Effective acquisition of clinical skills, history taking, physical examination, communication, and basic procedural competencies, forms the core of undergraduate medical education and is a primary focus of MBBS third-year training, when students first transition from preclinical knowledge to hands-on patient care. Third-year clinical postings therefore represent a crucial “gateway” for translating theoretical learning into practical competence and professional behaviour.¹

Traditional faculty-led teaching remains essential, but increasing class sizes, limited faculty time, and the need for repeated, low-stakes practice have driven medical schools to explore complementary teaching models. One widely used approach is near-peer teaching (NPT)—a structured form of peer-assisted learning in which senior students (near peers) teach and supervise more junior students. Near-peer instructors are typically close in training stage to their learners and can offer cognitive and social congruence that helps demystify clinical tasks, lower learners’ anxiety, and create opportunities for frequent, contextualised practice.²

A growing body of evidence suggests that peer-assisted and near-peer teaching can produce learning outcomes comparable to faculty instruction for many practical skills, and in some studies, superior gains in procedural performance and learner confidence. Systematic reviews and meta-analyses of peer-assisted learning in health professions education report significant positive effects on procedural/psychomotor skill acquisition and on self-reported confidence or self-efficacy, while often finding equivalent performance on knowledge tests compared with conventional methods.³

Several single-centre and discipline-specific studies have shown that structured NPT interventions (for example, train-the-tutor programs, checklist-based skill sessions, or repeated bedside practice supervised by near peers) improve objective assessments such as OSCE/skills station scores and subjective outcomes such as learner satisfaction and confidence. However, the literature also highlights important heterogeneity in study designs, tutor training, outcome measures, and the rigour of comparisons with faculty-led teaching—limiting generalizability, especially in diverse curricular contexts such as MBBS programmes.^4-5

In India, the competency-based MBBS curriculum explicitly emphasises early and structured skills training, recommending clear skill-modules and frequent supervised practice to ensure graduate competencies. Yet published evaluations of near-peer models within the Indian MBBS third-year context remain limited, and comparative evidence assessing both objective clinical performance and learner confidence is sparse. This gap is important because contextual factors (class size, clinical exposure, resource constraints, and cultural expectations) may modify the effectiveness of NPT programmes.⁶

Therefore, this comparative study investigates the effect of a structured near-peer teaching programme on MBBS third-year students’ clinical skills performance (measured by objective skills assessments) and self-reported confidence, compared with the standard faculty-led teaching approach. By using standardised skill checklists, validated confidence measures, and a clearly defined tutor training protocol, the study aims to provide robust, context-specific evidence to inform curriculum planners considering scalable strategies to enhance clinical skills training.

MATERIAL AND METHODS

Study Design and Setting

This prospective comparative interventional study was conducted at a single tertiary-care medical college among MBBS third-year students undergoing clinical postings in Sriganganagar, Rajasthan, India. The study compared outcomes between students participating in a structured near-peer teaching program and those receiving conventional faculty-led instruction.

Participants

Eligible participants included MBBS third-year students actively enrolled in clinical rotations during the study period. Students who had received formal training in the specific OSCE stations within the preceding three months were excluded to minimize prior exposure bias.

Participants were informed about the study through departmental announcements, and written informed consent was obtained prior to enrolment.

Group Allocation

Participants were allocated into two parallel groups based on existing academic batch divisions to maintain logistical feasibility and prevent contamination between sessions. One group received the near-peer teaching intervention, while the other underwent faculty-led instruction. Efforts were made to ensure comparable baseline characteristics between groups.

OSCE examiners were blinded to group allocation to reduce assessment bias. Due to the nature of the intervention, students and tutors were not blinded.

Interventions

Near-Peer Teaching Group:

Students attended six weekly sessions of 90 minutes each, conducted by trained near-peer tutors (final-year MBBS students or interns). Each session followed standardized lesson plans and structured checklists aligned with OSCE competencies. Sessions included demonstration, supervised practice, structured feedback, and simulated OSCE stations.

Near-peer tutors underwent two structured 2-hour preparatory workshops focusing on teaching methodology, checklist utilization, effective feedback delivery, and standardization of session content.

Faculty-Led Group:

Students received six weekly 90-minute sessions covering identical clinical skills content and OSCE stations, delivered by faculty members as per routine institutional practice. The duration, learning objectives, and skill checklists were matched with the near-peer group to ensure content equivalence.

Outcome Measures

Primary Outcome:

Clinical skills performance assessed by Objective Structured Clinical Examination (OSCE) conducted one week after completion of the intervention. The OSCE comprised six standardized stations evaluated using validated checklists, with total scores ranging from 0 to 100.

Secondary Outcomes:

1. Knowledge acquisition measured using a 30-item multiple-choice questionnaire (MCQ) administered before and after the intervention.
2. Self-reported confidence levels measured using a 5-point Likert scale (1 = very low confidence; 5 = very high confidence), assessed pre- and post-intervention.
3. Student satisfaction measured post-intervention using a 5-point Likert scale.

Sample Size

A total of 90 students (45 per group) were included. This sample size was considered adequate to detect an approximate 6% difference in mean OSCE scores between groups, assuming a standard deviation of approximately 9, with 80% statistical power and a two-sided significance level of 0.05.

Statistical Analysis

Data were analysed using SPSS V 26.0. Continuous variables were summarized as mean ± standard deviation (SD) or median (interquartile range) where appropriate.

Between-group comparisons were performed using Welch’s two-sample t-test for normally distributed continuous variables with unequal variances. Within-group pre- and post-intervention comparisons were conducted using paired t-tests for MCQ scores and Wilcoxon rank-sum test for confidence scores.

Categorical variables were analyzed using the chi-square test. A two-tailed p-value <0.05 was considered statistically significant.

RESULTS

A total of 90 third-year MBBS students were included in the analysis, with 45 students in the Near-Peer Teaching group and 45 in the Faculty-Led Teaching group. All participants completed the intervention and outcome assessments.

Baseline demographic and academic characteristics were comparable between groups (Table 1). The mean age of participants was 21.18 ± 1.05 years in the near-peer group and 21.40 ± 1.20 years in the faculty group (p = 0.34). The gender distribution was similar, with males comprising 60.0% and 57.8% of the near-peer and faculty groups, respectively (p = 0.83).

There were no statistically significant differences in baseline MCQ scores (18.54 ± 2.96 vs. 18.73 ± 2.88; p = 0.71) or baseline confidence scores (median 3 [IQR 3–4] in both groups; p = 0.89), indicating comparable pre-intervention academic and self-perceived competence levels.

Table 1. Baseline characteristics of study participants

Post-intervention OSCE scores were significantly higher in the Near-Peer Teaching group compared to the Faculty-Led Teaching group (78.04 ± 7.78 vs. 72.11 ± 8.85; p = 0.003).

The mean difference in OSCE scores between groups was 5.93 points (95% CI: 2.81 to 9.05), favouring the near-peer intervention (Table 2).

Table 2. Comparison of primary outcome (OSCE performance)

Baseline MCQ scores were similar between groups (p = 0.71). Following the intervention, both groups demonstrated improvement in knowledge scores; however, the near-peer group achieved significantly higher post-intervention MCQ scores (23.11 ± 2.85) compared to the faculty-led group (20.84 ± 3.10; p < 0.001) (Table 3).

The mean improvement in MCQ scores was +4.57 in the near-peer group and +2.11 in the faculty-led group.

Table 3. Comparison of knowledge assessment (MCQ scores)

Within-group paired analysis demonstrated statistically significant improvements in both groups. In the near-peer group, the mean increase was 4.57 points (paired t = 8.62, p < 0.001), while in the faculty-led group, the mean increase was 2.11 points (paired t = 3.24, p = 0.002) (Table 4).

Table 4. Within-group comparison of MCQ scores

Pre-intervention confidence levels were similar in both groups (median 3 [IQR 3–4]; p = 0.89). After the intervention, median confidence scores increased to 4 (IQR 3–4) in both groups, with no statistically significant difference in post-intervention confidence between groups (p = 0.21) (Table 5).

However, within-group analysis using the Wilcoxon signed-rank test demonstrated significant improvement in confidence levels in both the near-peer group (Z = −4.12, p < 0.001) and the faculty-led group (Z = −2.61, p = 0.01).

Table 5. Comparison of self-reported confidence levels

Student satisfaction scores were significantly higher in the Near-Peer Teaching group. A satisfaction score ≥4 was reported by 77.8% of students in the near-peer group compared to 57.8% in the faculty-led group (p = 0.04) (Table 6).

Table 6. Student satisfaction with teaching method

Students exposed to near-peer teaching reported significantly higher satisfaction compared to those taught by faculty.

DISCUSSION

In this prospective comparative interventional study of 90 third-year MBBS students, the structured near-peer teaching (NPT) programme was associated with superior clinical skills performance as measured by OSCE scores, greater gains in MCQ knowledge scores, and higher student satisfaction compared with an equivalent faculty-led programme. Both methods improved self-reported confidence, but the magnitude of confidence change did not differ significantly between groups. Overall, these results indicate that a well-structured NPT intervention can produce at least comparable and in several domains superior, short-term educational outcomes to faculty instruction in the MBBS third-year setting.

Our primary finding, higher OSCE scores among students taught by near-peers, aligns with several reports that demonstrate equal or improved practical performance following near-peer or peer-assisted programmes. Rashid et al. reported that a near-peer programme developed and delivered exclusively by senior students improved OSCE preparation and performance in undergraduate cohorts, suggesting that near-peer tutors can be trained to deliver reliable, high-quality skills training.⁷

Similarly, an interventional study comparing near-peer to faculty instruction in focused point-of-care ultrasound (POCUS) found comparable effectiveness of near-peer instruction for practical skill acquisition, supporting the use of near-peer instructors for procedural and bedside skills when appropriate tutor training and standardization are provided.⁸

Systematic reviews and meta-analyses reinforce these single-site results. A comprehensive systematic review of peer-assisted learning in medical education concluded that peer involvement generally improves academic performance and procedural skills, and is associated with gains in learner confidence although effect sizes vary by outcome and context. Our results (OSCE advantage ~6 points; larger knowledge gains in the NPT arm) are consistent with the positive pooled signal reported in that review.⁹

Mock OSCE and confidence-focused studies provide further context. Braier-Lorimer et al. described a near-peer-led mock OSCE that significantly increased students’ self-rated confidence ahead of high-stakes assessments, even when objective performance gains were mixed; this complements our observation that both groups reported increased confidence, while the near-peer group showed greater objective gains.¹⁰

Regional and discipline-specific evaluations including controlled comparative studies from Indian settings and surgical skills training commonly report that near-peer approaches are at least as effective as faculty teaching for procedural and clinical skills, and are often rated highly for accessibility, approachability, and learner satisfaction. These contextual findings support the feasibility and acceptability of implementing NPT within MBBS curricula in resource-constrained or high-student-teacher ratio environments.¹¹

Possible mechanisms

Several mechanisms likely explain the observed benefits. Near-peer tutors operate with cognitive and social congruence: they remember recent learner difficulties, use more targeted language and heuristics, and create a lower-anxiety learning climate that encourages repeated practice. When coupled with structured lesson plans, validated checklists, and tutor training (as in our programme), these factors improve feedback quality and increase deliberate practice — both crucial for psychomotor skill acquisition and retention. These mechanisms are consistent with theoretical and empirical discussions in the near-peer literature.^7,9

Strengths

Key strengths include: (1) matched teaching schedules and standardized checklists across arms, reducing content bias; (2) blinded OSCE examiners to reduce assessment bias; (3) multiple outcome domains (objective OSCE, knowledge MCQ, confidence, and satisfaction) offering a broader view of educational impact; and (4) tutor preparation workshops, which increased standardization of the NPT intervention and improve reproducibility.

Limitations

Several limitations should be acknowledged. First, the study design is a prospective comparative interventional study rather than a randomized controlled trial, allocation by existing academic groupings may introduce selection or cohort effects despite comparable baseline scores. Second, the follow-up was short term (OSCE one week after intervention); longer-term retention and transfer to real clinical settings were not assessed. Third, self-reported confidence and satisfaction are inherently subjective and susceptible to response bias. Fourth, although examiners were blinded, students and tutors were not, which could introduce performance or Hawthorne effects. Finally, while our sample size provided adequate power to detect the observed OSCE difference, the study was single-centre and may have limited generalizability to different institutional or cultural contexts.

Implications for educators and curriculum planners

Our findings support integrating structured NPT programmes into MBBS clinical skills curricula as a scalable approach to augment faculty teaching. Practically important elements that likely contributed to success and are recommended for replication include: formal tutor selection, short train-the-tutor workshops focused on teaching and feedback skills, use of validated checklists and standardized lesson plans, and examiner blinding when possible. Near-peer programmes can expand instructional capacity, increase opportunities for low-stakes repetitive practice, and improve learner satisfaction without compromising, and in many cases improving objective performance.

Future research

Future studies should consider cluster-randomized or crossover designs to strengthen causal inference, include multi-centre samples to enhance generalizability, and include longer follow-up to evaluate skill retention and workplace performance. Research comparing combinations of near-peer plus periodic faculty mentoring (the “blended” model) versus either method alone may clarify optimal timing and balance between peer accessibility and faculty clinical expertise. Cost-effectiveness analyses would also be valuable for institutions considering scale-up.

CONCLUSION

A structured near-peer teaching programme produced greater short-term improvements in OSCE performance, larger gains in knowledge scores, and higher student satisfaction than matched faculty-led teaching in this cohort of MBBS third-year students, while both methods improved learner confidence. These results add to a growing evidence base supporting near-peer approaches as an effective, acceptable, and scalable adjunct to conventional faculty teaching in undergraduate medical education.

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