Exploring Factors Affecting Informal Peer Tutoring Process Among Pre-Clinical Medical Students of a Private Medical College

Exploring Factors Affecting Informal Peer Tutoring Process Among Pre-Clinical Medical Students of a Private Medical College | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring Factors Affecting Informal Peer Tutoring Process Among Pre-Clinical Medical Students of a Private Medical College Umme Ammarah Omer Malik, Shabana Ali, Raheela Yasmeen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5537207/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Learner-mediated peer teaching and their preferred learning strategies are neglected niches in the current era of medical education due to a lack of institutional focus. Peer tutoring is a pedagogical approach incorporated into teaching and learning in higher education to promote collaborative learning. It is usually executed when students face daily learning challenges and regulate their training process with their fellows through informally planned peer tutoring sessions. The study aims to inquire how mutual learning of peers in the peer tutoring process occurs, preferably in a casual, self-determined environment. The study also examines what factors enable or hinder learners in achieving academic outcomes in knowledge, competencies, and conduct. Theoretically, it aligns the concept of arrangement for studying as a determinant of cognitive and social congruence through the scope of Vygotsky’s Zone of Proximal Development. Method: It was an exploratory qualitative study that was conducted through purposeful sampling from learners belonging to pre-clinical years of undergraduate medical school. Four rounds of FGDs were conducted. Two rounds were conducted from both 1 st year and 2 nd year medical students. The transcribed responses were manually analyzed to extract themes. Results: Eight themes were identified, each further divided into two sub-themes to evaluate the relevance of the data with the research objectives. It was observed that student-mediated peer tutoring, specifically in a casual and relaxed setting, is mostly an exam-driven consequence. The theme of “Organization of Sessions” highlighted subthemes of “Initial Planning” or “Spontaneous Arrangement”. The ”Tutor Roles” were based on the “Amicable Relationships” among peers, and “Knowledge-based Teaching” was preferred. Tutees showed significant satisfaction and trustworthiness with the content shared and instructional strategies used, with preferred informal language. Conclusion: This article gives an overview of the key concepts regarding the coexistence of peers as tutors and peers as tutees within the informal academic environment. The lack of scholarly literature on how these sessions are organized and conducted was identified as a research problem. The perceptions of learners actively involved in planning these sessions were investigated qualitatively. This exploratory investigation will benefit peer tutors and tutees and enhance the institution's educational environment. Informal Medical Education Peer Tutoring Undergraduate Medical Students Figures Figure 1 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Background In medical education, the transfer of medical expertise, abilities, and mindset has constantly developed in terms of curriculum, assessment, instructional strategies, resource allocation, and faculty development.( 1 ) Currently, there is an emphasis on empowering learners for collaborative learning in an inclusive educational environment. A flexible educational atmosphere where students can enhance their knowledge and skills through self-paced learning strategies. Therefore, it’s been observed that traditional didactic teaching methods have fallen short in curricular management, interactive lectures, and effective assessment. Additionally, the non-interaction during the didactic sessions has proven to be the source of student disengagement and decreased information retention. These factors have proven to limit effective knowledge among the learners in the current era of modernism.( 2 ) The gradual decline of traditional teaching strategies is because of strict adherence to the concept that learning must occur within a physical space, at a predetermined pace and schedule such as in the conventional classroom format. Teachers dominate the learning environment.( 3 ) Learners must show dependency on textbooks. The learning takes place at a pre-decided pace and schedule. These factors have proven to be less conducive to learning and have advocated against allowing learners to learn at their own pace. ( 4 ) Since lecture-based teaching does not permit the partnership of teachers and students and lacks integration of basic sciences with clinical skills it results in making medical curricula inadequate for the application of foundational theoretical knowledge and performance improvements at various levels of training in the medical program.( 5 ) This status quo demanded innovation not only in medical curricula but also in teaching techniques and assessment strategies to significantly advance the future of the classroom.( 6 ) Hence, pedagogical learning strategies became the focus of educational psychologists, which led to the emergence of a student-centered learning environment. When a student was empowered to be responsible for his/her learning, it gave rise to student-mediated teaching approaches, which can be visualized in Fig. 1 The peer tutoring technique is a dynamically unique way for peer tutors and peer tutees to interact socially and learn informally to accomplish their goals. Despite the prevalence of informal peer tutoring among medical students in informal settings such as libraries, cafes, or the like. There is a lack of comprehensive understanding regarding how these sessions are planned, arranged, and executed.( 7 ) Additionally, the barriers faced by participants in organizing these informal sessions and the institutional support required to transition them into a formalized peer teaching program remain unexplored.( 7 ) The existing literature in terms of exploring the arrangement and execution of peer tutoring in informal settings is quite limited. ( 8 ) Loda et al., have concluded with suggestions to further understand these informal arrangements of learners to stimulate independent learning with social interactions. ( 8 , 9 ) Also, to have a deeper insight into how informal peer tutoring processes can be transitioned as a structured program of the curriculum. ( 10 , 11 ) The purpose of this study is to describe the experiences of students engaged in the informal tutoring process in informal settings such as libraries or cafes, to explore the barriers faced by students while organizing their informal tutoring sessions, and to investigate expectations of tutors and tutees into what type of organizational support they expect to formalize the peer tutoring process. ( 12 , 13 ) The pedagogical approach of the informal peer tutoring process is taken as a variant of peer-assisted learning, which states that “learners from almost identical social groups who are not expert teachers help each other to learn mutually by engaging themselves in teaching.” ( 14 ) John Hattie, Professor of Education, has unfolded remarkable features of peer-oriented learning and comprehends it as an ongoing phenomenon that occurs independently in formal or casual environment. ( 15 ) The interplay of many learning theories has also explained the potential outcomes of peer engagement in collaborative learning. ( 16 ) An exploratory approach is taken in the study to empirically examine social interaction processes and cognitive development. Accounting for enhanced benefits for tutors and tutees the study focuses on its alignment with Schmidt & Moust's theory of cognitive congruence and social congruence. ( 17 )The study also relates the concept of the theory to the element of Vygotsky’s theory, the Zone of Proximal Development (ZPD), advocating that when learning requires guidance, the learner chooses their peer at a similar level of knowledge and shares a similar social role. ( 18 , 19 ) The theoretical background is shown in Fig. 2. The above-mentioned theoretical elements underpin the concept that in informal peer tutoring, cognitive congruence ensures that tutors explain concepts at a level that aligns with the learner's understanding. Social congruence fosters a comfortable, relatable atmosphere, encouraging open communication. Vygotsky’s Zone of Proximal Development (ZPD) highlights that learners can progress with guidance that is beyond their independent ability. Hence, they choose peers as their guides, who are close in knowledge and social status, to enhance their learning. ( 20 ) The tutee's learning outcomes can be viewed as a result of the proximity and interaction shared with the tutor. The casual and informal setting of the tutoring session contributes to a more open and engaging learning experience. These factors contribute to a collaborative learning environment that supports the development of higher levels of comprehension.( 21 ) In line with Vygotsky's sociocultural theory, this framework suggests that the compound outcomes of informal peer tutoring in medical education are linked to the social interactions and cultural context within which it occurs.( 22 ) Independent learners collaborate with their peers in an atmosphere that is suitable to promote their learning and development through self-determined guidance. ( 23 ) Considering the above, the study aims to explore the influential factors and bridge the gap by investigating challenges associated with the informal peer tutoring process. It also focuses on describing the expectations of students from their institutions to devise a structured peer tutoring program. ( 24 , 25 ) The literature revealed that a significant population of student tutees has found informal tutoring sessions to be clearer as compared to the lectures delivered. Many studies also revealed that peer tutoring has helped them clarify topics and aided well in the acquisition of skills, thus ensuring the effectiveness of peer tutoring process. ( 5 , 16 , 26 ) ( 27 ) Literature has appreciated that peer tutoring has stimulated team composition. Peers value their group arrangements, allowing them to decide on tutor roles.( 28 , 29 ) These can be consistently one or interchangeable activities, thus resulting in a profound impact on collective and guided learning among participating peers. Peer tutoring plays an important role in creating a sense of community, cooperation, and collaboration among preclinical medical students. ( 30 )They feel more comfortable communicating with peer tutors compared to faculty facilitators. The interpersonal skills of tutors and language preferences have been evident in providing a relaxed atmosphere to learners. ( 13 ) Informal instruction on specific content often leads tutees to feel more satisfied with the learning resources provided. This effect is supported in literature, where learners' perceptions of relaxed and casual communication are explored through qualitative analysis. The findings of this study can provide valuable information into how students have experienced their joint learning sessions arranged through social interactions, and what barriers they have faced in its execution. It also unfolds students’ expectations from their institutions in devising new ways to incorporate peer tutoring strategy as a structured program. ( 31 ) Methods Study Design: This study employed an exploratory qualitative study design. To achieve the aim of the study, factors influencing the arrangement of peer tutoring in a learner-preferred casual setting were explored. It also focused on the experiences of pre-clinical medical students involved in informal peer tutoring sessions. The study explored its objectives under the scope of the above-mentioned theoretical components. Vygotsky’s Zone of Proximal Development (ZPD) informed how peer tutors support learners beyond their current abilities. Cognitive and social congruence by Schmidt and Moust guided the exploration of shared understanding and relatable interactions between peers training at the same level in an undergraduate medical program.( 22 )Collectively, these frameworks shaped the construction of research questions, data collection and analysis by highlighting knowledge sharing and social dynamics in informal peer tutoring among preclinical medical students. The inquiry approach for data collection was kept aligned with the constructivist paradigm for this research project. ( 32 ) The research questions of the study were crafted under the scope of the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research Type) Framework. ( 33 ) It is considered more suitable for application to qualitative and mixed methods research. The study adheres to the framework by studying a smaller sample to understand the informal peer tutoring phenomenon. The focus group discussions were designed for data collection procedures, and a qualitative research approach was chosen to evaluate the subjective constructs of the phenomenon. ( 33 ) The research questions are as follows: How do preclinical medical students learn mutually using informal peer tutoring? What factors affect the peer tutoring process in medical students during informal efforts to learn? Google Scholar was used as a search engine and 03 databases: PubMed, Taylor & Francis & Science Direct have been used to gain access to relevant articles. These articles also aided in formulating the open-ended questions for data collection. The study spanned over six months, commencing from Feb 2024 to July 2024, after obtaining ethical approval from the Islamic International Medical College, Riphah International University. The study was approved by the Institutional Review Committee (Approval No: Riphah/IRC/24/1037). The study participants belonged to the Islamic International Medical College (IIMC) of Riphah International University, Rawalpindi, Pakistan. The institute facilitated the researcher to proceed with the on-campus data collection process by approaching the sample participants in their Self-Study slots of the timetable of pre-clinical years of the medical academic program. The ethical guidelines were aligned with the principles of qualitative research, such as taking informed consent with assurance given to participants for maintaining their confidentiality and anonymization of data. While pursuing the research for publication, the study also ensured autonomy to the participants by respecting their freedom of expression. The study intended to unfold the perceptions of participants involved in the peer tutoring process to maximize the benefits without any potential harm to participants. ( 34 ) Study Participants: The participants of the study were selected through a convenience purposive sampling technique. Purposive sampling aids the researcher in acquiring comprehensive information about a specified question of the study. ( 35 )It allowed the researcher to select the participants based on their convenience in time, location, and availability. ( 36 ) The sample was taken from undergraduate medical students. Participants belonged to undergraduate medical students from pre-clinical years who were 1st-year and 2nd-year medical students of the five-year MBBS program in IIMC Riphah International University. Flexible time schedules of the selected participants allowed learners to engage more frequently in casual peer-mediated tutoring sessions. Both male and female participants were considered preferably involved in a self-organized informal tutoring session with their peers. Participants were selected to ensure diversity in age, gender, socioeconomic status, residence (day scholars and hostelites), and academic performance. A total of 26 participants participated in this research project, of whom six were males and twenty were females. Data Collection: The data was collected through face-to-face, open-ended questions. After receiving consent from the participants, ensuring their confidentiality and privacy.( 36 ) Four FGD sessions were conducted in their free time or self-study sessions that were convenient for the participants. ( 37 )The research project was explained to every participant before the session. The responses were audio-recorded on the cell phone, and MS Office 365 was used for transcription. These responses of participants were transcribed using MS Word 365. The transcriptions of Focus Group Discussions were organized in Verbatim style, which captured every detail of the speech of respondents. The written transcribed data was repeatedly and carefully read by following the basic transcription guidelines, the redundant and irrelevant expressions were removed to preserve the precision of the transcription. The responses were streamlined to maintain a balance between content accuracy and readability. Focus group discussions (FGDs) were organized to explore the study's central phenomenon. A pilot FGD was conducted with 03 of the participants to trace the study's course, find problems with the comprehension of FGD questions, solve issues with audio recording of the responses, and transcription of the textual information collected. Following the pilot, no changes were made to the final set of questions, as they were found to be clear and effective in obtaining responses. Background noise was identified as a minor issue during the pilot sessions. Subsequently, data collection was conducted in quieter settings to ensure optimal audio quality. ( 38 )Four rounds of FGDs were conducted, two sessions from each of the pre-clinical years. Each session lasted 45 to 60 minutes. The participants were approached using phone numbers and emails. All the study participants participated voluntarily. The first FGD included eight participants: two male and six female participants. The other three rounds of FGD had six participants each. The second round included two male participants out of six respondents, and third FGD included only one male participant out of six respondents. The fourth round of FGD had all female participants. The sequence of FGD rounds is shown in Fig. 3. The transcription was done by a researcher and a colleague. Each transcription was analyzed by a volunteer member from the groups of participants to ensure accurate representation of perceptions. The selection of themes was based on the gaps or problems most frequently highlighted in literature. Broad themes were extracted after a rigorous literature review, which were “Arrangement of Informal Peer Tutoring Process, Benefits and Challenges experienced by both tutors and tutees, and Expected Institutional Support”. The following questions were developed based on a review of relevant literature to guide the data collection process. Few questions were supported with probing questions to provide clarity to participants and receive detailed insights into their experiences in casual peer learning sessions. The details of questions under their relevant category are shown in Table 1 . Table 1 Overview of the questions asked for collection of data Broad Themes Questions After introduction and greetings, opening questions to engage participants in a relaxed atmosphere. Q1: Can you describe your typical day in the pre-clinical year of the medical program? Q2: How do you explain the “role of a student in teaching and learning/as a teacher” Arrangement of informal peer tutoring process Q3: How do you plan and execute the peer tutoring process? Probing questions: • How did you get started with peer tutoring? • How do you arrange your informal peer tutoring sessions? • How do you manage your time to conduct peer tutoring? • How do you decide on taking roles of tutor and tutee? Q4: What factors affect your decision to join and participate in a group for peer tutoring? Probing Question: Have your social relationships and interactions helped you in the selection of members for conducting successful tutoring sessions? Q5: What factors affect your decision to leave a group for peer tutoring? Benefits and challenges experienced by both tutors and tutees. Q6: Besides academic learning, what additional advantages have you obtained as a tutor/ tutee through informal tutoring sessions? Q7: What challenges have you faced as a tutor/tutee during the informal peer tutoring process? Expected Institutional Support Q8: Will you suggest a module using peer tutoring? If yes, then suggest the possibilities or outline a framework using the peer tutoring model? Data Analysis: With informal peer tutoring being the phenomenon of Interest, the exploratory nature of the qualitative study design was evaluated through perceptions of the participants under the scope of Cognitive and Social Congruence. The theoretical concept was merged with Vygotsky’s Zone of Proximal Development to adhere to theoretical triangulation of the data received. ( 37 ) The analysis of qualitative study data begins with the identification of recurring and emerging themes. The data collected in fourth FGD revealed many repeated concepts that were gathered in the other three rounds. Continuing beyond this round would likely yield redundant data, offering no added value to the depth or scope of the analysis. Thus, it was perceived through discussions with supervisor, co-supervisor, and independent peer that saturation has been achieved. The transcribed responses were reviewed by the member checker. ( 35 ) A volunteer participant from each FGD group was nominated for the review of the transcriptions of the collected data. Each round of verbal responses was converted into written transcription and was assessed by a volunteer member of the participants for validation of the accuracy of responses. The suggested amendments given by the member-checker for their relevant group mostly included the removal of irrelevant expressions of respondents and confidential data used by a few participants, and reordering of the content relevant to the participants. Each participant was given a label to guarantee confidentiality and privacy of the participants. After reading the transcripts multiple times, the relevant data were coded line by line, and the statements were highlighted through “open coding” ( 39 ). After rereading the transcripts, the codes were combined to reduce in number. This is called axial coding ( 36 ). These codes and the most relevant quotations were transferred to a separate Word document for further analysis. Similar codes were grouped to form sub-themes. The themes were labels used to describe similar sub-themes ( 36 ). These themes were further described by designing categories. Each category reflects a holistic description of data, aligning it with relevant themes, sub-themes, and code. This whole process was done manually and repeated multiple times to reach its final shape. After analysis and to ensure inter-coder reliability, the tabulated version of analyzed data was shared with the supervisor, co-supervisor of the study, and one peer for feedback. Each independently reviewed the tabulated themes, followed by collaborative discussions to achieve consensus, thereby enhancing the credibility and consistency of the thematic interpretation. Themes were assessed for alignment with theoretical frameworks and for adequacy in representing participants' perspectives through thick descriptions. These amendments helped ensure rigor and clarity in qualitative research data analysis.( 40 ) Finally a mutual consensus was achieved among authors for determining the themes, sub-themes with relevant codes reflecting the alignment of the data with study’s objectives. Trustworthiness of findings: A four-step framework was used to ensure rigor in qualitative research.( 35 ) The framework included credibility, transferability, dependability, and conformability. Table 2 gives an overview of the strategies employed under each principle. Table 2 An overview of the pillars for trustworthiness of the findings Pillars Definition Strategies applied in the study Credibility (Internal Validity) Accuracy of the findings and true representation of the views of participants Ensuring confidentiality of participants with conducive and comfortable conditions for the participants during FGD rounds Periodic reviews, member checking, and periodic reviews with colleagues and volunteer participants to validate findings Transferability (External Validity/ Generalizability) Ensuring findings can be applied to similar educational settings. Thick descriptions of the context and participants. Highlighting minute details of sample size and participant selection criteria, context of the study, data collection procedure, and data analysis process, facilitating other readers. Dependability Reliability, Stability, and Consistency of the research findings and interpretations over time and conditions Discussion with peers as part of Peer Debriefing Use of an Audit Trail to document the findings and process. Confirmability Ensuring that findings reflect participants' experiences rather than researcher bias. Discussions with experts, as external audits to review findings Reflexive journaling and constant Member Checking Results In sessions of FGD, 26 respondents participated. Both male and female participants were a part of the data collection procedure. After fourth round, saturation in the responses appeared, which led to cessation of further data collection procedures. An overview of FGD rounds is given in Fig. 4 A systematic approach was used for the interpretation of data using thematic analysis. The study followed the steps of “Deductive thematic analysis.” This approach allowed researchers to derive themes directly from data that are well-aligned with a theoretical foundation. ( 41 ) A detailed account of the analysis is given in the end, showing what the researcher has inferred from the data, keeping the research objective aligned with the scope of the study. The broader terms were derived from the themes extracted from literature. These terms are presented as categories that are: “Arrangement of peer tutoring sessions, Benefits, Challenges, and Expected institutional support”. The themes are the manifest terms that emerged from the data; later, with subsequent multiple rounds of re-evaluation of transcripts, themes were refined, and sub-themes were generated. Code reduction led to terms aligning with sub-themes, following a top-down approach to data coding. Quotes of the participants are explicitly specified to ensure the alignment of data within the themes described. Figure 5 The manual analysis of the data obtained from 26 participants generated a total of 8 themes and 16 subthemes under the broad 4 categories, contributing to the suggestions of research questions and objectives of the study. The initial coding resulted in 78 initial manifest terms, and with the refinement of the data, 43 codes were finalized through redundant coding. The theme-wise tabulated results are shown in Table 3 . The deductive approach of thematic analysis aided the researcher in linking the emergent themes with theoretical foundations. The research problem was explicitly synchronized with the analyzed data through an iterative process and refinement of themes and codes. Various stages followed for interpretation of data are shown in Fig. 5 Table 3 Tabulated form of Thematic Analysis CATEGORIES ( 4 ) THEMES ( 8 ) SUB-THEMES ( 16 ) CODES ( 43 ) Arrangement of Peer Tutoring Session informally Organization of the sessions Initial Preparations Pre-planned session Time management Alignment with pre-determined learning objectives Spontaneous Sessions Random gathering Need-based sessions Tutor/Tutee Selection Knowledge-based Teaching Level of comprehension Simplified explanations Reinforcement of concepts Amicable Relationships Bond of Friendship Minimal verbal barriers Comfort in asking questions Benefits Personal Development Non-cognitive Skills enhancement Communication skills Confidence to speak in public Leadership skills as a tutor Self- Control Cognitive Skills Memory retention Problem-solving Skills Active Learning Motivation Academic Benefits Exam-driven efficient Learning, Concepts clarification Mutual academic support Social-Emotional Support Emotional attachment Comfort level Social support Familiarity with peers Challenges Students as Teachers Learning Pace Fast Learners Slow Learners Tutoring Skills Consolidated prior knowledge Knowledge sharing Enhances learning Hindrance to Engagement Conflicting Timetables Unavailability of peers Mismatched Schedules Non-Serious Behavior Disruptive tools Casual Attitude Lack of discipline Expected Institutional Support Learning environment Physical Locations Quiet Place Weather Conditions Lack of Resources Limited access to Skill Lab Availability of models Inadequate hands-on practice Formalizing Peer Tutoring Program Supportive Structured Modules Training Sessions Feedback Mechanism Flexible Self-Study Periods Adaptable Time Slots Casual Sessions Category 1: Arrangement of Peer Tutoring Session informally: 1.1: Organization of the sessions: This theme was derived from the data when participants were asked to express their views on how they manage their time and decide the content to be discussed in these informal peer tutoring sessions. Participants were also asked about how they decided on their venue for conducting peer tutoring sessions. The responses from the participants varied in Initial preparation and Spontaneous Sessions subthemes. Spontaneous sessions were exclusively student-driven and adhered to casual and comfortable settings in flexible timings for all members involved. These instructional periods were open, natural, and unplanned sessions that would allow the students to gather and join a group under the discussion topic as represented in the quote of participant. “It's generally a spontaneous process because no one really plans to find a group for study, or no one really plans to gather someone to teach a particular topic.”(P-15) Most of the participants have shown an inclination towards the pre-planned peer tutoring sessions. These are also exclusively student-driven but structured in terms of time, place of conducting the session, and content they want to learn. These sessions are planned ahead of some major tasks such as summative exams. “For me, the peer tutoring process comes into play during exams, so we plan it by coming to college earlier and going to our specific location that does not have a lot of disturbance.”(P-22) 1.2: Tutor and Tutee Selection: Knowledge-based criteria and amicable relationships have emerged as two sub-themes, also being the most evident reasons for deciding on tutoring roles. The criteria set for selecting a tutor is done after comparing the level of prior knowledge on a relative topic with each other. The learners as tutees would expect their peers as tutors to have the ability to teach for reinforcement of the concepts and enhance memory retention. “I am a tutee, and my friend is a tutor because she has a better way of explanation.” (P-9) “I think that my peers should be knowledgeable about the subject that they're teaching,”(P-3) Category 2: Benefits of the sessions: 2.1: Personal Development: The personal development theme is derived from the sub-themes related to the enhancement of cognitive and non-cognitive skills. Participants have expressed their satisfaction that peer tutoring sessions arranged with friends have supplemented their academic and non-academic skills. They learn to solve problems, actively participate in sharing knowledge, and discuss complex topics for clarification of concepts has all contributed to an increase in memory and they were able to cover larger content in less time. “When you study things from the book they're very volatile and you forget them easily but when you do it with friends, you build a deeper understanding”.(P-11) 2.2: Motivation: This theme highlights the aspects of academic goals and emotional and social support. Students were motivated to see their fellows learning to achieve a similar academic goal, that is excelling in exams. The shared motive to excel in academic years through progress in their assessments has engaged students in peer tutoring sessions. “So one of the major factors that enable me to go for peer tutoring is that we all as students have shared academic goals, so we know that a certain topic is going to help us for our academic studies”(P-21) The social and emotional bonds developed among peers were due to their interrelationships within the same training program. Peers being familiar with each other through being together in a learning environment played a vital role in building a comfort level that motivated them to learn and accomplish their learning objectives. Category 3: Challenges: 3.1: Students as Teachers: The theme has featured the sub-themes of learning pace and teaching skills as qualities of tutors that allow a learner to either join or leave peer tutoring sessions. Many participants had brought to focus that tutee learners are at different levels of learning and face a challenge to keep up the pace with the group. For many participants, tutors who were unable to take each member along forced them to leave the group of peer tutoring. It is the quality of the tutor to keep the session flexible to allow slow-paced learners to get the maximum benefit from the sessions. “Someone is a fast learner and some people are slow learners like me. So that really compels me to leave the group.”(P-17) The type of skills that participants expressed in their peers as tutors were prior knowledge, the ability to share knowledge in a simplified way, and the ability to clarify the concepts at the level of understanding of the members of the peer tutoring group. 3.2: Hindrance to Engagement: This theme classifies the barriers faced by the participants in executing the peer tutoring process. When students want to engage in a learning process, conflicting timetables hinder their combined learning sessions. Participants are arranged in different batches in their institute but for peer tutoring, they would want to gather with their friends. So, the unavailability of peers had been mostly due to overlapping schedules and it had interfered with the execution of the participant’s peer tutoring sessions. “I think that the most important factor which affect my decision to leave the group is the availability of my classmates”(P-6) Another factor that participants faced as a barrier was the non-serious behavior of certain members including tutors. Irrelevant use of social media, unorganized learning content of the members, and diverting the conversations away from the desired outcome are the factors highlighted by participants that forced them to leave a certain group. “For me, it's the non-serious attitude of my peers because of course, if they're not standing by themselves, how will they teach me? So that really is a mood killer. And that makes me leave the group.”(P-26) Category 4: Expected Institutional Support: 4.1: Learning environment: The institutional learning environment is a broader term that is comprehended at varying levels. Through interpretation of data, it was revealed that participants expressed a comfortable physical location that is quiet and can reduce the weather conditions. Participants had shown their grievances about the unavailability of spots that could allow them to assemble for casual learning during harsh summers or rainy days. “During Summer it's harsh weather and we can't sit in the garden or somewhere to study.”(P-19) The information collected about the resources also affected their comfort level within an institution. Resources pointed out by participants are the availability of models of anatomical structures in the skill lab of anatomy to understand the concepts better with friends. The participants desired to have access to the lab during their break time to sit together and study complicated topics. Few participants even highlighted the requirement of models for the neuroanatomy module to grasp the anatomical structures of the human brain and its extensions. “So, I will suggest CNS and ANS module because it was such a lengthy module as there was so much sulci and gyri and all that. So, the method that I will suggest is, first of all, I'll ask everyone to organize study material and the models from the labs.”(P-25) 4.2: Formalizing Peer Tutoring Program: Learners had moderately shown their interest in formalizing peer tutoring sessions. They had recommended having supportive structured sessions and flexibility in their self-study sessions. The participants showed a willingness to have support from faculty only in training tutors on how to deliver more functional and productive learning sessions with their peers. They wanted to be responsible for their learning at their own pace, in their comfortable learning environment with their friends. But at the same time desired to have support from expert faculty in terms of feedback for their progress and training the tutor. “I suggest training sessions and regular feedback mechanisms., structured study materials, and support from faculty to the tutor.”(P-10) Students also highlighted having flexibility in self-study sessions. They wanted to have casual; informally organized group study sessions preferred with the fellows of their choice. Some participants even expressed to formalize a peer tutoring session for low achievers to have better learning with their peers without any communication barriers. The linkages of themes extracted from literature to themes extracted from data are shown in Fig. 6 . Discussion Peer tutoring is considered a useful skill that refines the delivery of instruction, promotes lifetime learning, and helps students become more knowledgeable and socially interactive. ( 42 ) Literature analysis confirms that informal peer tutoring complements academic success.( 43 ) It improves the motivation to learn and creates a feeling of connectedness among learners, thereby, allowing members of the groups to progress better as “tutee role” and “tutor role”. Peers engaged in tutoring sessions are motivated to set goals for their learning and monitor their learning progress, and behavior informally among their fellows.( 44 ) This study was aimed at exploring factors influencing peer tutoring and how the members strive to achieve excellence in their overall personal performance academically and generically. ( 45 )( 46 ) Proposed Model of Peer-Tutoring Process in Informal Setting: Keeping in view the existing literature on different models of peer tutoring and the data analyzed a systematic approach is discussed on how to transition from informal peer sessions to formal peer sessions. ( 46 )The rationale for this recommendation is to allow undergraduate medical students to polish their teaching skills, organization, and search for learning content, and enhance their generic skills in phases. This will aid in sharing the burden of heavily committed faculty and can produce future doctors with more productive learning outcomes. According to the scoping review of Bowyer’s and Shaw, What Goes Behind the Closed Doors , the study explains the query in the discussion. ( 47 )The closed doors phrase is metaphorically used for informal settings that learners choose for themselves, inside or outside the institution, for the collective purpose of learning. ( 48 ) Literature has given enough evidence concerning initiatives taken by institutions in formalizing the peer tutoring program. Inflexibility in schedules and scarcity of feedback resulted in the discontinuation of the programs.( 49 ) In view of the above concept, the study proposes distinct phases involved in any model of peer tutoring process defined by literature are shown in Fig. 7 Planning Phase: To organize the tutoring sessions, institutions should recruit volunteers for tutor roles. In the selection policy, peers from the same class or senior years should be allowed. The content to be taught can be determined by the tutees. ( 50 )The format of the sessions should be determined by the faculty based on the learning needs and can be incorporated as: Tutor-tutee pairs One Tutor and several tutees in a group For optimal pairing and group arrangement, factors need to be considered, such as learning styles and pace, frequency of the sessions, and schedules of tutors and tutees. ( 13 )Paired Tutoring provides individualized attention and targeted support customized to tutees' specific needs. A group format can address several learners with similar goals in the same sessions through discussion-based interaction. ( 51 ) A Structure of the sessions should be created to give the participants an overview on how they can execute the sessions thus, aiding in an increase in the number of volunteers. ( 30 )The framework should highlight the occurrence of sessions and the duration of these sessions. A template for sessions to include learning objectives in the form of knowledge reinforcement, competencies with active learning strategies, and maintenance of reflective journals. ( 46 ) The provision of adequate resources should account for content-related and location. Availability of textbooks, worksheets, models, and other learning materials to support tutoring and learning. ( 52 ) Institutions should ensure access to appropriate spaces for tutoring sessions which allows the learners to maintain their relaxed learning atmosphere where students can have casual conversations and are not intimidated from making mistakes. ( 53 ) Execution Phase: Before conducting institution-assisted peer tutoring sessions, preparing for the sessions and delivering them effectively takes a lot of time outside of regular coursework. This struggle is initiated by the learner tutors themselves.( 54 ) What they’ve prepared individually is what they want to share by tutoring. Hence, Tutors struggle to balance tutoring with their studies. This struggle of tutors can be catered to by the institution through the provision of relevant content and a relaxed, physically well-equipped venue. ( 55 ) This execution phase may or may not have faculty-supported sessions. This will have multidimensional influences on all three stakeholders, which are tutors, tutees, and institutions. ( 56 )The faculty-supervised sessions can be simultaneously considered as tutor training and evaluative sessions. These evaluative measures can be a source of gathering information to improve the program with collective views and performances of tutors and tutees. ( 28 , 57 )Some students may be hesitant to ask for help from peers or participate in the tutoring process. Overcoming this resistance requires tutors to establish a good connection and showcase their expertise, which can be addressed effectively with the expert-supervised tutoring sessions. ( 58 ) Evaluation phase: Periodic and consistent evaluation of the peer tutoring program should be carried out by gathering student feedback and performance data. This information is to be used to improve the program and resolve any issues that may arise. ( 59 ) Institutions should also consider providing incentives such as academic credit, financial compensation, or other rewards to encourage students to participate as tutors. Additionally, recognition for tutors' contributions can be given through awards, certificates, or letters of recommendation. ( 60 ) Implications of findings: Research indicates that peer tutoring can be especially helpful for younger students, low-achieving students, and minority groups. Customizing peer tutoring programs to provide targeted support to meet the specific needs of these populations can improve their effectiveness. The peer tutoring approach can be implemented by carefully designing the structure of the sessions. It offers significant benefits to medical institutions, with minimal financial costs or faculty time. It can also be considered that if a fully structured program cannot be formalized, then minor tutor training sessions can generate profound benefits among tutors. Limitations The informal setting encouraged openness but may have limited the depth of academic reflection. The small, purposively selected sample from pre-clinical subjects and a single-setting study has restricted generalizability. The credibility of the study was enhanced using theoretical and investigator triangulation. However, the use of multiple data collection tools and data source triangulation could not be implemented, which remains a limitation of the study. Finally, researchers’ interpretation during thematic analysis may have introduced subjective bias despite efforts to ensure inter-coder reliability. The study's data collection highlights the aspect of female gender pre-dominance as respondents in focus group discussions, specifically in the fourth round of FGD, which was composed of only female participants. Since the current focus of the study was not gender-specific, the participants’ responses from mixed-gender group reflected consistent results with only female respondents' group. This aspect is not emphasized in the study; hence, future research should examine the impact of different genders on the effectiveness of peer tutoring, and researchers should highlight the gender-based approaches to the peer tutoring process. Future studies should focus on devising a flexible and adaptable model for peer tutoring programs that can incorporate various types of tutoring, such as Class-wide, Reciprocal, and Near-Peer, according to need. The need to explore phase-wise peer tutoring using various study designs will refine further foundations of peer tutoring process. Conclusion The study focused on exploring informal peer tutoring sessions arranged by pre-clinical medical students and identifying facilitators and barriers that affect informal peer tutoring. It was observed that informal peer tutoring is a preferred learning method among medical students. This research has shown benefits in cognitive, psychomotor, and affective domains, as well as enhancing generic skills like self-confidence, time management, and team building. Overall, improving communication skills for counseling and presentations had a more pronounced effect on tutors and tutees as compared to a range of academic, cognitive, and social benefits. However, lack of resources, absence of a subdued atmosphere, and incoherent pace of teaching tutors were some of the major challenges reported by the participants of the study. These barriers also included the expected support that participants require from the institute to conduct their tutoring sessions with peers at their convenient time and place. Further researchers can examine the application of peer tutoring based on addressing the obstacles faced by the participants. This can provide a way forward to the process of implementing peer tutoring as a formal format of teaching and learning in medical curricula. Assessing how to formalize peer tutoring in the curricula can also pave the way for tutor training sessions. Declarations Author Contribution Umme Ammarah Omer Malik wrote the main manuscript, conducted a comprehensive literature search, and planned and executed data collection procedures with an analysis of the dataShabana Ali supervised the entire study in a systematic manner, helped prepare figures and tables, was a member of the panel of experts who validated questions to be asked in focus group discussions, facilitated the venue for conducting focus group discussions, and assisted in the analysis and alignment of the data. Raheela Yasmmen supervised the entire process of the study, facilitated in acceptance certificate of the study, was a member of panel of experts who validated the questions to be asked in focus group discussions Acknowledgement I would like to express my sincere appreciation to Mr. M. Omer Malik for his invaluable support during the study. 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Does group cohesion foster self-directed learning for medical students? A longitudinal study. BMC Med Educ. 2020;20(1). Van Lankveld T, Schoonenboom J, Kusurkar R, Beishuizen J, Croiset G, Volman M. Informal teacher communities enhancing the professional development of medical teachers: A qualitative study. BMC Med Educ. 2016;16(1). Engels D, Kraus E, Obirei B, Dethleffsen K. Peer teaching beyond the formal medical curriculum. Adv Physiol Educ. 2018;42(3):439–48. Nagraj S, Miles S, Bryant P, Holland R. Medical Students’ Views About Having Different Types of Problem-Based Learning Tutors. Med Sci Educ [Internet]. 2019 Mar 15 [cited 2023 Dec 25];29(1):93–100. Available from: http://www.ncbi.nlm.nih.gov/pubmed/34457456 Bugaj TJ, Blohm M, Schmid C, Koehl N, Huber J, Huhn D et al. Peer-assisted learning (PAL): Skills lab tutors’ experiences and motivation. BMC Med Educ. 2019;19(1). Belsi A, Murtagh GM. Peer tutoring in clinical communication teaching: the experience of 1st year students and their peer tutors. MedEdPublish (2016) [Internet]. 2018 Jun 20 [cited 2023 Dec 25];7:135. Available from: http://www.ncbi.nlm.nih.gov/pubmed/38074557 Agius A, Stabile I. Undergraduate peer assisted learning tutors’ performance in summative anatomy examinations: a pilot study. Int J Med Educ. 2018;9:93–8. Additional Declarations No competing interests reported. Supplementary Files CriticalAppraisalofLiteratureReview.docx FGDTranscription1.docx FGDTranscription2.docx FGDTranscription3.docx FGDTranscription4.docx VerbatimTranscription1.docx VerbatimTranscription2.docx VerbatimTranscription3.docx VernatimTranscription4.docx RawData.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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17:14:28","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":34347,"visible":true,"origin":"","legend":"","description":"","filename":"VerbatimTranscription1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5537207/v1/b678da2f9ef1eb915d977cf8.docx"},{"id":81845748,"identity":"b07a53eb-ebd3-4d79-8c6b-5737eb4030b9","added_by":"auto","created_at":"2025-05-02 17:38:28","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":31558,"visible":true,"origin":"","legend":"","description":"","filename":"VerbatimTranscription2.docx","url":"https://assets-eu.researchsquare.com/files/rs-5537207/v1/90759da304feb3d18dbca65b.docx"},{"id":81844570,"identity":"8a678da8-56da-438d-a899-3381bf32edd4","added_by":"auto","created_at":"2025-05-02 17:14:29","extension":"docx","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":33144,"visible":true,"origin":"","legend":"","description":"","filename":"VerbatimTranscription3.docx","url":"https://assets-eu.researchsquare.com/files/rs-5537207/v1/ba35354e56fd968bdb6e77cb.docx"},{"id":81844837,"identity":"00da4ac9-642c-4726-964e-2905f996c341","added_by":"auto","created_at":"2025-05-02 17:22:29","extension":"docx","order_by":9,"title":"","display":"","copyAsset":false,"role":"supplement","size":29370,"visible":true,"origin":"","legend":"","description":"","filename":"VernatimTranscription4.docx","url":"https://assets-eu.researchsquare.com/files/rs-5537207/v1/1e60ac8c785eaf4f305731d3.docx"},{"id":81845335,"identity":"6b1687a6-82ff-4b0e-9935-f14dd2385847","added_by":"auto","created_at":"2025-05-02 17:30:28","extension":"docx","order_by":10,"title":"","display":"","copyAsset":false,"role":"supplement","size":33674,"visible":true,"origin":"","legend":"","description":"","filename":"RawData.docx","url":"https://assets-eu.researchsquare.com/files/rs-5537207/v1/6f8ab73c1231362c00c5eaae.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eExploring Factors Affecting Informal Peer Tutoring Process Among Pre-Clinical Medical Students of a Private Medical College\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eIn medical education, the transfer of medical expertise, abilities, and mindset has constantly developed in terms of curriculum, assessment, instructional strategies, resource allocation, and faculty development.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Currently, there is an emphasis on empowering learners for collaborative learning in an inclusive educational environment. A flexible educational atmosphere where students can enhance their knowledge and skills through self-paced learning strategies. Therefore, it\u0026rsquo;s been observed that traditional didactic teaching methods have fallen short in curricular management, interactive lectures, and effective assessment. Additionally, the non-interaction during the didactic sessions has proven to be the source of student disengagement and decreased information retention. These factors have proven to limit effective knowledge among the learners in the current era of modernism.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe gradual decline of traditional teaching strategies is because of strict adherence to the concept that learning must occur within a physical space, at a predetermined pace and schedule such as in the conventional classroom format. Teachers dominate the learning environment.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Learners must show dependency on textbooks. The learning takes place at a pre-decided pace and schedule. These factors have proven to be less conducive to learning and have advocated against allowing learners to learn at their own pace. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Since lecture-based teaching does not permit the partnership of teachers and students and lacks integration of basic sciences with clinical skills it results in making medical curricula inadequate for the application of foundational theoretical knowledge and performance improvements at various levels of training in the medical program.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) This status quo demanded innovation not only in medical curricula but also in teaching techniques and assessment strategies to significantly advance the future of the classroom.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Hence, pedagogical learning strategies became the focus of educational psychologists, which led to the emergence of a student-centered learning environment. When a student was empowered to be responsible for his/her learning, it gave rise to student-mediated teaching approaches, which can be visualized in Fig.\u0026nbsp;1\u003c/p\u003e \u003cp\u003eThe peer tutoring technique is a dynamically unique way for peer tutors and peer tutees to interact socially and learn informally to accomplish their goals. Despite the prevalence of informal peer tutoring among medical students in informal settings such as libraries, cafes, or the like. There is a lack of comprehensive understanding regarding how these sessions are planned, arranged, and executed.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Additionally, the barriers faced by participants in organizing these informal sessions and the institutional support required to transition them into a formalized peer teaching program remain unexplored.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) The existing literature in terms of exploring the arrangement and execution of peer tutoring in informal settings is quite limited. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) Loda et al., have concluded with suggestions to further understand these informal arrangements of learners to stimulate independent learning with social interactions. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) Also, to have a deeper insight into how informal peer tutoring processes can be transitioned as a structured program of the curriculum. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe purpose of this study is to describe the experiences of students engaged in the informal tutoring process in informal settings such as libraries or cafes, to explore the barriers faced by students while organizing their informal tutoring sessions, and to investigate expectations of tutors and tutees into what type of organizational support they expect to formalize the peer tutoring process. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe pedagogical approach of the informal peer tutoring process is taken as a variant of peer-assisted learning, which states that \u0026ldquo;learners from almost identical social groups who are not expert teachers help each other to learn mutually by engaging themselves in teaching.\u0026rdquo; (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) John Hattie, Professor of Education, has unfolded remarkable features of peer-oriented learning and comprehends it as an ongoing phenomenon that occurs independently in formal or casual environment. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) The interplay of many learning theories has also explained the potential outcomes of peer engagement in collaborative learning. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAn exploratory approach is taken in the study to empirically examine social interaction processes and cognitive development. Accounting for enhanced benefits for tutors and tutees the study focuses on its alignment with Schmidt \u0026amp; Moust's theory of cognitive congruence and social congruence. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)The study also relates the concept of the theory to the element of Vygotsky\u0026rsquo;s theory, the Zone of Proximal Development (ZPD), advocating that when learning requires guidance, the learner chooses their peer at a similar level of knowledge and shares a similar social role. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) The theoretical background is shown in Fig.\u0026nbsp;2.\u003c/p\u003e \u003cp\u003eThe above-mentioned theoretical elements underpin the concept that in informal peer tutoring, cognitive congruence ensures that tutors explain concepts at a level that aligns with the learner's understanding. Social congruence fosters a comfortable, relatable atmosphere, encouraging open communication. Vygotsky\u0026rsquo;s Zone of Proximal Development (ZPD) highlights that learners can progress with guidance that is beyond their independent ability. Hence, they choose peers as their guides, who are close in knowledge and social status, to enhance their learning. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe tutee's learning outcomes can be viewed as a result of the proximity and interaction shared with the tutor. The casual and informal setting of the tutoring session contributes to a more open and engaging learning experience. These factors contribute to a collaborative learning environment that supports the development of higher levels of comprehension.(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) In line with Vygotsky's sociocultural theory, this framework suggests that the compound outcomes of informal peer tutoring in medical education are linked to the social interactions and cultural context within which it occurs.(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) Independent learners collaborate with their peers in an atmosphere that is suitable to promote their learning and development through self-determined guidance. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eConsidering the above, the study aims to explore the influential factors and bridge the gap by investigating challenges associated with the informal peer tutoring process. It also focuses on describing the expectations of students from their institutions to devise a structured peer tutoring program. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe literature revealed that a significant population of student tutees has found informal tutoring sessions to be clearer as compared to the lectures delivered. Many studies also revealed that peer tutoring has helped them clarify topics and aided well in the acquisition of skills, thus ensuring the effectiveness of peer tutoring process. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) Literature has appreciated that peer tutoring has stimulated team composition. Peers value their group arrangements, allowing them to decide on tutor roles.(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) These can be consistently one or interchangeable activities, thus resulting in a profound impact on collective and guided learning among participating peers. Peer tutoring plays an important role in creating a sense of community, cooperation, and collaboration among preclinical medical students. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)They feel more comfortable communicating with peer tutors compared to faculty facilitators. The interpersonal skills of tutors and language preferences have been evident in providing a relaxed atmosphere to learners. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) Informal instruction on specific content often leads tutees to feel more satisfied with the learning resources provided. This effect is supported in literature, where learners' perceptions of relaxed and casual communication are explored through qualitative analysis.\u003c/p\u003e \u003cp\u003eThe findings of this study can provide valuable information into how students have experienced their joint learning sessions arranged through social interactions, and what barriers they have faced in its execution. It also unfolds students\u0026rsquo; expectations from their institutions in devising new ways to incorporate peer tutoring strategy as a structured program. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design:\u003c/h2\u003e \u003cp\u003eThis study employed an exploratory qualitative study design. To achieve the aim of the study, factors influencing the arrangement of peer tutoring in a learner-preferred casual setting were explored. It also focused on the experiences of pre-clinical medical students involved in informal peer tutoring sessions. The study explored its objectives under the scope of the above-mentioned theoretical components. Vygotsky\u0026rsquo;s Zone of Proximal Development (ZPD) informed how peer tutors support learners beyond their current abilities. Cognitive and social congruence by Schmidt and Moust guided the exploration of shared understanding and relatable interactions between peers training at the same level in an undergraduate medical program.(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)Collectively, these frameworks shaped the construction of research questions, data collection and analysis by highlighting knowledge sharing and social dynamics in informal peer tutoring among preclinical medical students. The inquiry approach for data collection was kept aligned with the constructivist paradigm for this research project. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe research questions of the study were crafted under the scope of the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research Type) Framework. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) It is considered more suitable for application to qualitative and mixed methods research. The study adheres to the framework by studying a smaller sample to understand the informal peer tutoring phenomenon. The focus group discussions were designed for data collection procedures, and a qualitative research approach was chosen to evaluate the subjective constructs of the phenomenon. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) The research questions are as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow do preclinical medical students learn mutually using informal peer tutoring?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat factors affect the peer tutoring process in medical students during informal efforts to learn?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eGoogle Scholar was used as a search engine and 03 databases: PubMed, Taylor \u0026amp; Francis \u0026amp; Science Direct have been used to gain access to relevant articles. These articles also aided in formulating the open-ended questions for data collection.\u003c/p\u003e \u003cp\u003e The study spanned over six months, commencing from Feb 2024 to July 2024, after obtaining ethical approval from the Islamic International Medical College, Riphah International University. The study was approved by the Institutional Review Committee (Approval No: Riphah/IRC/24/1037). The study participants belonged to the Islamic International Medical College (IIMC) of Riphah International University, Rawalpindi, Pakistan. The institute facilitated the researcher to proceed with the on-campus data collection process by approaching the sample participants in their Self-Study slots of the timetable of pre-clinical years of the medical academic program. The ethical guidelines were aligned with the principles of qualitative research, such as taking informed consent with assurance given to participants for maintaining their confidentiality and anonymization of data. While pursuing the research for publication, the study also ensured autonomy to the participants by respecting their freedom of expression. The study intended to unfold the perceptions of participants involved in the peer tutoring process to maximize the benefits without any potential harm to participants. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Participants:\u003c/h3\u003e\n\u003cp\u003eThe participants of the study were selected through a convenience purposive sampling technique. Purposive sampling aids the researcher in acquiring comprehensive information about a specified question of the study. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)It allowed the researcher to select the participants based on their convenience in time, location, and availability. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) The sample was taken from undergraduate medical students. Participants belonged to undergraduate medical students from pre-clinical years who were 1st-year and 2nd-year medical students of the five-year MBBS program in IIMC Riphah International University. Flexible time schedules of the selected participants allowed learners to engage more frequently in casual peer-mediated tutoring sessions. Both male and female participants were considered preferably involved in a self-organized informal tutoring session with their peers. Participants were selected to ensure diversity in age, gender, socioeconomic status, residence (day scholars and hostelites), and academic performance. A total of 26 participants participated in this research project, of whom six were males and twenty were females.\u003c/p\u003e\n\u003ch3\u003eData Collection:\u003c/h3\u003e\n\u003cp\u003eThe data was collected through face-to-face, open-ended questions. After receiving consent from the participants, ensuring their confidentiality and privacy.(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) Four FGD sessions were conducted in their free time or self-study sessions that were convenient for the participants. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e)The research project was explained to every participant before the session. The responses were audio-recorded on the cell phone, and MS Office 365 was used for transcription. These responses of participants were transcribed using MS Word 365. The transcriptions of Focus Group Discussions were organized in Verbatim style, which captured every detail of the speech of respondents. The written transcribed data was repeatedly and carefully read by following the basic transcription guidelines, the redundant and irrelevant expressions were removed to preserve the precision of the transcription. The responses were streamlined to maintain a balance between content accuracy and readability.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFocus group discussions (FGDs) were organized to explore the study's central phenomenon. A pilot FGD was conducted with 03 of the participants to trace the study's course, find problems with the comprehension of FGD questions, solve issues with audio recording of the responses, and transcription of the textual information collected. Following the pilot, no changes were made to the final set of questions, as they were found to be clear and effective in obtaining responses. Background noise was identified as a minor issue during the pilot sessions. Subsequently, data collection was conducted in quieter settings to ensure optimal audio quality. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e)Four rounds of FGDs were conducted, two sessions from each of the pre-clinical years. Each session lasted 45 to 60 minutes. The participants were approached using phone numbers and emails. All the study participants participated voluntarily. The first FGD included eight participants: two male and six female participants. The other three rounds of FGD had six participants each. The second round included two male participants out of six respondents, and third FGD included only one male participant out of six respondents. The fourth round of FGD had all female participants. The sequence of FGD rounds is shown in Fig.\u0026nbsp;3. The transcription was done by a researcher and a colleague. Each transcription was analyzed by a volunteer member from the groups of participants to ensure accurate representation of perceptions.\u003c/p\u003e\u003cp\u003eThe selection of themes was based on the gaps or problems most frequently highlighted in literature. Broad themes were extracted after a rigorous literature review, which were \u0026ldquo;Arrangement of Informal Peer Tutoring Process, Benefits and Challenges experienced by both tutors and tutees, and Expected Institutional Support\u0026rdquo;. The following questions were developed based on a review of relevant literature to guide the data collection process. Few questions were supported with probing questions to provide clarity to participants and receive detailed insights into their experiences in casual peer learning sessions. The details of questions under their relevant category are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverview of the questions asked for collection of data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBroad Themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuestions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter introduction and greetings, opening questions to engage participants in a relaxed atmosphere.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQ1: Can you describe your typical day in the pre-clinical year of the medical program?\u003c/p\u003e \u003cp\u003eQ2: How do you explain the \u0026ldquo;role of a student in teaching and learning/as a teacher\u0026rdquo;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArrangement of informal peer tutoring process\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQ3: How do you plan and execute the peer tutoring process?\u003c/p\u003e \u003cp\u003eProbing questions:\u003c/p\u003e \u003cp\u003e\u0026bull; How did you get started with peer tutoring?\u003c/p\u003e \u003cp\u003e\u0026bull; How do you arrange your informal peer tutoring sessions?\u003c/p\u003e \u003cp\u003e\u0026bull; How do you manage your time to conduct peer tutoring?\u003c/p\u003e \u003cp\u003e\u0026bull; How do you decide on taking roles of tutor and tutee?\u003c/p\u003e \u003cp\u003eQ4: What factors affect your decision to join and participate in a group for peer tutoring?\u003c/p\u003e \u003cp\u003eProbing Question:\u003c/p\u003e \u003cp\u003eHave your social relationships and interactions helped you in the selection of members for conducting successful tutoring sessions?\u003c/p\u003e \u003cp\u003eQ5: What factors affect your decision to leave a group for peer tutoring?\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenefits and challenges experienced by both tutors and tutees.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQ6: Besides academic learning, what additional advantages have you obtained as a tutor/ tutee through informal tutoring sessions?\u003c/p\u003e \u003cp\u003eQ7: What challenges have you faced as a tutor/tutee during the informal peer tutoring process?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpected Institutional Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQ8: Will you suggest a module using peer tutoring? If yes, then suggest the possibilities or outline a framework using the peer tutoring model?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis:\u003c/h2\u003e \u003cp\u003eWith informal peer tutoring being the phenomenon of Interest, the exploratory nature of the qualitative study design was evaluated through perceptions of the participants under the scope of Cognitive and Social Congruence. The theoretical concept was merged with Vygotsky\u0026rsquo;s Zone of Proximal Development to adhere to theoretical triangulation of the data received. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe analysis of qualitative study data begins with the identification of recurring and emerging themes. The data collected in fourth FGD revealed many repeated concepts that were gathered in the other three rounds. Continuing beyond this round would likely yield redundant data, offering no added value to the depth or scope of the analysis. Thus, it was perceived through discussions with supervisor, co-supervisor, and independent peer that saturation has been achieved. The transcribed responses were reviewed by the member checker. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) A volunteer participant from each FGD group was nominated for the review of the transcriptions of the collected data. Each round of verbal responses was converted into written transcription and was assessed by a volunteer member of the participants for validation of the accuracy of responses. The suggested amendments given by the member-checker for their relevant group mostly included the removal of irrelevant expressions of respondents and confidential data used by a few participants, and reordering of the content relevant to the participants. Each participant was given a label to guarantee confidentiality and privacy of the participants. After reading the transcripts multiple times, the relevant data were coded line by line, and the statements were highlighted through \u0026ldquo;open coding\u0026rdquo; (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). After rereading the transcripts, the codes were combined to reduce in number. This is called axial coding (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). These codes and the most relevant quotations were transferred to a separate Word document for further analysis. Similar codes were grouped to form sub-themes. The themes were labels used to describe similar sub-themes (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). These themes were further described by designing categories. Each category reflects a holistic description of data, aligning it with relevant themes, sub-themes, and code. This whole process was done manually and repeated multiple times to reach its final shape. After analysis and to ensure inter-coder reliability, the tabulated version of analyzed data was shared with the supervisor, co-supervisor of the study, and one peer for feedback. Each independently reviewed the tabulated themes, followed by collaborative discussions to achieve consensus, thereby enhancing the credibility and consistency of the thematic interpretation. Themes were assessed for alignment with theoretical frameworks and for adequacy in representing participants' perspectives through thick descriptions. These amendments helped ensure rigor and clarity in qualitative research data analysis.(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) Finally a mutual consensus was achieved among authors for determining the themes, sub-themes with relevant codes reflecting the alignment of the data with study\u0026rsquo;s objectives.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTrustworthiness of findings:\u003c/h3\u003e\n\u003cp\u003eA four-step framework was used to ensure rigor in qualitative research.(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) The framework included credibility, transferability, dependability, and conformability. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e gives an overview of the strategies employed under each principle.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAn overview of the pillars for trustworthiness of the findings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePillars\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDefinition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStrategies applied in the study\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCredibility\u003c/p\u003e \u003cp\u003e(Internal Validity)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAccuracy of the findings and true representation of the views of participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEnsuring confidentiality of participants with conducive and comfortable conditions for the participants during FGD rounds\u003c/p\u003e \u003cp\u003ePeriodic reviews, member checking, and periodic reviews with colleagues and volunteer participants to validate findings\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransferability\u003c/p\u003e \u003cp\u003e(External Validity/ Generalizability)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEnsuring findings can be applied to similar educational settings.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThick descriptions of the context and participants.\u003c/p\u003e \u003cp\u003eHighlighting minute details of sample size and participant selection criteria, context of the study, data collection procedure, and data analysis process, facilitating other readers.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReliability, Stability, and Consistency of the research findings and interpretations over time and conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiscussion with peers as part of Peer Debriefing\u003c/p\u003e \u003cp\u003eUse of an Audit Trail to document the findings and process.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfirmability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEnsuring that findings reflect participants' experiences rather than researcher bias.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiscussions with experts, as external audits to review findings\u003c/p\u003e \u003cp\u003eReflexive journaling and constant Member Checking\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003c/p\u003e \u003cp\u003eIn sessions of FGD, 26 respondents participated. Both male and female participants were a part of the data collection procedure. After fourth round, saturation in the responses appeared, which led to cessation of further data collection procedures. An overview of FGD rounds is given in Fig.\u0026nbsp;4\u003c/p\u003e \u003cp\u003eA systematic approach was used for the interpretation of data using thematic analysis. The study followed the steps of \u0026ldquo;Deductive thematic analysis.\u0026rdquo; This approach allowed researchers to derive themes directly from data that are well-aligned with a theoretical foundation. (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eA detailed account of the analysis is given in the end, showing what the researcher has inferred from the data, keeping the research objective aligned with the scope of the study. The broader terms were derived from the themes extracted from literature. These terms are presented as categories that are: \u0026ldquo;Arrangement of peer tutoring sessions, Benefits, Challenges, and Expected institutional support\u0026rdquo;. The themes are the manifest terms that emerged from the data; later, with subsequent multiple rounds of re-evaluation of transcripts, themes were refined, and sub-themes were generated. Code reduction led to terms aligning with sub-themes, following a top-down approach to data coding. Quotes of the participants are explicitly specified to ensure the alignment of data within the themes described. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe manual analysis of the data obtained from 26 participants generated a total of 8 themes and 16 subthemes under the broad 4 categories, contributing to the suggestions of research questions and objectives of the study. The initial coding resulted in 78 initial manifest terms, and with the refinement of the data, 43 codes were finalized through redundant coding. The theme-wise tabulated results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The deductive approach of thematic analysis aided the researcher in linking the emergent themes with theoretical foundations. The research problem was explicitly synchronized with the analyzed data through an iterative process and refinement of themes and codes. Various stages followed for interpretation of data are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTabulated form of Thematic Analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCATEGORIES (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTHEMES (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSUB-THEMES (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCODES (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eArrangement of Peer Tutoring Session informally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOrganization of the sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInitial Preparations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-planned session\u003c/p\u003e \u003cp\u003eTime management\u003c/p\u003e \u003cp\u003eAlignment with pre-determined learning objectives\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpontaneous Sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRandom gathering\u003c/p\u003e \u003cp\u003eNeed-based sessions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTutor/Tutee Selection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKnowledge-based Teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLevel of comprehension\u003c/p\u003e \u003cp\u003eSimplified explanations\u003c/p\u003e \u003cp\u003eReinforcement of concepts\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmicable Relationships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBond of Friendship\u003c/p\u003e \u003cp\u003eMinimal verbal barriers\u003c/p\u003e \u003cp\u003eComfort in asking questions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBenefits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePersonal Development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-cognitive Skills enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCommunication skills\u003c/p\u003e \u003cp\u003eConfidence to speak in public\u003c/p\u003e \u003cp\u003eLeadership skills as a tutor\u003c/p\u003e \u003cp\u003eSelf- Control\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCognitive Skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMemory retention\u003c/p\u003e \u003cp\u003eProblem-solving Skills\u003c/p\u003e \u003cp\u003eActive Learning\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMotivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcademic Benefits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExam-driven efficient Learning,\u003c/p\u003e \u003cp\u003eConcepts clarification\u003c/p\u003e \u003cp\u003eMutual academic support\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSocial-Emotional Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEmotional attachment Comfort level\u003c/p\u003e \u003cp\u003eSocial support\u003c/p\u003e \u003cp\u003eFamiliarity with peers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eChallenges\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStudents as Teachers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLearning Pace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFast Learners\u003c/p\u003e \u003cp\u003eSlow Learners\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTutoring Skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eConsolidated prior knowledge\u003c/p\u003e \u003cp\u003eKnowledge sharing\u003c/p\u003e \u003cp\u003eEnhances learning\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHindrance to Engagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConflicting Timetables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUnavailability of peers\u003c/p\u003e \u003cp\u003eMismatched Schedules\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-Serious Behavior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDisruptive tools\u003c/p\u003e \u003cp\u003eCasual Attitude\u003c/p\u003e \u003cp\u003eLack of discipline\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eExpected Institutional Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLearning environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhysical Locations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQuiet Place\u003c/p\u003e \u003cp\u003eWeather Conditions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLack of Resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLimited access to Skill Lab\u003c/p\u003e \u003cp\u003eAvailability of models\u003c/p\u003e \u003cp\u003eInadequate hands-on practice\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFormalizing Peer Tutoring Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupportive Structured Modules\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTraining Sessions\u003c/p\u003e \u003cp\u003eFeedback Mechanism\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFlexible Self-Study Periods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdaptable Time Slots\u003c/p\u003e \u003cp\u003eCasual Sessions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eCategory 1: Arrangement of Peer Tutoring Session informally:\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e1.1: Organization of the sessions:\u003c/h2\u003e \u003cp\u003eThis theme was derived from the data when participants were asked to express their views on how they manage their time and decide the content to be discussed in these informal peer tutoring sessions. Participants were also asked about how they decided on their venue for conducting peer tutoring sessions. The responses from the participants varied in Initial preparation and Spontaneous Sessions subthemes.\u003c/p\u003e \u003cp\u003eSpontaneous sessions were exclusively student-driven and adhered to casual and comfortable settings in flexible timings for all members involved. These instructional periods were open, natural, and unplanned sessions that would allow the students to gather and join a group under the discussion topic as represented in the quote of participant.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It's generally a spontaneous process because no one really plans to find a group for study, or no one really plans to gather someone to teach a particular topic.\u0026rdquo;(P-15)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eMost of the participants have shown an inclination towards the pre-planned peer tutoring sessions. These are also exclusively student-driven but structured in terms of time, place of conducting the session, and content they want to learn. These sessions are planned ahead of some major tasks such as summative exams.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;For me, the peer tutoring process comes into play during exams, so we plan it by coming to college earlier and going to our specific location that does not have a lot of disturbance.\u0026rdquo;(P-22)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e1.2: Tutor and Tutee Selection:\u003c/h2\u003e \u003cp\u003eKnowledge-based criteria and amicable relationships have emerged as two sub-themes, also being the most evident reasons for deciding on tutoring roles. The criteria set for selecting a tutor is done after comparing the level of prior knowledge on a relative topic with each other. The learners as tutees would expect their peers as tutors to have the ability to teach for reinforcement of the concepts and enhance memory retention.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I am a tutee, and my friend is a tutor because she has a better way of explanation.\u0026rdquo; (P-9)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think that my peers should be knowledgeable about the subject that they're teaching,\u0026rdquo;(P-3)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCategory 2: Benefits of the sessions:\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e2.1: Personal Development:\u003c/h2\u003e \u003cp\u003eThe personal development theme is derived from the sub-themes related to the enhancement of cognitive and non-cognitive skills. Participants have expressed their satisfaction that peer tutoring sessions arranged with friends have supplemented their academic and non-academic skills. They learn to solve problems, actively participate in sharing knowledge, and discuss complex topics for clarification of concepts has all contributed to an increase in memory and they were able to cover larger content in less time.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When you study things from the book they're very volatile and you forget them easily but when you do it with friends, you build a deeper understanding\u0026rdquo;.(P-11)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e2.2: Motivation:\u003c/h2\u003e \u003cp\u003eThis theme highlights the aspects of academic goals and emotional and social support. Students were motivated to see their fellows learning to achieve a similar academic goal, that is excelling in exams. The shared motive to excel in academic years through progress in their assessments has engaged students in peer tutoring sessions.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;So one of the major factors that enable me to go for peer tutoring is that we all as students have shared academic goals, so we know that a certain topic is going to help us for our academic studies\u0026rdquo;(P-21)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe social and emotional bonds developed among peers were due to their interrelationships within the same training program. Peers being familiar with each other through being together in a learning environment played a vital role in building a comfort level that motivated them to learn and accomplish their learning objectives.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eCategory 3: Challenges:\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.1: Students as Teachers:\u003c/h2\u003e \u003cp\u003eThe theme has featured the sub-themes of learning pace and teaching skills as qualities of tutors that allow a learner to either join or leave peer tutoring sessions. Many participants had brought to focus that tutee learners are at different levels of learning and face a challenge to keep up the pace with the group. For many participants, tutors who were unable to take each member along forced them to leave the group of peer tutoring. It is the quality of the tutor to keep the session flexible to allow slow-paced learners to get the maximum benefit from the sessions.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Someone is a fast learner and some people are slow learners like me. So that really compels me to leave the group.\u0026rdquo;(P-17)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe type of skills that participants expressed in their peers as tutors were prior knowledge, the ability to share knowledge in a simplified way, and the ability to clarify the concepts at the level of understanding of the members of the peer tutoring group.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.2: Hindrance to Engagement:\u003c/h2\u003e \u003cp\u003eThis theme classifies the barriers faced by the participants in executing the peer tutoring process. When students want to engage in a learning process, conflicting timetables hinder their combined learning sessions. Participants are arranged in different batches in their institute but for peer tutoring, they would want to gather with their friends. So, the unavailability of peers had been mostly due to overlapping schedules and it had interfered with the execution of the participant\u0026rsquo;s peer tutoring sessions.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think that the most important factor which affect my decision to leave the group is the availability of my classmates\u0026rdquo;(P-6)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnother factor that participants faced as a barrier was the non-serious behavior of certain members including tutors. Irrelevant use of social media, unorganized learning content of the members, and diverting the conversations away from the desired outcome are the factors highlighted by participants that forced them to leave a certain group.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;For me, it's the non-serious attitude of my peers because of course, if they're not standing by themselves, how will they teach me? So that really is a mood killer. And that makes me leave the group.\u0026rdquo;(P-26)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eCategory 4: Expected Institutional Support:\u003c/h2\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003e4.1: Learning environment:\u003c/h2\u003e \u003cp\u003eThe institutional learning environment is a broader term that is comprehended at varying levels. Through interpretation of data, it was revealed that participants expressed a comfortable physical location that is quiet and can reduce the weather conditions. Participants had shown their grievances about the unavailability of spots that could allow them to assemble for casual learning during harsh summers or rainy days.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;During Summer it's harsh weather and we can't sit in the garden or somewhere to study.\u0026rdquo;(P-19)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe information collected about the resources also affected their comfort level within an institution. Resources pointed out by participants are the availability of models of anatomical structures in the skill lab of anatomy to understand the concepts better with friends. The participants desired to have access to the lab during their break time to sit together and study complicated topics. Few participants even highlighted the requirement of models for the neuroanatomy module to grasp the anatomical structures of the human brain and its extensions.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;So, I will suggest CNS and ANS module because it was such a lengthy module as there was so much sulci and gyri and all that. So, the method that I will suggest is, first of all, I'll ask everyone to organize study material and the models from the labs.\u0026rdquo;(P-25)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.2: Formalizing Peer Tutoring Program:\u003c/h2\u003e \u003cp\u003eLearners had moderately shown their interest in formalizing peer tutoring sessions. They had recommended having supportive structured sessions and flexibility in their self-study sessions. The participants showed a willingness to have support from faculty only in training tutors on how to deliver more functional and productive learning sessions with their peers. They wanted to be responsible for their learning at their own pace, in their comfortable learning environment with their friends. But at the same time desired to have support from expert faculty in terms of feedback for their progress and training the tutor.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I suggest training sessions and regular feedback mechanisms., structured study materials, and support from faculty to the tutor.\u0026rdquo;(P-10)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eStudents also highlighted having flexibility in self-study sessions. They wanted to have casual; informally organized group study sessions preferred with the fellows of their choice. Some participants even expressed to formalize a peer tutoring session for low achievers to have better learning with their peers without any communication barriers. The linkages of themes extracted from literature to themes extracted from data are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePeer tutoring is considered a useful skill that refines the delivery of instruction, promotes lifetime learning, and helps students become more knowledgeable and socially interactive. (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) Literature analysis confirms that informal peer tutoring complements academic success.(\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) It improves the motivation to learn and creates a feeling of connectedness among learners, thereby, allowing members of the groups to progress better as \u0026ldquo;tutee role\u0026rdquo; and \u0026ldquo;tutor role\u0026rdquo;. Peers engaged in tutoring sessions are motivated to set goals for their learning and monitor their learning progress, and behavior informally among their fellows.(\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) This study was aimed at exploring factors influencing peer tutoring and how the members strive to achieve excellence in their overall personal performance academically and generically. (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e)(\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e)\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eProposed Model of Peer-Tutoring Process in Informal Setting:\u003c/h2\u003e \u003cp\u003eKeeping in view the existing literature on different models of peer tutoring and the data analyzed a systematic approach is discussed on how to transition from informal peer sessions to formal peer sessions. (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e)The rationale for this recommendation is to allow undergraduate medical students to polish their teaching skills, organization, and search for learning content, and enhance their generic skills in phases. This will aid in sharing the burden of heavily committed faculty and can produce future doctors with more productive learning outcomes. According to the scoping review of Bowyer\u0026rsquo;s and Shaw, \u003cem\u003eWhat Goes Behind the Closed Doors\u003c/em\u003e, the study explains the query in the discussion. (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e)The closed doors phrase is metaphorically used for informal settings that learners choose for themselves, inside or outside the institution, for the collective purpose of learning. (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eLiterature has given enough evidence concerning initiatives taken by institutions in formalizing the peer tutoring program. Inflexibility in schedules and scarcity of feedback resulted in the discontinuation of the programs.(\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e) In view of the above concept, the study proposes distinct phases involved in any model of peer tutoring process defined by literature are shown in Fig.\u0026nbsp;7\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003ePlanning Phase:\u003c/h2\u003e \u003cp\u003eTo organize the tutoring sessions, institutions should recruit volunteers for tutor roles. In the selection policy, peers from the same class or senior years should be allowed. The content to be taught can be determined by the tutees. (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)The format of the sessions should be determined by the faculty based on the learning needs and can be incorporated as:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTutor-tutee pairs\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eOne Tutor and several tutees in a group\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eFor optimal pairing and group arrangement, factors need to be considered, such as learning styles and pace, frequency of the sessions, and schedules of tutors and tutees. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)Paired Tutoring provides individualized attention and targeted support customized to tutees' specific needs. A group format can address several learners with similar goals in the same sessions through discussion-based interaction. (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eA Structure of the sessions should be created to give the participants an overview on how they can execute the sessions thus, aiding in an increase in the number of volunteers. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)The framework should highlight the occurrence of sessions and the duration of these sessions. A template for sessions to include learning objectives in the form of knowledge reinforcement, competencies with active learning strategies, and maintenance of reflective journals. (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe provision of adequate resources should account for content-related and location. Availability of textbooks, worksheets, models, and other learning materials to support tutoring and learning. (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e) Institutions should ensure access to appropriate spaces for tutoring sessions which allows the learners to maintain their relaxed learning atmosphere where students can have casual conversations and are not intimidated from making mistakes. (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eExecution Phase:\u003c/h2\u003e \u003cp\u003eBefore conducting institution-assisted peer tutoring sessions, preparing for the sessions and delivering them effectively takes a lot of time outside of regular coursework. This struggle is initiated by the learner tutors themselves.(\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e) What they\u0026rsquo;ve prepared individually is what they want to share by tutoring. Hence, Tutors struggle to balance tutoring with their studies. This struggle of tutors can be catered to by the institution through the provision of relevant content and a relaxed, physically well-equipped venue. (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThis execution phase may or may not have faculty-supported sessions. This will have multidimensional influences on all three stakeholders, which are tutors, tutees, and institutions. (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e)The faculty-supervised sessions can be simultaneously considered as tutor training and evaluative sessions. These evaluative measures can be a source of gathering information to improve the program with collective views and performances of tutors and tutees. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e)Some students may be hesitant to ask for help from peers or participate in the tutoring process. Overcoming this resistance requires tutors to establish a good connection and showcase their expertise, which can be addressed effectively with the expert-supervised tutoring sessions. (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e)\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eEvaluation phase:\u003c/h2\u003e \u003cp\u003ePeriodic and consistent evaluation of the peer tutoring program should be carried out by gathering student feedback and performance data. This information is to be used to improve the program and resolve any issues that may arise. (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eInstitutions should also consider providing incentives such as academic credit, financial compensation, or other rewards to encourage students to participate as tutors. Additionally, recognition for tutors' contributions can be given through awards, certificates, or letters of recommendation. (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eImplications of findings:\u003c/h2\u003e \u003cp\u003eResearch indicates that peer tutoring can be especially helpful for younger students, low-achieving students, and minority groups. Customizing peer tutoring programs to provide targeted support to meet the specific needs of these populations can improve their effectiveness. The peer tutoring approach can be implemented by carefully designing the structure of the sessions. It offers significant benefits to medical institutions, with minimal financial costs or faculty time. It can also be considered that if a fully structured program cannot be formalized, then minor tutor training sessions can generate profound benefits among tutors.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitations\u003c/strong\u003e \u003cp\u003eThe informal setting encouraged openness but may have limited the depth of academic reflection. The small, purposively selected sample from pre-clinical subjects and a single-setting study has restricted generalizability. The credibility of the study was enhanced using theoretical and investigator triangulation. However, the use of multiple data collection tools and data source triangulation could not be implemented, which remains a limitation of the study. Finally, researchers\u0026rsquo; interpretation during thematic analysis may have introduced subjective bias despite efforts to ensure inter-coder reliability.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe study's data collection highlights the aspect of female gender pre-dominance as respondents in focus group discussions, specifically in the fourth round of FGD, which was composed of only female participants. Since the current focus of the study was not gender-specific, the participants\u0026rsquo; responses from mixed-gender group reflected consistent results with only female respondents' group. This aspect is not emphasized in the study; hence, future research should examine the impact of different genders on the effectiveness of peer tutoring, and researchers should highlight the gender-based approaches to the peer tutoring process.\u003c/p\u003e \u003cp\u003eFuture studies should focus on devising a flexible and adaptable model for peer tutoring programs that can incorporate various types of tutoring, such as Class-wide, Reciprocal, and Near-Peer, according to need. The need to explore phase-wise peer tutoring using various study designs will refine further foundations of peer tutoring process.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study focused on exploring informal peer tutoring sessions arranged by pre-clinical medical students and identifying facilitators and barriers that affect informal peer tutoring. It was observed that informal peer tutoring is a preferred learning method among medical students. This research has shown benefits in cognitive, psychomotor, and affective domains, as well as enhancing generic skills like self-confidence, time management, and team building. Overall, improving communication skills for counseling and presentations had a more pronounced effect on tutors and tutees as compared to a range of academic, cognitive, and social benefits. However, lack of resources, absence of a subdued atmosphere, and incoherent pace of teaching tutors were some of the major challenges reported by the participants of the study. These barriers also included the expected support that participants require from the institute to conduct their tutoring sessions with peers at their convenient time and place. Further researchers can examine the application of peer tutoring based on addressing the obstacles faced by the participants. This can provide a way forward to the process of implementing peer tutoring as a formal format of teaching and learning in medical curricula. Assessing how to formalize peer tutoring in the curricula can also pave the way for tutor training sessions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eUmme Ammarah Omer Malik wrote the main manuscript, conducted a comprehensive literature search, and planned and executed data collection procedures with an analysis of the dataShabana Ali supervised the entire study in a systematic manner, helped prepare figures and tables, was a member of the panel of experts who validated questions to be asked in focus group discussions, facilitated the venue for conducting focus group discussions, and assisted in the analysis and alignment of the data. Raheela Yasmmen supervised the entire process of the study, facilitated in acceptance certificate of the study, was a member of panel of experts who validated the questions to be asked in focus group discussions\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eI would like to express my sincere appreciation to Mr. M. Omer Malik for his invaluable support during the study. His guidance in managing work-life balance and encouragement in advancing my career as a medical educationist has been instrumental in my professional development.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eQualitative data is given in supplementary information files as following:1. Four FGDs Transcriptions as separate files - each giving the raw data of audio files conversion to text file. 2. Four Verbatim Transcriptions as separate files - each giving the aligned transcriptions as per verbatim guidelines and highlighted quotes that were used in coding cycles 3. Raw Data File - representing the codes extracted from transcription files\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMckimm J, Swanwick T. Understanding Medical Education: Evidence, Theory and Practice, Second Edition [Internet]. 2014. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.leadershipacademy.nhs.uk/\u003c/span\u003e\u003cspan address=\"http://www.leadershipacademy.nhs.uk/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSadia C, Shimmi M, Tanveer Hossain, Parash. Fairrul Masnah @ Kadir. Curriculum for Undergraduate Medical Sciences: Traditional, Integrated or Both. Borneo J Med Sci (BJMS). 2023;17(2):1\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbolbashari S, Moonaghi HK, Bazzaz MM. 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Peer-assisted learning (PAL): Skills lab tutors\u0026rsquo; experiences and motivation. BMC Med Educ. 2019;19(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBelsi A, Murtagh GM. Peer tutoring in clinical communication teaching: the experience of 1st year students and their peer tutors. MedEdPublish (2016) [Internet]. 2018 Jun 20 [cited 2023 Dec 25];7:135. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ncbi.nlm.nih.gov/pubmed/38074557\u003c/span\u003e\u003cspan address=\"http://www.ncbi.nlm.nih.gov/pubmed/38074557\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgius A, Stabile I. Undergraduate peer assisted learning tutors\u0026rsquo; performance in summative anatomy examinations: a pilot study. Int J Med Educ. 2018;9:93\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Informal, Medical Education, Peer Tutoring, Undergraduate Medical Students ","lastPublishedDoi":"10.21203/rs.3.rs-5537207/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5537207/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLearner-mediated peer teaching and their preferred learning strategies are neglected niches in the current era of medical education due to a lack of institutional focus. Peer tutoring is a pedagogical approach incorporated into teaching and learning in higher education to promote collaborative learning. It is usually executed when students face daily learning challenges and regulate their training process with their fellows through informally planned peer tutoring sessions.\u003c/p\u003e\n\u003cp\u003eThe study aims to inquire how mutual learning of peers in the peer tutoring process occurs, preferably in a casual, self-determined environment. The study also examines what factors enable or hinder learners in achieving academic outcomes in knowledge, competencies, and conduct. Theoretically, it aligns the concept of arrangement for studying as a determinant of cognitive and social congruence through the scope of Vygotsky’s Zone of Proximal Development.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt was an exploratory qualitative study that was conducted through purposeful sampling from learners belonging to pre-clinical years of undergraduate medical school. Four rounds of FGDs were conducted. Two rounds were conducted from both 1\u003csup\u003est\u003c/sup\u003e year and 2\u003csup\u003end\u003c/sup\u003e year medical students. The transcribed responses were manually analyzed to extract themes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEight themes were identified, each further divided into two sub-themes to evaluate the relevance of the data with the research objectives. It was observed that student-mediated peer tutoring, specifically in a casual and relaxed setting, is mostly an exam-driven consequence. The theme of “Organization of Sessions” highlighted subthemes of “Initial Planning” or “Spontaneous Arrangement”. The ”Tutor Roles” were based on the “Amicable Relationships” among peers, and “Knowledge-based Teaching” was preferred. Tutees showed significant satisfaction and trustworthiness with the content shared and instructional strategies used, with preferred informal language.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article gives an overview of the key concepts regarding the coexistence of peers as tutors and peers as tutees within the informal academic environment. The lack of scholarly literature on how these sessions are organized and conducted was identified as a research problem. The perceptions of learners actively involved in planning these sessions were investigated qualitatively. This exploratory investigation will benefit peer tutors and tutees and enhance the institution's educational environment.\u003c/p\u003e","manuscriptTitle":"Exploring Factors Affecting Informal Peer Tutoring Process Among Pre-Clinical Medical Students of a Private Medical College","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-02 17:14:22","doi":"10.21203/rs.3.rs-5537207/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5c61087c-762c-471d-ae6d-b181c5401a43","owner":[],"postedDate":"May 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-22T05:08:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-02 17:14:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5537207","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5537207","identity":"rs-5537207","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}