospective study. PLoS One. 2020;15(5):e0233748. doi:10.1371/journal.pone.0233748

88.

Kim

Nguyen

Neilson

. The effectiveness of student-led musculoskeletal and vascular ultrasound workshops at a single institution: a retrospective survey analysis. Cureus. 2023;15(7):e41902. doi:10.7759/cureus.41902

89.

Roehr

Maykowski

, et al. The feasibility of virtual reality and student-led simulation training as methods of lumbar puncture instruction. Med Sci Educ. 2021;31(1):117–124. doi:10.1007/s40670-020-01141-6

90.

Eimer

Duschek

Jung

, et al. Video-based, student tutor- versus faculty staff-led ultrasound course for medical students – a prospective randomized study. BMC Med Educ. 2020;20(1):512. doi:10.1186/s12909-020-02431-8

91.

Nisar

Mahboob

Khan

Rehman

. Challenges of peer assisted learning in online clinical skills training of ophthalmology module. BMC Med Educ. 2021;21(1):530. doi:10.1186/s12909-021-02959-3

92.

Kumar

Stubley

Hashmi

Ahmed

. Clinical orthopaedic teaching programme for students (COTS). Postgrad Med J. 2021;97(1154):749–754. doi:10.1136/postgradmedj-2020-138822

93.

Pintér

Kardos

Varga

, et al. Effectivity of near-peer teaching in training of basic surgical skills – a randomized controlled trial. BMC Med Educ. 2021;21(1):156. doi:10.1186/s12909-021-02590-2

94.

Kronschnabl

Baerwald

Rotzoll

. Evaluating the effectiveness of a structured, simulator-assisted, peer-led training on cardiovascular physical examination in third-year medical students: a prospective, randomized, controlled trial. GMS J Med Educ. 2021;38(6):Doc108. doi:10.3205/zma001504

95.

Divya

Abeetha

Nedunchezhiyan

Sadhana

. Peer assisted learning: a new teaching approach in undergraduate medical students. J Clin Diagn Res. 2021;15(7):JC01–JC04. doi:10.7860/JCDR/2021/48267.15081

96.

George

Rahim

Moorkoth

Balakrishnan

SMP

. Peer-assisted learning versus faculty-led learning in procedural skill acquisition utilizing skills laboratory. Med J Dr DY Patil Vidyapeeth. 2021;14(4):434–441. doi:10.4103/mjdrdypu.mjdrdypu_284_19

97.

Nourkami-Tutdibi

Hofer

Zemlin

Abdul-Khaliq

Tutdibi

. Teaching must go on: flexibility and advantages of peer assisted learning during the COVID-19 pandemic for undergraduate medical ultrasound education – perspective from the “sonoBYstudents” ultrasound group. GMS J Med Educ. 2021;38(1):Doc5. doi:10.3205/zma001401

98.

Schaffer

O’Neill

Hassan

Pearson

Subramaniam

Validating the use of peer-assisted learning laparoscopic simulation training for medical students. Med Sci Educ. 2021;31(2):359–363. doi:10.1007/s40670-020-01199-2

99.

Manolopoulos

Chatzidakis

Vasilakou

Balta

Ntourakis

. A standardized workshop for peer-teaching simple interrupted sutures to medical students: analysis of the student factors that affect outcomes. J Invest Surg. 2022;35(6):1379–1384. doi:10.1080/08941939.2022.2045394

100.

Gripay

André

Laval

, et al. Benefits of semiology taught using near-peer tutoring are sustainable. BMC Med Educ. 2022;22(1):26. doi:10.1186/s12909-021-03086-9

101.

Kim

Young

Nausheen

. Comparing the effectiveness and image quality of musculoskeletal ultrasound of first-year medical students after training by student tutors versus ultrasound instructors: a pilot study. Cureus. 2022;14(7):e26890. doi:10.7759/cureus.26890

102.

Avonts

Bombeke

Hens

Coenen

Vanderveken

De Winter

. Does peer teaching improve academic results and competencies during medical school? A mixed methods study. BMC Med Educ. 2022;22(1):431. doi:10.1186/s12909-022-03507-3

103.

Rong

Lee

Herbst

. Effectiveness of near-peer versus faculty point-of-care ultrasound instruction to third-year medical students. POCUS J. 2022;7(2):239–244. doi:10.24908/pocus.v7i2.15746

104.

Harris

Gao

Good

Harris

Renton

. Near-peer teaching in conjunction with flipped classroom to teach first-year medical students basic surgical skills. Med Sci Educ. 2022;32(5):1015–1022. doi:10.1007/s40670-022-01602-0

105.

Aydin

Kafa

Ozkaya

Alper

Haque

. Peer-assisted skills learning in structured undergraduate medical curriculum: an experiential perspective of tutors and tutees. Niger J Clin Pract. 2022;25(5):589–596. doi:10.4103/njcp.njcp_1410_21

106.

Loda

Berner

Erschens

Nikendei

Zipfel

Herrmann-Werner

. Student tutors go online – investigation of cognitive and social congruence in online student tutorials: a longitudinal study. Med Educ Online. 2022;27(1):2100038. doi:10.1080/10872981.2022.2100038

107.

Bedada

Hsiao

Chilisa

Yarranton

Chinyepi

Azzie

. Surgical simulation training for medical students: strategies and implications in Botswana. World J Surg. 2022;46(7):1637–1642. doi:10.1007/s00268-022-06529-6

108.

Spelde

Blatt

Lewis

Owens

Greenberg

. A different approach to teaching pre-clerkship students physical diagnosis: standardized patient instructor–senior medical student teaching teams. BMC Med Educ. 2023;23(1):887. doi:10.1186/s12909-023-04782-4

109.

Weimer

Rolef

Müller

, et al. FoCUS cardiac ultrasound training for undergraduates based on current national guidelines: a prospective, controlled, single-center study on transferability. BMC Med Educ. 2023;23(1):4062. doi:10.1186/s12909-023-04062-1

110.

Avonts

Bombeke

Vanderveken

De Winter

. How can peer teaching influence the development of medical students? A descriptive, longitudinal interview study. BMC Med Educ. 2023;23(1):861. doi:10.1186/s12909-023-04801-4

111.

Hari

Kälin

Birrenbach

, et al. Near-peer compared to faculty teaching of abdominal ultrasound for medical students: a randomized-controlled trial. Ultraschall Med. 2024;45(1):77–83. doi:10.1055/a-2103-4787

112.

Swallow

Wride

Donroe

. Peer-assisted learning in a longitudinal hybrid physical exam course. Med Sci Educ. 2023;33(2):359–362. doi:10.1007/s40670-023-01755-6

113.

Chen

Lam

Hung

IFN

, et al. Peer-to-peer clinical teaching by medical students in the formal curriculum. Asia Pac Scholar. 2023;8(4):13–22. doi:10.29060/TAPS.2023-8-4/OA3093

114.

Gillam

Crawshaw

Booker

Allsop

. Prompt identification of struggling candidates in near peer-led basic life support training: piloting an online performance scoring system. BMC Med Educ. 2023;23(1):303. doi:10.1186/s12909-023-04225-0

115.

Weimer

Dionysopoulou

Strelow

, et al. Undergraduate ultrasound training: prospective comparison of two different peer assisted course models on national standards. BMC Med Educ. 2023;23(1):513. doi:10.1186/s12909-023-04511-x

116.

Zhao

Deng

Ghanem

, et al. Using tele-ultrasound to teach medical students: a randomised control equivalence study. Australas J Ultrasound Med. 2023;26(2):91–99. doi:10.1002/ajum.12335

117.

Aquino

Santamaria

Quadri

, et al. Comparing peer-taught student tutors to faculty-taught student tutors in educating medical students on musculoskeletal ultrasound. Cureus. 2024;16(4):e59166. doi:10.7759/cureus.59166

118.

Hari

Caprez

Dolmans

Huwendiek

Robbiani

Stalmeijer

. Describing ultrasound skills teaching by near-peer and faculty tutors using cognitive apprenticeship. Teach Learn Med. 2024;36(1):33–42. doi:10.1080/10401334.2022.2140430

119.

Iyer

Mok

Sehmbi

, et al. Online versus in-person surgical near-peer teaching in undergraduate medical education during the COVID-19 pandemic: a mixed-methods study. Health Sci Rep. 2024;7(2):e1889. doi:10.1002/hsr2.1889

120.

Alt

Walter

Harris

Hari

Optimal timing of faculty teaching when combined with near-peer teaching: a mixed methods analysis. Med Teach. 2024;46(11):1448–1455. doi:10.1080/0142159X.2024.2308788

121.

Abdulrahman

Alkhateeb

Othman

. Peer-assisted learning versus faculty-led teaching of interviewing skills: a comparative study. Indian Pediatr. 2024;61(8):735–739.

122.

World Health Organization. Regional offices. WHO website. Published. 2025. https://www.who.int/about/who-we-are/regional-offices. (Accessed February 8, 2025).

123.

Bulte

Betts

Garner

Durning

. Student teaching: views of student near-peer teachers and learners. Med Teach. 2007;29(6):583–590. doi:10.1080/01421590701583824

124.

Zhao

Kong

Guidance for Online Learning Technologies and Platforms: Online Education During COVID-19 Pandemic. Center for Higher Education Research, Southern University of Science and Technology; 2020. Accessed September 26, 2023. https://iite.unesco.org/wp-content/uploads/2020/06/Guidance-for-Using-Technologies-and-Platforms.pdf

125.

Buckley

. Partial truths – research papers in medical education. Med Educ. 1998;32(1):1–2. doi:10.1046/j.1365-2923.1998.00187.x

126.

Tavakol

Murphy

Rahemei-Madeseh

Torabi

. The involvement of clinicians in medical education research. Qual Prim Care. 2008;16(5):335–340.

127.

Tavakol

Sandars

. Quantitative and qualitative methods in medical education research: AMEE guide No. 90: part I. Med Teach. 2014;36(9):746–756. doi:10.3109/0142159X.2014.915298

128.

ten Cate

Durning

. Peer teaching in medical education: twelve reasons to move from theory to practice. Med Teach. 2007;29(6):591–599. doi:10.1080/01421590701606799

129.

Stufflebeam

DL.

The CIPP model for evaluation. In: Evaluation Models: Viewpoints on Educational and Human Services Evaluation. Springer; 2000;p. 279–317.

130.

Lin

Zhou

Wang

. Peer tutoring in higher education: power from pedagogical training. Humanit Soc Sci Commun. 2025;12(1):1–13.

131.

Miflin

. Small groups and problem-based learning: are we singing from the same hymn sheet? Med Teach. 2004;26(5):444–450. doi:10.1080/01421590410001696425

132.

Crosby

. Learning in small groups. Med Teach. 1996;18(3):189–202. doi:10.3109/01421599609034160

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