A Decade of Peer Tutoring: How Teaching Shapes Clinical Competence in Medical Education

A Decade of Peer Tutoring: How Teaching Shapes Clinical Competence in Medical Education | 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 A Decade of Peer Tutoring: How Teaching Shapes Clinical Competence in Medical Education Amanda Eklund, Teemu Silver, Ville Bister This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9401177/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Peer tutoring is widely used in undergraduate medical education, albeit its longer-term effects on tutors remain less well understood. This research examined how current and former peer tutors in a clinical skills programme perceived the effects of tutoring on learning during medical school, later work, and early career orientation. Methods A single centre, cross-sectional questionnaire study was conducted with convergent mixed-methods analysis at the University of Helsinki, Finland. All identifiable current and former Skills lab peer tutors from 2015 to 2025 were invited and 25 complete questionnaires were analysed. Quantitative data were analysed descriptively, and associations between tutoring exposure and student-period composite scores were examined using Spearman’s rank correlation. Open-ended responses were analysed using inductive content analysis. Results Twenty-five complete responses were analysed from 61 eligible tutors (41.0%). All respondents reported that peer tutoring had been rewarding. Most agreed that it had supported their development as physicians (24/25), developed skills relevant to professional practice (24/25), and enabled active influence over their own learning (23/25). Agreement was lower for understanding of pedagogy (17/25) and evidence-based practice (9/25). Higher annual tutoring workload instead of longer duration of service, was associated with higher student-period composite scores (rho = 0.47; Holm-adjusted p = 0.049). Among graduates, the strongest influence concerned continued active competence development after graduation and greater effectiveness as a teacher or supervisor at work, whereas perceived influence on career choice was uncommon. Open-ended responses most often concerned teaching and supervision, learning through teaching and reflection, and programme development. Participants described teaching as a way of consolidating knowledge, identifying gaps in understanding, and gaining confidence in supervising others. Conclusions Sustained peer tutoring in a clinical skills programme was perceived to support active learning during medical school, practical and interpersonal development, and later teaching and supervisory work. The reported benefits were strongest in enacted teaching and supervision rather than in explicit pedagogical or evidence-based understanding. A more structured tutor preparation program and closer collaboration with clinical teachers may strengthen these benefits. Medical education peer tutoring near-peer teaching (NPT) Peer-assisted learning (PAL) clinical skills professional development Figures Figure 1 Figure 2 Figure 3 Background Peer-assisted learning (PAL), has become an established component of undergraduate medical education, defined as “people from similar social groupings who are not professional teachers helping each other to learn and learning themselves by teaching.”(1) A subset of PAL is the concept of near-peer teaching (NPT), where the tutor is only a short educational distance ahead of the learner, typically a more senior student teaching a junior student within the same curriculum. (2) Interest in formal PAL has developed alongside increasing student numbers and pressure on clinical teaching capacity. However, PAL should be considered of importance past its effect on helping medical schools deliver teaching at scale. It is increasingly conceptualised as a developmental educational practice that may influence tutors’ own clinical competence, pedagogical growth, and early career paths. As peer tutors have recently completed the same curricular milestones, they may offer explanations, feedback, and role modelling that appear accessible, relevant, and psychologically safe to junior learners. In clinical settings, PAL has been studied in support of students’ transition from classroom learning to workplace learning while giving more senior students early experience of the teaching responsibilities expected of doctors. This mechanism seems especially relevant in clinical skills education. Khaw and Raw (2016) have described near-peer clinical skills teaching as acceptable and beneficial, with learners valuing the accessible atmosphere, correspondence with assessment needs, and teaching pitched at an appropriate level, while tutors reported improvement in knowledge consolidation, communication, facilitation, and teamwork. (3) Khalid et al. described similar findings in a 2-year integrated peer-tutored clinical skills programme, in which learners valued approachability, assessment relevance and an encouraging environment, while tutors reported improvement in facilitation and teamwork. (4) Benefits for tutors appear to extend past immediate clinical skills rehearsal. A systematic review by Burgess et al. describes many perceived improvements for student tutors, especially in teaching, communication and professional development (5), later arguing that PAL is most educationally productive when it is intentionally designed and supported, rather than assuming that asking senior students to teach will automatically produce high-quality learning for either group (6). Therefore, the relevant educational question is not the effectiveness of PAL, but rather the kinds of competence and professional role development it affords the student tutor. Recent work has begun to address the tutor-centred question more directly. One important contribution to the recent medical education literature is the suggestion that peer teaching may shape professional identity as well as teaching techniques. In a 2-year longitudinal interview study, Avonts et al. provided evidence that peer teachers’ motivation shifted from self-benefit towards helping others, while self-efficacy in both clinical and teaching skills increased over time. Participants described becoming role models, reflecting more actively on their own performance, and moving from assessment-driven learning towards learning aimed at becoming a good doctor. (7) This was interpreted as a developmental trajectory of maturation through the combination of multiple healthcare competence areas. This perspective of professional identity formation through integrated competence development fits well with competency-based medical education. The CanMEDS framework (8) defines physicians as medical experts and communicators, collaborators, leaders, professionals and scholars. Within the scholar role, physicians are tasked with engaging in ongoing learning, teaching students and other health professionals, and integrating the best available evidence into practice. Finnish objectives regarding competency-based medical education place similar emphasis on graduating doctors being able to interview and examine patients independently, work effectively in teams, communicate professionally and continue to develop their own competence. (9,10) Peer tutoring may therefore function as an authentic setting in which students rehearse teaching, feedback, reflection, teamwork and self-directed professional development before graduation. Recent tutor-centred studies indicate that these benefits are not automatic and depend substantially on programme design. Sahba et al. determined that student tutors frequently described insufficient formal preparation and wanted training that combined evidence-informed pedagogy with contextualised practice and feedback. (11) Simultaneously, in a multi-institutional qualitative study, Skjærseth et al. argued that peer teachers learn to facilitate rather than simply transmit knowledge, to recognise the limits of their own understanding, to adapt teaching to learner needs, and to foster psychological safety, but that these outcomes depend on accessible teaching opportunities, adequate preparation, agency and support during teaching. (12) Despite growing use of PAL and NPT, important gaps remain. Existing literature is cross-sectional, single-institutional and focused on specific skills sessions, assessment preparation or short-term perceptions of teaching quality. In comparison, considerably less is known about whether sustained participation in peer tutoring shapes tutors’ later clinical self-perceptions, workplace teaching roles, interest in academic medicine, or early career trajectories after graduation. This is an important research area at a time when medical schools need both scalable clinical teaching models and a future workforce willing to assume educational responsibilities. PAL and NPT further improve accountability, which is a core concept of competency-based medical education systems. (13) At the Faculty of Medicine, University of Helsinki, Skills lab provides a research setting in which to examine these questions. The Skills lab peer tutoring system is a structured skills workshop centred on practical skills and simulation pedagogy, with peer tutoring beginning in 2015. By the end of 2025, the programme had therefore completed a decade of operation. Over this period, Skills lab has included student-led teaching in procedural skills, physical examination, patient interviewing, themed sessions, interprofessional learning and simulation exercises. This breadth and continuity provide a rare opportunity to study how peer tutoring may influence both self-perceived clinical competence and later career development. Therefore, the present study aims to research how current and former Skills lab peer tutors perceive the effects of tutoring on their own learning, self-perceived clinical competence, teaching and supervisory skills, and early career orientation. Methods Study design and setting This study was a single-centre, cross-sectional questionnaire study with a convergent mixed-methods analysis approach, conducted at the Faculty of Medicine, University of Helsinki, Finland. This study examined the self-perceived educational and career-related impact of serving as a peer tutor in Skills lab, a student-led clinical skills teaching programme established in 2015. Quantitative and qualitative data were collected concurrently within a single Finnish-language online questionnaire and were analysed separately before integration at the interpretation stage. Data were collected and managed using REDCap. (14) Participants and recruitment A census-based invitation strategy was used. All identifiable current and former Skills lab peer tutors in programme records were eligible, providing an invitation population of 61 individuals: 18 current tutors and 43 graduates. Invitations were distributed by email through a generic survey link. No personalised survey links were used. Participation was voluntary and questionnaire involved no direct identifiers. However, as the cohort of current and former peer tutors was small, the dataset was treated as indirectly identifiable. Background variables were therefore collected in general categories, and all reporting was designed to minimise deductive disclosure. For current employment and career effects, the focus was on graduates. Current students and the most recent 2025 graduates were excluded from the postgraduation analysis as they had limited postgraduation work experience. Questionnaire development and content The questionnaire was developed specifically for this study by the authors, informed by previous literature on peer-assisted learning and near-peer teaching, and refined with input from experienced clinical educators with longstanding experience in Skills lab. The instrument covered four domains: background characteristics, experiences of peer tutoring during medical school, perceived effects of peer tutoring on work and career after graduation and attitudes and future plans relating to specialisation, teaching, and research. An institutional ethical research review was obtained from the University of Helsinki Faculty of Medicine Research Ethics Committee (Approval Decision 14/2025). Background items included age group, graduation year or student status, duration of service as a peer tutor, estimated annual tutoring workload, current career stage, speciality group, academic degree, and current employment role. The first structured item category comprised 11 five-point Likert items addressing the medical school period, including reward, active influence over learning, development of professionally relevant skills, interest in teaching, leadership, self-appraisal of competence, evidence-based practice, independent competence development, and understanding of pedagogy. The second structured item category comprised 7 postgraduation Likert items addressing perceived effects on work and career, including usefulness of tutoring-derived skills, effectiveness as a teacher/supervisor, active competence development, workplace skills, teamwork, and career influence. This section also included a “not applicable” response option. The survey further included multiple-response items on specialisation, teaching and supervision roles, clinical teaching, and research, alongside open-ended questions on perceived benefits, career influence, teaching development, programme limitations, and suggested improvements. Outcome measures The primary outcomes were self-perceived effects of peer tutoring on learning and professional development, particularly on the development of clinical competence, self-directed learning, reflective capacity, and teaching and supervisory capabilities. Secondary outcomes were self-reported career-related effects, including perceived influence on career choices, current or intended teaching responsibility, specialisation intentions, and research aspirations. The principal exposure variables were duration of service as a peer tutor and self-estimated annual tutoring workload. Analysis Quantitative analysis was primarily descriptive. Responses to the 11 student-period Likert items were coded from 1 = strongly disagree to 5 = strongly agree and summed to form an exploratory 11-item overall composite score (possible range 11-55), with higher scores indicating more favourable perceived educational impact during medical school. Item-level results are reported as counts and percentages for each response category, the proportion agreeing or strongly agreeing with exact 95% binomial confidence intervals, and the median. Internal consistency of the 11-item composite was assessed using Cronbach’s alpha. Exploratory inferential analyses were used to examine whether greater peer-tutoring exposure was associated with more favourable self-reported educational impact. Exposure was operationalised as duration of peer-tutor service and estimated annual tutoring workload, both treated as ordinal variables. Associations between these exposure measures and the overall student-period composite score were examined using Spearman’s rank correlation coefficient. Differences in overall student-period composite scores across independent career-stage groups were examined using the Kruskal-Wallis test. Due to the small sample size and the absence of a non-tutor comparison group, inferential findings were interpreted cautiously, with emphasis placed on effect size, direction, and consistency. All inferential analyses were exploratory and two-sided. Raw p-values were supplemented with Holm-adjusted p-values. Open-ended responses were analysed using inductive qualitative content analysis. The study aims were grouped into subcategories and general themes. The analysis approach followed the principles described by Elo and Kyngäs (15) and by Graneheim and Lundman (16), in regard to credibility, transparency, and trustworthiness. The frequency of coded segments was reported descriptively to indicate the relative prominence of themes. Quantitative and qualitative data were analysed separately and integrated at the interpretation stage using complete cases only no imputation was performed. Data analysis was performed using RStudio (Posit Software, PBC, version 2025.09.2+418). Results Background characteristics Of the 61 eligible current and former Skills lab peer tutors, 27 returned questionnaires and 25 complete responses were included in the analysis, corresponding to a complete-case response rate of 41.0% overall, 46.5% among graduates, and 27.8% among current tutors/students. Respondents were predominantly aged 26-35 years (19/25, 76.0%). Five participants were current medical students and 20 were graduates. The largest tutoring-duration categories were 1 year or more (10/25, 40.0%) and 2 years or more (11/25, 44.0%), and the most common estimated annual tutoring workload was 40-60 hours (10/25, 40.0%) ( Table 1 ). Table 1 . Participant characteristics Complete cases, n = 25 Characteristic n (%) Age group 21-25 <3 (<8.0%) 26-30 11 (44.0%) 31-35 8 (32.0%) 36-40 4 (16.0%) 41-45 <3 (<8.0%) Graduation year / student status Undergraduate medical student 5 (20.0%) 2025 3 (12.0%) 2024 5 (20.0%) 2023 <3 (<8.0%) 2022 <3 (<8.0%) 2021 4 (16.0%) 2020 <3 (<8.0%) 2019 <3 (<8.0%) 2018 <3 (<8.0%) Duration of service as peer tutor 1 year 10 (40.0%) 2 years 11 (44.0%) 3 years 3 (12.0%) 4 years <3 (<8.0%) Estimated annual tutoring workload 10-20h 5 (20.0%) 20-40h 6 (24.0%) 40-60h 10 (40.0%) 60-80h <3 (100h <3 (<8.0%) Derived career stage Specialty trainee 13 (52.0%) Qualified doctor 6 (24.0%) Student 5 (20.0%) Specialist physician <3 (<8.0%) Current work role Specialty trainee 11 (44.0%) General practitioner 5 (20.0%) Student 5 (20.0%) Researcher <3 (<8.0%) Specialist physician <3 (<8.0%) Other <3 (<8.0%) Specialty group among respondents reporting a specialty Surgical specialties 6 (50.0%) Medical specialties 4 (33.3%) Diagnostic specialties <3 (<16.7%) Primary care <3 (<16.7%) Academic degree Licentiate of Medicine (primary medical qualification) 13 (65.0%) Doctor of Medicine (doctoral degree; PhD-equivalent) 5 (25.0%) Bachelor of Medicine (undergraduate) <3 (<10.0%) Experiences of peer tutoring during medical school Responses concerning the medical school period indicated a positive inclination towards peer tutoring ( Figure 1 ). All respondents indicated agreement that peer tutoring had been rewarding (25/25, 100.0%). High agreement was also observed for supporting their development as physicians (24/25, 96.0%), developing skills relevant to professional practice (24/25, 96.0%), enabling active influence over their own learning (23/25, 92.0%), and being manageable alongside other studies (23/25, 92.0%). The level of agreement regarding interest in teaching was expressed by 22/25 respondents (88.0%). More heterogeneous distributions were seen for leadership development (19/25, 76.0%), supporting ongoing independent competence development (18/25, 72.0%), self-appraisal of competence (17/25, 68.0%), and understanding of pedagogy (17/25, 68.0%). The lowest level of agreement item was increased understanding of evidence-based practice, with 9/25 respondents (36.0%) agreeing or strongly agreeing, with the median response remaining neutral. The subgroup comparisons by career stage also provided a difference in median scores, with the highest medical school period responses among current students and lower medians among graduates and respondents in speciality training. The median overall medical school total was 45/55 (IQR 44-50). The median development subscale score was 21/25 (IQR 20-23), and the median pedagogy or self-directed learning subscale was 24/30 (IQR 22-26). In the composite-score analyses, annual tutoring workload was positively associated with the medical-school total score (Spearman rho = 0.47, raw p = 0.016; Holm-adjusted p = 0.049), whereas duration of tutoring service was not (rho = 0.16, raw p = 0.431; Holm-adjusted p = 0.862). Medical-school total scores did not differ significantly across career-stage groups (Kruskal-Wallis raw p = 0.496; Holm-adjusted p = 0.862). These findings suggest that tutoring intensity, rather than duration of participation, was associated with more favourable self-perceived educational impact. Internal consistency of the 11-item medical-school composite was deemed acceptable (Cronbach’s alpha = 0.75). Perceived effects of peer tutoring on work and career after graduation Postgraduation items were summarised among all graduates (n = 20), with item-specific applicable denominators ( Figure 2 ). Agreement was highest for continued active competence development after graduation (20/20, 100.0%) and stronger effectiveness as a teacher or supervisor in the workplace (18/20, 90.0%). Most graduates also reported that tutoring-derived skills had been repeatedly useful in practice (15/20, 75.0%), that peer tutoring had had a positive overall effect on their career (15/20, 75.0%), that it had strengthened workplace and interpersonal skills (16/20, 80.0%), and that it had improved their ability to work effectively in different teams (13/20, 65.0%). In contrast, only 4/19 applicable respondents (21.1%) agreed that peer tutoring had influenced career choice directly, and the median response for this item was neutral. Figure 3 shows subgroup distributions at the item level. Current students generally rated items more positively compared to other career stages. Postgraduate qualitative responses concerned future employment-related findings. The most frequent postgraduation themes concerned teaching and supervision, clinical confidence, and readiness to take on broader professional roles. Representative comments in this regard are, “I learned that I enjoy teaching and would like to become a trainer physician,” and “My readiness to guide less experienced colleagues is higher.” Other respondents emphasised transferability to practice: “peer tutoring fostered an open attitude toward new tasks and multiprofessional collaboration.” A smaller countertheme was also present, with brief responses such as “I have not noticed any clear benefit” and “Not really anything.” Attitudes and future plans relating to specialisation, teaching and research Interest in future teaching and specialisation was described as high. Altogether 21/25 respondents (84.0%) reported an intention to specialise. Also, eleven (44.0%) respondents reported that their current role already included teaching or supervision, while 20/25 (80.0%) indicated that they would like such responsibility alongside clinical work in the future. One respondent had already worked as a clinical teacher, but 14/25 (56.0%) aimed to do so in future. Research orientation followed a different pattern. Nine respondents (36.0%) reported having worked as full-time researchers, and only two (8.0%) wanted to do so in future. Most respondents planned to specialise and also expressed interest in including teaching or supervisory responsibility in their future clinical work, albeit not necessarily in full-time research roles. Table 3. Qualitative themes from open-ended responses Theme, n/N (%) Theme analysis Participant q uotation s Learning through teaching and reflection, 15/82 (18.3%) Consolidation of knowledge through repeated teaching, recognition of one’s own knowledge gaps, deeper engagement with underlying theory, and use of teaching as a learning strategy. “I noticed which things I myself was still unclear about when a student asked.” “The things I taught stayed very well in mind. “Through teaching, I learned the underlying theory very thoroughly: why something is done the way it is.” “Greater analytical thinking when learning new things; I have learned to learn more efficiently.” “Using teaching as a learning tool.” “Themed days helped me learn subjects that interest me in greater depth.” Leadership, teamwork and organisation, 8/82 (9.8%) Leadership in teaching situations, organisation of learning activities, development of teamwork, self-awareness, and time management. “I was able to conceptualise a new training format quite freely. I learned leadership and learned to present myself.” “Recognising my own strengths and weaknesses, teamwork skills, and time management.” “I am able to work more independently and take responsibility in new situations.” Teaching and supervision, 27/82 (32.9%) Readiness to guide junior learners and colleagues, ability to adapt teaching to different learners, management of larger groups, giving feedback, and later confidence in supervisory roles. “I learned the importance of a safe learning environment and encouragement, especially when a student has already failed once and trying again feels intimidating.” “My readiness to guide less experienced colleagues is higher than that of my classmates.” Clinical skills and confidence, 8/82 (9.8%) Growth in manual skills, willingness to practice, procedural confidence, and confidence in acting despite uncertainty or fear of failure. “Practical skills improved, and I became more willing to practise them.” “My confidence in tasks requiring manual skill increased.” Career orientation and role expansion, 9/82 (11.0%) Emergence of an educator role, openness to broader workplace responsibilities, and continuation of simulation or supervisory work, without strong evidence of direct influence on career choice itself. “I learned that I enjoy teaching and would like to become a trainer physician.” “Peer tutoring fostered an open attitude to new tasks and responsibilities at work.” “A more open attitude to new tasks and areas of responsibility at work, such as supervising junior students and collaborating or developing ideas with other professional groups such as nurses.” Programme development and resources, 10/82 (12.2%) Requests for more tutor training, closer collaboration with clinical teachers, greater continuity in leadership, more capacity, and stronger institutional resourcing. “I would have liked more training for tutors in different areas.” “More collaboration between peer tutors and clinical teachers is needed.” “More collaboration between peer tutors and clinical teachers is needed in themed sessions. It is important that when a peer tutor teaches capable medical students, an expert in the subject area is present to answer more demanding questions. Everyone learns from that, and tutors also see different supervisory and teaching styles.” No clear benefit, 5/82 (6.1%) Neutral or skeptical responses indicating that the qualitative material was not uniformly affirmative. “I have not noticed any.” “It is hard to say. I do not know how competent I would have been if I had used the same amount of time on something else.” Note: All quotations were translated from Finnish by the authors. Frequencies refer to coded segments rather than respondents. An individual respondent could contribute more than one coded segment. After excluding blanks and dash-only placeholders, there were 17 analyzable responses to “largest benefit for career development”, 18 to “largest benefit for learning/competence development”, 11 to “concrete benefits for career development”, 14 to “concrete benefits for competence development”, 12 to “concrete benefits for teaching/supervision development”, 7 to “what did not work / development suggestions”, and 3 to “anything else”. Across the open-ended material ( Table 3 ), 82 open answer segments were identified. The most frequent themes were teaching and supervision (27/82, 32.9%) and learning by teaching and reflection (15/82, 18.3%), followed by programme development and resources (10/82, 12.2%), career orientation and role expansion (9/82, 11.0%), leadership and teamwork and organisation (8/82, 9.8%), clinical skills and confidence (8/82, 9.8%), and no clear benefit (5/82, 6.1%). In relation to future orientation and programme development, respondents repeatedly described a need for more structured tutor training, closer collaboration with clinical teachers, and more institutional resources for peer teaching. In this regard, one participant noted, “I would have liked even more training for tutors in different areas,” and “More collaboration between peer tutors and clinical teachers.” The open-ended responses also describe the perceived benefits of tutoring during medical school, in particular, learning-through-teaching and practical skill development. Representative statements included, “Teaching others is the best way to make a topic stick,” and “Through teaching, I learned theory behind things very thoroughly-why things are done the way they are.” Respondents also frequently described procedural confidence, with the following representative statement: “Practical skills improved, and my confidence in performing tasks that require manual skills increased,” and “Excellent cannulation skills.” Discussion Principal findings Peer tutoring was found to primarily associate with positive self-perceptions of learning, practical professional development, and later workplace teaching or supervision. The highest level of agreement area presented around reward, active involvement in learning, practical skills for professional work, and becoming a more effective teacher or supervisor after graduation. In contrast, the lowest levels of agreement were observed in understanding of evidence-based practice and explicit pedagogical theory. These findings indicate that respondents located the main value of Skills lab in experiential learning, repeated practice, and educational role rehearsal, rather than in the acquisition of formal pedagogical theory or career direction. A second notable finding was that the intensity of involvement appeared more informative than duration. These findings suggest that the intensity of participation may be more consequential than the longevity of service when respondents reflect on how peer tutoring shapes learning during medical school. Most peer tutors in Skills lab start in their third year and stay throughout the rest of their studies, with only a small subset quitting earlier for different reasons. This result seems to indicate alignment with an interpretation of peer tutoring as a form of deliberate, repeated educational practice. This was evident among respondents who taught more frequently. They may have had more opportunities to rehearse, explain, supervise, and reflect than those whose involvement extended over a longer period, but at a lower intensity. Thirdly, graduates commonly expressed feeling that tutoring had made them more effective teachers and supervisors and had supported active postgraduation development. This would suggest that peer tutoring may shape how graduates inhabit clinical work and educational responsibilities. Relation to prior literature The findings of this study indicate consistency with the classic rationale for peer teaching as described by Ten Cate and Durning, who argued that peer teaching is valuable for reducing faculty burden, providing accessible role models to improve motivation, and preparing future doctors for their educational role. ( 2 ) Alignment is also found in the present results with Topping’s broader account of peer tutoring as a reciprocal educational arrangement with cognitive, social, and organisational benefits. ( 1 ) These findings can also be interpreted against the broader national context described in the Finnish Medical Association’s nationwide education survey of 1,227 medical students. ( 17 ) Here, the clearest unmet educational needs concerned practice-based learning where 80% of respondents wished for more opportunities to perform clinical procedures and 67% wished for more opportunities for patient encounters and examination. The concern about the accumulation of medical competence became more pronounced toward the later years of study and emphasised that adequate orientation, feedback, and senior support are important for the development of professional self-confidence. The current results on practical skill development, learning through teaching, and increased confidence in later supervisory roles suggest that structured peer tutoring may help address needs that are also visible at the national level. The present findings also extend the literature in an area where evidence remains relatively sparse, the longer-term tutor perspective. Burgess et al. concluded that evidence for tutor benefits is strongest in communication, teaching, and professional development, but much less is known about later work roles or career development.( 6 ) Avonts et al. subsequently argued longitudinally that peer teachers may evolve from self-focused motives towards helping others, improve self-efficacy in clinical and teaching skills, and grow into role-model identities.( 7 ) The present findings are broadly consistent with those findings as respondents described teaching as a mechanism for consolidating their own learning, developing confidence, and normalising later supervisory roles. However, these responses also suggest that the most durable effect may be on postgraduate workplace teaching identity rather than on formal career choice. Ng et al.’s qualitative study of placement mentoring highlighted integration into the clinical team, feedback, and clearer expectations as central features of a successful mentoring experience. They concluded that mentor training could improve the consistency of mentoring experiences, helping ensure all students receive comparable support. ( 18 ) This finding provides agreement with the current respondents’ requests for more structured tutor development, clearer collaboration with clinical teachers, and stronger educational infrastructure around the peer-tutor role. Secondly, Coakley et al. researched improved near-peer support for newly qualified doctors and, in their findings, emphasised transition-to-practice support and professional identity. ( 19 ) The present graduates’ accounts of increased readiness to supervise junior colleagues, stronger confidence in workplace teaching, and sustained self-development seem to show alignment in this regard as well. The present findings also seem to fit with the wider subject of professional identity formation. Haruta et al. described professional socialisation as a staged process spanning medical school and later clinical roles. In this regard, Skills lab may be understood as a structured “bridge space” in which students rehearse roles they will later perform more formally as doctors, teachers, supervisors, team members, and organisers. The dominant themes of teaching and supervision, learning-by-teaching, and leadership and teamwork would seem to support that interpretation. Similarly, Mulholland et al. argued that doctors remain teachers whether or not they explicitly identify as such.( 20 ) In the present study, the high level of interest in future teaching responsibility suggests that peer tutoring may make this implicit professional expectation more explicit and more acceptable to learners early in their careers. One of the more interesting findings was the relatively low level of agreement regarding the evidence-based practice and explicit pedagogy items compared with the higher level of agreement for practical learning and later supervision. This may indicate that participation in a clinical skills peer-tutoring programme does not automatically translate into explicit awareness of educational theory. Instead, the programme appears to generate tacit pedagogical capability more readily than explicit pedagogical language. This distinction is educationally important. Implications for programme design and career development The programme-development suggestions offered by respondents point towards a need for more tutor training, more collaboration with clinical teachers, clearer continuity of responsibility, and more resourcing, which point towards a requirement of a more professional educational structure. These findings also support consideration of a structured educator-development strand within or alongside Skills lab. For example, short tutor development sessions on feedback, learner support, facilitation of simulation debriefing, psychologically safe supervision, and translating tacit clinical know-how. Such an approach would also better align the programme with competency-based frameworks in which doctors are expected to teach, supervise, collaborate, and continue learning throughout practice. Strengths, limitations and implication for future research This study has several strengths. It examines a decade of a structured peer-tutoring programme and provides a distinction between the perceptions of medical students and those of graduated doctors. It includes both current and former tutors, which allows a comparison between the medical school period and the early postgraduation career. In terms of limitations, the response rate was modest, and self-selection bias is likely to be present. Respondents who were especially positive or especially critical may have been more inclined to participate. Second, all outcomes were self-reported, and many graduate accounts were retrospective, introducing some extent of recall bias. Thirdly, there was no non-tutor comparison group, so the causal effects of tutoring on competence or career outcomes could not be demonstrated. Further work could address multi-centre longitudinal studies to determine whether the pattern seen here is reproduced across different institutional settings, curricular structures, and peer-tutoring models. Comparative designs, including non-tutors or tutors with different levels of teaching exposure, would be interesting in clarifying whether the apparent importance of tutoring intensity is reproducible.Future research should also address mechanism. The present findings carefully suggest that repeated enactment of the tutor role may matter more than simple duration and that tutoring may develop tacit pedagogical capability more readily than explicit pedagogical understanding. Conclusions The present findings suggest that sustained participation in Skills lab peer tutoring might be associated, in participants’ own accounts, with three closely related forms of development: greater agency in learning during medical school, strengthening of practical and interpersonal capacities relevant to clinical practice, and preparedness for subsequent teaching and supervisory responsibilities. Peer tutoring appeared to influence less the eventual direction of career choice than the manner in which graduates later approached clinical work, particularly in relation to guiding others, working collaboratively, and maintaining active professional development after qualification. The results further indicate educational value of tutoring primarily in repeated enactment of the tutor role. Higher tutoring workload, rather than longer duration of service, was associated with more favourable student-period evaluations, whereas improvement in explicit pedagogical and evidence-based understanding was less evident. Although the single-centre, cross-sectional, self-report design precludes causal inference, the results support the view on peer tutoring can be understood as a pragmatic means of delivering clinical skills teaching and a structured setting for and early professional development. More systematic tutor preparation, closer integration with clinical teachers, and stronger pedagogical emphasis may further strengthen that contribution. Declarations Grammarly (Grammarly, Inc., Version 1.156.1.0) was used to assist with language editing and improve the clarity of the manuscript. All content was reviewed and verified by the authors. Authors declare full responsibility for the entire content of the manuscript. Ethics approval and consent to participate All participants were provided written informed consent, and the survey was conducted on a voluntary basis. The study was approved by the University of Helsinki Faculty of Medicine Board of Research Ethics (20.5.2025, Decision number: 14/2025). Availability of data and materials Data is available upon reasonable request from the authors and subject to the restrictions imposed by the ethics approval. Acknowledgements We would like to thank all Skills-lab peer-tutors, current and former, and the teachers for making this possible. In addition, we are grateful for the initiators Risto Renkonen, Kirsi Rauhala, Klaus Olkkola, Anne Pitkäranta, and Hanna Lampela who made possible to start this peer-tutoring. But above all, the Skills lab co-ordinators Marit Raukola and Minna-Maria Mattila deserve our warmest thanks for maintaining the daily routines, without which this study would not have been possible. Competing interests The authors declare no competing interests. Funding This research did not receive funding. References Topping KJ. The Effectiveness of Peer Tutoring in Further and Higher Education: A Typology and Review of the Literature. Education [Internet]. 1996. Available from: https://www.jstor.org/stable/3448075 Ten Cate O, Durning S. Dimensions and psychology of peer teaching in medical education. Med Teach. 2007;29(6):546–52. 10.1080/01421590701583816 . Khaw C, Raw L. The outcomes and acceptability of near-peer teaching among medical students in clinical skills. Int J Med Educ. 2016;7:189–95. 10.5116/ijme.5749.7b8b . Khalid H, Shahid S, Punjabi N, Sahdev N. An integrated 2-year clinical skills peer tutoring scheme in a UK-based medical school: perceptions of tutees and peer tutors. Adv Med Educ Pract. 2018;9:423–32. 10.2147/AMEP.S159502 . Burgess A, McGregor D, Mellis C. Medical students as peer tutors: a systematic review. BMC Med Educ. 2014;14(1):115. 10.1186/1472-6920-14-115 . Burgess A, van Diggele C, Roberts C, Mellis C. Planning peer assisted learning (PAL) activities in clinical schools. BMC Med Educ. 2020;20(S2):453. 10.1186/s12909-020-02289-w . Avonts M, Bombeke K, Michels NR, Vanderveken OM, De Winter BY. How can peer teaching influence the development of medical students? a descriptive, longitudinal interview study. BMC Med Educ. 2023;23(1):861. 10.1186/s12909-023-04801-4 . The Royal College of Physicians and Surgeons of Canada. Ottawa (ON). The Royal College of Physicians and Surgeons of Canada [Internet]. 2026 [cited 2026 Mar 18]. CanMEDS Guide. Available from: https://canmeds.royalcollege.ca/guide Niemi-Murola L, Merenmies J. Peruskoulutuksen osaamistavoitteet uudistuvan erikoislääkärikoulutuksen perustana. Duodecim. 2019;135(135):477–85. Merenmies J et al. Valmistuvan lääkärin osaamistavoitteet 2020. 2020;17. Sahba SG, Bonnevier A, Stenfors T, Kenne E. Learning to teach by teaching your peers: exploring students’ needs for training in the undergraduate medical education curriculum. BMC Med Educ. 2025;25(1). 10.1186/s12909-025-07022-z . PubMed PMID: 40119411. Skjærseth IG, Mildestvedt T, Bonnevier A, Sharma SP, Kvernenes M. Learning Outputs for Peer Teachers in Undergraduate Medical Education. Med Sci Educ. 2025;35(3):1617–26. 10.1007/s40670-025-02365-0 . Carraccio CL, Englander R. From Flexner to Competencies. Acad Med. 2013;88(8):1067–73. 10.1097/ACM.0b013e318299396f . Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inf. 2019;95:103208. 10.1016/j.jbi.2019.103208 . Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107–15. 10.1111/j.1365-2648.2007.04569.x . Graneheim UH, Lindgren BM, Lundman B. Methodological challenges in qualitative content analysis: A discussion paper. Nurse Educ Today. 2017;56:29–34. 10.1016/j.nedt.2017.06.002 Lääkäriliitto S, Medisiinariliitto S. Opiskelijatutkimus 2024 [Internet]. Helsinki: Suomen Lääkäriliitto; 2025. Available from: https://www.laakariliitto.fi/wp-content/uploads/2025/02/Opiskelijatutkimus-2024.pdf Ng KYB, Lynch S, Kelly J, Mba O. Medical students’ experiences of the benefits and influences regarding a placement mentoring programme preparing them for future practice as junior doctors: a qualitative study. BMJ Open. 2020;10(1):e032643. 10.1136/bmjopen-2019-032643 . Coakley N, Wiese A, O’Leary P, Bennett D. Experience of enhanced near-peer support for new medical graduates of an Irish university: a phenomenological study. BMJ Open. 2023;13(5):e069101. 10.1136/bmjopen-2022-069101 . Mulholland M, McNaughten B, Bourke T. Im a doctor, not a teacher’: the roles and responsibilities of paediatricians in relation to education. Arch Dis Child Educ Pract Ed. 2022;107(3):223–6. 10.1136/archdischild-2020-320266 . Additional Declarations No competing interests reported. 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postgraduation question items (A-D).\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9401177/v1/e1b30643c6c51f1c21b0fb78.jpeg"},{"id":109279099,"identity":"e7e48de7-a65d-4ee8-a892-ff60b67a8a4e","added_by":"auto","created_at":"2026-05-14 16:17:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":113788,"visible":true,"origin":"","legend":"\u003cp\u003eGraduate responses categorised according to teaching responsibility in current employment.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9401177/v1/a05f663ac84282e8ccbf3721.png"},{"id":109279101,"identity":"d4b7f443-ee73-469f-85bd-9ff6c1c7a30f","added_by":"auto","created_at":"2026-05-14 16:17:07","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":406780,"visible":true,"origin":"","legend":"\u003cp\u003eResponses according to career stage and tutor workload.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-9401177/v1/f17224a7c811db0bb7ac5dcb.png"},{"id":109297297,"identity":"f5c1e89c-8e2b-4dfb-8d91-c85ec7cca4c5","added_by":"auto","created_at":"2026-05-15 08:55:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1515018,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9401177/v1/cff28925-05a9-4672-b160-dc831d5831cb.pdf"},{"id":109296110,"identity":"e6b86f23-3754-4a4d-8728-b469a18349c0","added_by":"auto","created_at":"2026-05-15 08:45:44","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":41057,"visible":true,"origin":"","legend":"","description":"","filename":"Supplements.docx","url":"https://assets-eu.researchsquare.com/files/rs-9401177/v1/1efe38c5e17c04886297dfea.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Decade of Peer Tutoring: How Teaching Shapes Clinical Competence in Medical Education","fulltext":[{"header":"Background","content":"\u003cp\u003ePeer-assisted learning (PAL), has become an established component of undergraduate medical education, defined as “people from similar social groupings who are not professional teachers helping each other to learn and learning themselves by teaching.”(1) A subset of PAL is the concept of near-peer teaching (NPT), where the tutor is only a short educational distance ahead of the learner, typically a more senior student teaching a junior student within the same curriculum. (2)\u0026nbsp;Interest in formal PAL has developed alongside increasing student numbers and pressure on clinical teaching capacity. However, PAL should be considered of importance past its effect on helping medical schools deliver teaching at scale. It is increasingly conceptualised as a developmental educational practice that may influence tutors’ own clinical competence, pedagogical growth, and early career paths. As peer tutors have recently completed the same curricular milestones, they may offer explanations, feedback, and role modelling that appear accessible, relevant, and psychologically safe to junior learners.\u003c/p\u003e\n\u003cp\u003eIn clinical settings, PAL has been studied in support of students’ transition from classroom learning to workplace learning while giving more senior students early experience of the teaching responsibilities expected of doctors. This mechanism seems especially relevant in clinical skills education. Khaw and Raw (2016) have described near-peer clinical skills teaching as acceptable and beneficial, with learners valuing the accessible atmosphere, correspondence with assessment needs, and teaching pitched at an appropriate level, while tutors reported improvement in knowledge consolidation, communication, facilitation, and teamwork. (3) Khalid et al. described similar findings in a 2-year integrated peer-tutored clinical skills programme, in which learners valued approachability, assessment relevance and an encouraging environment, while tutors reported improvement in facilitation and teamwork. (4)\u003c/p\u003e\n\u003cp\u003eBenefits for tutors appear to extend past immediate clinical skills rehearsal. A systematic review by Burgess et al. describes many perceived improvements for student tutors, especially in teaching, communication and professional development (5), later arguing that PAL is most educationally productive when it is intentionally designed and supported, rather than assuming that asking senior students to teach will automatically produce high-quality learning for either group (6). Therefore, the relevant educational question is not the effectiveness of PAL, but rather the kinds of competence and professional role development it affords the student tutor.\u003c/p\u003e\n\u003cp\u003eRecent work has begun to address the tutor-centred question more directly. One\u0026nbsp;important contribution to the recent medical education literature is the suggestion that peer teaching may shape professional identity as well as teaching techniques. In a 2-year longitudinal interview study, Avonts et al. provided evidence that peer teachers’ motivation shifted from self-benefit towards helping others, while self-efficacy in both clinical and teaching skills increased over time. Participants described becoming role models, reflecting more actively on their own performance, and moving from assessment-driven learning towards learning aimed at becoming a good doctor. (7) This was interpreted as a developmental trajectory of maturation through the combination of multiple healthcare competence areas.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis perspective of professional identity formation through integrated competence development fits well with competency-based medical education. The CanMEDS framework (8)\u0026nbsp;defines physicians as medical experts and communicators, collaborators, leaders, professionals and scholars. Within the scholar role, physicians are tasked with engaging in ongoing learning, teaching students and other health professionals, and integrating the best available evidence into practice. Finnish objectives regarding competency-based medical education place similar emphasis on graduating\u0026nbsp;doctors being able to interview and examine patients independently, work effectively in teams, communicate professionally and continue to develop their own competence. (9,10)\u0026nbsp;Peer tutoring may therefore function as an authentic setting in which students rehearse teaching, feedback, reflection, teamwork and self-directed professional development before graduation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRecent tutor-centred studies indicate that these benefits are not automatic and depend substantially on programme design. Sahba et al. determined that student tutors frequently described insufficient formal preparation and wanted training that combined evidence-informed pedagogy with contextualised practice and feedback. (11)\u0026nbsp;Simultaneously, in a multi-institutional qualitative study, Skjærseth et al. argued that peer teachers learn to facilitate rather than simply transmit knowledge, to recognise the limits of their own understanding, to adapt teaching to learner needs, and to foster psychological safety, but that these outcomes depend on accessible teaching opportunities, adequate preparation, agency and support during teaching. (12)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite growing use of PAL and NPT, important gaps remain. Existing literature is cross-sectional, single-institutional and focused on specific skills sessions, assessment preparation or short-term perceptions of teaching quality. In comparison, considerably less is known about whether sustained participation in peer tutoring shapes tutors’ later clinical self-perceptions, workplace teaching roles, interest in academic medicine, or early career trajectories after graduation. This is an important research area at a time when medical schools need both scalable clinical teaching models and a future workforce willing to assume educational responsibilities. PAL and NPT further improve accountability, which is a core concept of competency-based medical education systems. (13)\u003c/p\u003e\n\u003cp\u003eAt the Faculty of Medicine, University of Helsinki, Skills lab provides a research setting in which to examine these questions. The Skills lab peer tutoring system is a structured skills workshop centred on practical skills and simulation pedagogy, with peer tutoring beginning in 2015. By the end of 2025, the programme had therefore completed a decade of operation. Over this period, Skills lab has included student-led teaching in procedural skills, physical examination, patient interviewing, themed sessions, interprofessional learning and simulation exercises. This breadth and continuity provide a rare opportunity to study how peer tutoring may influence both self-perceived clinical competence and later career development. Therefore, the present study aims to research how current and former Skills lab peer tutors perceive the effects of tutoring on their own learning, self-perceived clinical competence, teaching and supervisory skills, and early career orientation.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy design and setting\u003c/p\u003e\n\u003cp\u003eThis study was a single-centre, cross-sectional questionnaire study with a convergent mixed-methods analysis approach, conducted at the Faculty of Medicine, University of Helsinki, Finland. This study examined the self-perceived educational and career-related impact of serving as a peer tutor in Skills lab, a student-led clinical skills teaching programme established in 2015. Quantitative and qualitative data were collected concurrently within a single Finnish-language online questionnaire and were analysed separately before integration at the interpretation stage. Data were collected and managed using REDCap. (14)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants and recruitment\u003c/p\u003e\n\u003cp\u003eA census-based invitation strategy was used. All identifiable current and former Skills lab peer tutors in programme records were eligible, providing an invitation population of 61 individuals: 18 current tutors and 43 graduates. Invitations were distributed by email through a generic survey link. No personalised survey links were used. Participation was voluntary and questionnaire involved no direct identifiers. However, as the cohort of current and former peer tutors was small, the dataset was treated as indirectly identifiable. Background variables were therefore collected in general categories, and all reporting was designed to minimise deductive disclosure. For current employment and career effects, the focus was on graduates. Current students and the most recent 2025 graduates were excluded from the postgraduation analysis as they had limited postgraduation work experience.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eQuestionnaire development and content\u003c/p\u003e\n\u003cp\u003eThe questionnaire was developed specifically for this study by the authors, informed by previous literature on peer-assisted learning and near-peer teaching, and refined with input from experienced clinical educators with longstanding experience in\u0026nbsp;Skills lab. The instrument covered four domains: background characteristics, experiences of peer tutoring during medical school, perceived effects of peer tutoring on work and career after graduation and attitudes and future plans relating to specialisation, teaching, and research. An institutional ethical research review was obtained from the University of Helsinki Faculty of Medicine Research Ethics Committee (Approval Decision 14/2025).\u003c/p\u003e\n\u003cp\u003eBackground items included age group, graduation year or student status, duration of service as a peer tutor, estimated annual tutoring workload, current career stage, speciality group, academic degree, and current employment role. The first structured item category comprised 11 five-point Likert items addressing the medical school period, including reward, active influence over learning, development of professionally relevant skills, interest in teaching, leadership, self-appraisal of competence, evidence-based practice, independent competence development, and understanding of pedagogy. The second structured item category comprised 7 postgraduation Likert items addressing perceived effects on work and career, including usefulness of tutoring-derived skills, effectiveness as a teacher/supervisor, active competence development, workplace skills, teamwork, and career influence. This section also included a “not applicable” response option. The survey further included multiple-response items on specialisation, teaching and supervision roles, clinical teaching, and research, alongside open-ended questions on perceived benefits, career influence, teaching development, programme limitations, and suggested improvements.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOutcome measures\u003c/p\u003e\n\u003cp\u003eThe primary outcomes were self-perceived effects of peer tutoring on learning and professional development, particularly on the development of clinical competence, self-directed learning, reflective capacity, and teaching and supervisory capabilities. Secondary outcomes were self-reported career-related effects, including perceived influence on career choices, current or intended teaching responsibility, specialisation intentions, and research aspirations. The principal exposure variables were duration of service as a peer tutor and self-estimated annual tutoring workload.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnalysis\u003c/p\u003e\n\u003cp\u003eQuantitative analysis was primarily descriptive. Responses to the 11 student-period Likert items were coded from 1 = strongly disagree to 5 = strongly agree and summed to form an exploratory 11-item overall composite score (possible range 11-55), with higher scores indicating more favourable perceived educational impact during medical school. Item-level results are reported as counts and percentages for each response category, the proportion agreeing or strongly agreeing with exact 95% binomial confidence intervals, and the median. Internal consistency of the 11-item composite was assessed using Cronbach’s alpha.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExploratory inferential analyses were used to examine whether greater peer-tutoring exposure was associated with more favourable self-reported educational impact. Exposure was operationalised as duration of peer-tutor service and estimated annual tutoring workload, both treated as ordinal variables. Associations between these exposure measures and the overall student-period composite score were examined using Spearman’s rank correlation coefficient. Differences in overall student-period composite scores across independent career-stage groups were examined using the Kruskal-Wallis test. Due to the small sample size and the absence of a non-tutor comparison group, inferential findings were interpreted cautiously, with emphasis placed on effect size, direction, and consistency. All inferential analyses were exploratory and two-sided. Raw p-values were supplemented with Holm-adjusted p-values.\u003c/p\u003e\n\u003cp\u003eOpen-ended responses were analysed using inductive qualitative content analysis. The study aims were grouped into subcategories and general themes. The analysis approach followed the principles described by Elo and Kyngäs (15) and by Graneheim and Lundman (16), in regard to credibility, transparency, and trustworthiness. The frequency of coded segments was reported descriptively to indicate the relative prominence of themes. Quantitative and qualitative data were analysed separately and integrated at the interpretation stage using complete cases only no imputation was performed. Data analysis was performed using RStudio (Posit Software, PBC, version 2025.09.2+418).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBackground characteristics\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOf the 61 eligible current and former Skills lab peer tutors, 27 returned questionnaires and 25 complete responses were included in the analysis, corresponding to a complete-case response rate of 41.0% overall, 46.5% among graduates, and 27.8% among current tutors/students. Respondents were predominantly aged 26-35 years (19/25, 76.0%). Five participants were current medical students and 20 were graduates. The largest tutoring-duration categories were 1 year or more (10/25, 40.0%) and 2 years or more (11/25, 44.0%), and the most common estimated annual tutoring workload was 40-60 hours (10/25, 40.0%) (\u003cstrong\u003eTable 1\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e. Participant characteristics\u003c/p\u003e\n\u003cp\u003eComplete cases, n = 25\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"327\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e21-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e26-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e11 (44.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e31-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e8 (32.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e36-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4 (16.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e41-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGraduation year / student status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eUndergraduate medical student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e5 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e3 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e5 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4 (16.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of service as peer tutor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e10 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2 years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e11 (44.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e3 years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e3 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e4 years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimated annual tutoring workload\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e10-20h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e5 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e20-40h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e6 (24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e40-60h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e10 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e60-80h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026gt;100h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDerived career stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eSpecialty trainee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e13 (52.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eQualified doctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e6 (24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e5 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eSpecialist physician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent work role\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eSpecialty trainee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e11 (44.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eGeneral practitioner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e5 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e5 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eResearcher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eSpecialist physician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecialty group among respondents reporting a specialty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eSurgical specialties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e6 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eMedical specialties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eDiagnostic specialties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003ePrimary care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcademic degree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eLicentiate of Medicine (primary medical qualification)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e13 (65.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eDoctor of Medicine (doctoral degree; PhD-equivalent)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e5 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eBachelor of Medicine (undergraduate)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;3 (\u0026lt;10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eExperiences of peer tutoring during medical school\u003c/p\u003e\n\u003cp\u003eResponses concerning the medical school period indicated a positive inclination towards peer tutoring (\u003cstrong\u003eFigure 1\u003c/strong\u003e). All respondents indicated agreement that peer tutoring had been rewarding (25/25, 100.0%). High agreement was also observed for supporting their development as physicians (24/25, 96.0%), developing skills relevant to professional practice (24/25, 96.0%), enabling active influence over their own learning (23/25, 92.0%), and being manageable alongside other studies (23/25, 92.0%). The level of agreement regarding interest in teaching was expressed by 22/25 respondents (88.0%).\u003c/p\u003e\n\u003cp\u003eMore heterogeneous distributions were seen for leadership development (19/25, 76.0%), supporting ongoing independent competence development (18/25, 72.0%), self-appraisal of competence (17/25, 68.0%), and understanding of pedagogy (17/25, 68.0%). The lowest level of agreement item was increased understanding of evidence-based practice, with 9/25 respondents (36.0%) agreeing or strongly agreeing, with the median response remaining neutral.\u003c/p\u003e\n\u003cp\u003eThe subgroup comparisons by career stage also provided a difference in median scores, with the highest medical school period responses among current students and lower medians among graduates and respondents in speciality training. The median overall medical school total was 45/55 (IQR 44-50). The median development subscale score was 21/25 (IQR 20-23), and the median pedagogy or self-directed learning subscale was 24/30 (IQR 22-26).\u003c/p\u003e\n\u003cp\u003eIn the composite-score analyses, annual tutoring workload was positively associated with the medical-school total score (Spearman rho = 0.47, raw p = 0.016; Holm-adjusted p = 0.049), whereas duration of tutoring service was not (rho = 0.16, raw p = 0.431; Holm-adjusted p = 0.862). Medical-school total scores did not differ significantly across career-stage groups (Kruskal-Wallis raw p = 0.496; Holm-adjusted p = 0.862). These findings suggest that tutoring intensity, rather than duration of participation, was associated with more favourable self-perceived educational impact. Internal consistency of the 11-item medical-school composite was deemed acceptable (Cronbach\u0026rsquo;s alpha = 0.75). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePerceived effects of peer tutoring on work and career after graduation\u003c/p\u003e\n\u003cp\u003ePostgraduation items were summarised among all graduates (n = 20), with item-specific applicable denominators (\u003cstrong\u003eFigure 2\u003c/strong\u003e). Agreement was highest for continued active competence development after graduation (20/20, 100.0%) and stronger effectiveness as a teacher or supervisor in the workplace (18/20, 90.0%). Most graduates also reported that tutoring-derived skills had been repeatedly useful in practice (15/20, 75.0%), that peer tutoring had had a positive overall effect on their career (15/20, 75.0%), that it had strengthened workplace and interpersonal skills (16/20, 80.0%), and that it had improved their ability to work effectively in different teams (13/20, 65.0%). In contrast, only 4/19 applicable respondents (21.1%) agreed that peer tutoring had influenced career choice directly, and the median response for this item was neutral.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 3\u003c/strong\u003e shows subgroup distributions at the item level. Current students generally rated items more positively compared to other career stages. Postgraduate qualitative responses concerned future employment-related findings. The most frequent postgraduation themes concerned teaching and supervision, clinical confidence, and readiness to take on broader professional roles. Representative comments in this regard are, \u0026ldquo;I learned that I enjoy teaching and would like to become a trainer physician,\u0026rdquo; and \u0026ldquo;My readiness to guide less experienced colleagues is higher.\u0026rdquo; Other respondents emphasised transferability to practice: \u0026ldquo;peer tutoring fostered an open attitude toward new tasks and multiprofessional collaboration.\u0026rdquo; A smaller countertheme was also present, with brief responses such as \u0026ldquo;I have not noticed any clear benefit\u0026rdquo; and \u0026ldquo;Not really anything.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eAttitudes and future plans relating to specialisation, teaching and research\u003c/p\u003e\n\u003cp\u003eInterest in future teaching and specialisation was described as high. Altogether 21/25 respondents (84.0%) reported an intention to specialise. Also, eleven (44.0%) respondents reported that their current role already included teaching or supervision, while 20/25 (80.0%) indicated that they would like such responsibility alongside clinical work in the future. One respondent had already worked as a clinical teacher, but 14/25 (56.0%) aimed to do so in future. Research orientation followed a different pattern. Nine respondents (36.0%) reported having worked as full-time researchers, and only two (8.0%) wanted to do so in future. Most respondents planned to specialise and also expressed interest in including teaching or supervisory responsibility in their future clinical work, albeit not necessarily in full-time research roles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eQualitative themes from open-ended responses\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"617\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme, n/N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 277px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant q\u003c/strong\u003e\u003cstrong\u003euotation\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eLearning through teaching and reflection, 15/82 (18.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eConsolidation of knowledge through repeated teaching, recognition of one\u0026rsquo;s own knowledge gaps, deeper engagement with underlying theory, and use of teaching as a learning strategy.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026ldquo;I noticed which things I myself was still unclear about when a student asked.\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;The things I taught stayed very well in mind.\u003cbr\u003e\u0026nbsp;\u0026ldquo;Through teaching, I learned the underlying theory very thoroughly: why something is done the way it is.\u0026rdquo; \u0026ldquo;Greater analytical thinking when learning new things; I have learned to learn more efficiently.\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Using teaching as a learning tool.\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Themed days helped me learn subjects that interest me in greater depth.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eLeadership, teamwork and organisation, 8/82 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eLeadership in teaching situations, organisation of learning activities, development of teamwork, self-awareness, and time management.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026ldquo;I was able to conceptualise a new training format quite freely. I learned leadership and learned to present myself.\u0026rdquo;\u003cbr\u003e\u0026nbsp;\u0026ldquo;Recognising my own strengths and weaknesses, teamwork skills, and time management.\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;I am able to work more independently and take responsibility in new situations.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTeaching and supervision, 27/82 (32.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eReadiness to guide junior learners and colleagues, ability to adapt teaching to different learners, management of larger groups, giving feedback, and later confidence in supervisory roles.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026ldquo;I learned the importance of a safe learning environment and encouragement, especially when a student has already failed once and trying again feels intimidating.\u0026rdquo;\u003cbr\u003e\u0026nbsp;\u0026ldquo;My readiness to guide less experienced colleagues is higher than that of my classmates.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eClinical skills and confidence, 8/82 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eGrowth in manual skills, willingness to practice, procedural confidence, and confidence in acting despite uncertainty or fear of failure.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026ldquo;Practical skills improved, and I became more willing to practise them.\u0026rdquo;\u003cbr\u003e\u0026nbsp;\u0026ldquo;My confidence in tasks requiring manual skill increased.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCareer orientation and role expansion, 9/82 (11.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eEmergence of an educator role, openness to broader workplace responsibilities, and continuation of simulation or supervisory work, without strong evidence of direct influence on career choice itself.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026ldquo;I learned that I enjoy teaching and would like to become a trainer physician.\u0026rdquo;\u003cbr\u003e\u0026nbsp;\u0026ldquo;Peer tutoring fostered an open attitude to new tasks\u0026nbsp;and responsibilities at work.\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;A more open attitude to new tasks and areas of responsibility at work, such as supervising junior students and collaborating or developing ideas with other professional groups such as nurses.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eProgramme development and resources, 10/82 (12.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eRequests for more tutor training, closer collaboration with clinical teachers, greater continuity in leadership, more capacity, and stronger institutional resourcing.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026ldquo;I would have liked more training for tutors in different areas.\u0026rdquo;\u003cbr\u003e\u0026nbsp;\u0026ldquo;More collaboration between peer tutors and clinical teachers is needed.\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;More collaboration between peer tutors and clinical teachers is needed in themed sessions. It is important that when a peer tutor teaches capable medical students, an expert in the subject area is present to answer more demanding questions. Everyone learns from that, and tutors also see different supervisory and teaching styles.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNo clear benefit, 5/82 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNeutral or skeptical responses indicating that the qualitative material was not uniformly affirmative.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026ldquo;I have not noticed any.\u0026rdquo;\u003cbr\u003e\u0026nbsp;\u0026ldquo;It is hard to say. I do not know how competent I would have been if I had used the same amount of time on something else.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: All quotations were translated from Finnish by the authors. Frequencies refer to coded segments rather than respondents. An individual respondent could contribute more than one coded segment. After excluding blanks and dash-only placeholders, there were 17 analyzable responses to \u0026ldquo;largest benefit for career development\u0026rdquo;, 18 to \u0026ldquo;largest benefit for learning/competence development\u0026rdquo;, 11 to \u0026ldquo;concrete benefits for career development\u0026rdquo;, 14 to \u0026ldquo;concrete benefits for competence development\u0026rdquo;, 12 to \u0026ldquo;concrete benefits for teaching/supervision development\u0026rdquo;, 7 to \u0026ldquo;what did not work / development suggestions\u0026rdquo;, and 3 to \u0026ldquo;anything else\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eAcross the open-ended material (\u003cstrong\u003eTable 3\u003c/strong\u003e), 82 open answer segments were identified. The most frequent themes were teaching and supervision (27/82, 32.9%) and learning by teaching and reflection (15/82, 18.3%), followed by programme development and resources (10/82, 12.2%), career orientation and role expansion (9/82, 11.0%), leadership and teamwork and organisation (8/82, 9.8%), clinical skills and confidence (8/82, 9.8%), and no clear benefit (5/82, 6.1%). In relation to future orientation and programme development, respondents repeatedly described a need for more structured tutor training, closer collaboration with clinical teachers, and more institutional resources for peer teaching. In this regard, one participant noted, \u0026ldquo;I would have liked even more training for tutors in different areas,\u0026rdquo; and \u0026ldquo;More collaboration between peer tutors and clinical teachers.\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe open-ended responses also describe the perceived benefits of tutoring during medical school, in particular, learning-through-teaching and practical skill development. Representative statements included, \u0026ldquo;Teaching others is the best way to make a topic stick,\u0026rdquo; and \u0026ldquo;Through teaching, I learned theory behind things very thoroughly-why things are done the way they are.\u0026rdquo; Respondents also frequently described procedural confidence, with the following representative statement: \u0026ldquo;Practical skills improved, and my confidence in performing tasks that require manual skills increased,\u0026rdquo; and \u0026ldquo;Excellent cannulation skills.\u0026rdquo;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrincipal findings\u003c/p\u003e \u003cp\u003ePeer tutoring was found to primarily associate with positive self-perceptions of learning, practical professional development, and later workplace teaching or supervision. The highest level of agreement area presented around reward, active involvement in learning, practical skills for professional work, and becoming a more effective teacher or supervisor after graduation. In contrast, the lowest levels of agreement were observed in understanding of evidence-based practice and explicit pedagogical theory. These findings indicate that respondents located the main value of Skills lab in experiential learning, repeated practice, and educational role rehearsal, rather than in the acquisition of formal pedagogical theory or career direction.\u003c/p\u003e \u003cp\u003eA second notable finding was that the intensity of involvement appeared more informative than duration. These findings suggest that the intensity of participation may be more consequential than the longevity of service when respondents reflect on how peer tutoring shapes learning during medical school. Most peer tutors in Skills lab start in their third year and stay throughout the rest of their studies, with only a small subset quitting earlier for different reasons. This result seems to indicate alignment with an interpretation of peer tutoring as a form of deliberate, repeated educational practice. This was evident among respondents who taught more frequently. They may have had more opportunities to rehearse, explain, supervise, and reflect than those whose involvement extended over a longer period, but at a lower intensity.\u003c/p\u003e \u003cp\u003eThirdly, graduates commonly expressed feeling that tutoring had made them more effective teachers and supervisors and had supported active postgraduation development. This would suggest that peer tutoring may shape how graduates inhabit clinical work and educational responsibilities.\u003c/p\u003e \u003cp\u003eRelation to prior literature\u003c/p\u003e \u003cp\u003eThe findings of this study indicate consistency with the classic rationale for peer teaching as described by Ten Cate and Durning, who argued that peer teaching is valuable for reducing faculty burden, providing accessible role models to improve motivation, and preparing future doctors for their educational role. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Alignment is also found in the present results with Topping\u0026rsquo;s broader account of peer tutoring as a reciprocal educational arrangement with cognitive, social, and organisational benefits. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThese findings can also be interpreted against the broader national context described in the Finnish Medical Association\u0026rsquo;s nationwide education survey of 1,227 medical students. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) Here, the clearest unmet educational needs concerned practice-based learning where 80% of respondents wished for more opportunities to perform clinical procedures and 67% wished for more opportunities for patient encounters and examination. The concern about the accumulation of medical competence became more pronounced toward the later years of study and emphasised that adequate orientation, feedback, and senior support are important for the development of professional self-confidence. The current results on practical skill development, learning through teaching, and increased confidence in later supervisory roles suggest that structured peer tutoring may help address needs that are also visible at the national level.\u003c/p\u003e \u003cp\u003eThe present findings also extend the literature in an area where evidence remains relatively sparse, the longer-term tutor perspective. Burgess et al. concluded that evidence for tutor benefits is strongest in communication, teaching, and professional development, but much less is known about later work roles or career development.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Avonts et al. subsequently argued longitudinally that peer teachers may evolve from self-focused motives towards helping others, improve self-efficacy in clinical and teaching skills, and grow into role-model identities.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) The present findings are broadly consistent with those findings as respondents described teaching as a mechanism for consolidating their own learning, developing confidence, and normalising later supervisory roles. However, these responses also suggest that the most durable effect may be on postgraduate workplace teaching identity rather than on formal career choice.\u003c/p\u003e \u003cp\u003eNg et al.\u0026rsquo;s qualitative study of placement mentoring highlighted integration into the clinical team, feedback, and clearer expectations as central features of a successful mentoring experience. They concluded that mentor training could improve the consistency of mentoring experiences, helping ensure all students receive comparable support. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) This finding provides agreement with the current respondents\u0026rsquo; requests for more structured tutor development, clearer collaboration with clinical teachers, and stronger educational infrastructure around the peer-tutor role. Secondly, Coakley et al. researched improved near-peer support for newly qualified doctors and, in their findings, emphasised transition-to-practice support and professional identity. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) The present graduates\u0026rsquo; accounts of increased readiness to supervise junior colleagues, stronger confidence in workplace teaching, and sustained self-development seem to show alignment in this regard as well.\u003c/p\u003e \u003cp\u003eThe present findings also seem to fit with the wider subject of professional identity formation. Haruta et al. described professional socialisation as a staged process spanning medical school and later clinical roles. In this regard, Skills lab may be understood as a structured \u0026ldquo;bridge space\u0026rdquo; in which students rehearse roles they will later perform more formally as doctors, teachers, supervisors, team members, and organisers. The dominant themes of teaching and supervision, learning-by-teaching, and leadership and teamwork would seem to support that interpretation. Similarly, Mulholland et al. argued that doctors remain teachers whether or not they explicitly identify as such.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) In the present study, the high level of interest in future teaching responsibility suggests that peer tutoring may make this implicit professional expectation more explicit and more acceptable to learners early in their careers.\u003c/p\u003e \u003cp\u003eOne of the more interesting findings was the relatively low level of agreement regarding the evidence-based practice and explicit pedagogy items compared with the higher level of agreement for practical learning and later supervision. This may indicate that participation in a clinical skills peer-tutoring programme does not automatically translate into explicit awareness of educational theory. Instead, the programme appears to generate tacit pedagogical capability more readily than explicit pedagogical language. This distinction is educationally important.\u003c/p\u003e \u003cp\u003eImplications for programme design and career development\u003c/p\u003e \u003cp\u003eThe programme-development suggestions offered by respondents point towards a need for more tutor training, more collaboration with clinical teachers, clearer continuity of responsibility, and more resourcing, which point towards a requirement of a more professional educational structure. These findings also support consideration of a structured educator-development strand within or alongside Skills lab. For example, short tutor development sessions on feedback, learner support, facilitation of simulation debriefing, psychologically safe supervision, and translating tacit clinical know-how. Such an approach would also better align the programme with competency-based frameworks in which doctors are expected to teach, supervise, collaborate, and continue learning throughout practice.\u003c/p\u003e \u003cp\u003eStrengths, limitations and implication for future research\u003c/p\u003e \u003cp\u003eThis study has several strengths. It examines a decade of a structured peer-tutoring programme and provides a distinction between the perceptions of medical students and those of graduated doctors. It includes both current and former tutors, which allows a comparison between the medical school period and the early postgraduation career.\u003c/p\u003e \u003cp\u003eIn terms of limitations, the response rate was modest, and self-selection bias is likely to be present. Respondents who were especially positive or especially critical may have been more inclined to participate. Second, all outcomes were self-reported, and many graduate accounts were retrospective, introducing some extent of recall bias. Thirdly, there was no non-tutor comparison group, so the causal effects of tutoring on competence or career outcomes could not be demonstrated.\u003c/p\u003e \u003cp\u003eFurther work could address multi-centre longitudinal studies to determine whether the pattern seen here is reproduced across different institutional settings, curricular structures, and peer-tutoring models. Comparative designs, including non-tutors or tutors with different levels of teaching exposure, would be interesting in clarifying whether the apparent importance of tutoring intensity is reproducible.Future research should also address mechanism. The present findings carefully suggest that repeated enactment of the tutor role may matter more than simple duration and that tutoring may develop tacit pedagogical capability more readily than explicit pedagogical understanding.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe present findings suggest that sustained participation in Skills lab peer tutoring might be associated, in participants\u0026rsquo; own accounts, with three closely related forms of development: greater agency in learning during medical school, strengthening of practical and interpersonal capacities relevant to clinical practice, and preparedness for subsequent teaching and supervisory responsibilities. Peer tutoring appeared to influence less the eventual direction of career choice than the manner in which graduates later approached clinical work, particularly in relation to guiding others, working collaboratively, and maintaining active professional development after qualification.\u003c/p\u003e \u003cp\u003eThe results further indicate educational value of tutoring primarily in repeated enactment of the tutor role. Higher tutoring workload, rather than longer duration of service, was associated with more favourable student-period evaluations, whereas improvement in explicit pedagogical and evidence-based understanding was less evident. Although the single-centre, cross-sectional, self-report design precludes causal inference, the results support the view on peer tutoring can be understood as a pragmatic means of delivering clinical skills teaching and a structured setting for and early professional development. More systematic tutor preparation, closer integration with clinical teachers, and stronger pedagogical emphasis may further strengthen that contribution.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eGrammarly (Grammarly, Inc., Version 1.156.1.0) was used to assist with language editing and improve the clarity of the manuscript. All content was reviewed and verified by the authors. Authors declare full responsibility for the entire content of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants were provided written informed consent, and the survey was conducted on a voluntary basis. The study was approved by the University of Helsinki Faculty of Medicine Board of Research Ethics (20.5.2025, Decision number: 14/2025).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is available upon reasonable request from the authors and subject to the restrictions imposed by the ethics approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all Skills-lab peer-tutors, current and former, and the teachers for making this possible. In addition, we are grateful for the initiators Risto Renkonen, Kirsi Rauhala, Klaus Olkkola, Anne Pitkäranta, and Hanna Lampela who made possible to start this peer-tutoring. But above all, the Skills lab co-ordinators Marit Raukola and Minna-Maria Mattila deserve our warmest thanks for maintaining the daily routines, without which this study would not have been possible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive funding.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTopping KJ. The Effectiveness of Peer Tutoring in Further and Higher Education: A Typology and Review of the Literature. Education [Internet]. 1996. 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Im a doctor, not a teacher\u0026rsquo;: the roles and responsibilities of paediatricians in relation to education. Arch Dis Child Educ Pract Ed. 2022;107(3):223\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/archdischild-2020-320266\u003c/span\u003e\u003cspan address=\"10.1136/archdischild-2020-320266\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Medical education, peer tutoring, near-peer teaching (NPT), Peer-assisted learning (PAL), clinical skills, professional development","lastPublishedDoi":"10.21203/rs.3.rs-9401177/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9401177/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePeer tutoring is widely used in undergraduate medical education, albeit its longer-term effects on tutors remain less well understood. This research examined how current and former peer tutors in a clinical skills programme perceived the effects of tutoring on learning during medical school, later work, and early career orientation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA single centre, cross-sectional questionnaire study was conducted with convergent mixed-methods analysis at the University of Helsinki, Finland. All identifiable current and former Skills lab peer tutors from 2015 to 2025 were invited and 25 complete questionnaires were analysed. Quantitative data were analysed descriptively, and associations between tutoring exposure and student-period composite scores were examined using Spearman\u0026rsquo;s rank correlation. Open-ended responses were analysed using inductive content analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTwenty-five complete responses were analysed from 61 eligible tutors (41.0%). All respondents reported that peer tutoring had been rewarding. Most agreed that it had supported their development as physicians (24/25), developed skills relevant to professional practice (24/25), and enabled active influence over their own learning (23/25). Agreement was lower for understanding of pedagogy (17/25) and evidence-based practice (9/25). Higher annual tutoring workload instead of longer duration of service, was associated with higher student-period composite scores (rho\u0026thinsp;=\u0026thinsp;0.47; Holm-adjusted p\u0026thinsp;=\u0026thinsp;0.049). Among graduates, the strongest influence concerned continued active competence development after graduation and greater effectiveness as a teacher or supervisor at work, whereas perceived influence on career choice was uncommon. Open-ended responses most often concerned teaching and supervision, learning through teaching and reflection, and programme development. Participants described teaching as a way of consolidating knowledge, identifying gaps in understanding, and gaining confidence in supervising others.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eSustained peer tutoring in a clinical skills programme was perceived to support active learning during medical school, practical and interpersonal development, and later teaching and supervisory work. The reported benefits were strongest in enacted teaching and supervision rather than in explicit pedagogical or evidence-based understanding. A more structured tutor preparation program and closer collaboration with clinical teachers may strengthen these benefits.\u003c/p\u003e","manuscriptTitle":"A Decade of Peer Tutoring: How Teaching Shapes Clinical Competence in Medical Education","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-14 16:17:03","doi":"10.21203/rs.3.rs-9401177/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"9873144143960601282825302477687047180","date":"2026-05-17T21:28:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T06:52:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63679237620969648160388714953867297498","date":"2026-05-07T07:06:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-06T07:21:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-16T11:03:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-15T00:59:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-15T00:59:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-04-13T08:38:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aacea57f-800e-4845-9080-adaa83e13bfc","owner":[],"postedDate":"May 14th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"9873144143960601282825302477687047180","date":"2026-05-17T21:28:34+00:00","index":66,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T06:52:57+00:00","index":46,"fulltext":""},{"type":"reviewerAgreed","content":"63679237620969648160388714953867297498","date":"2026-05-07T07:06:24+00:00","index":43,"fulltext":""},{"type":"reviewersInvited","content":"30","date":"2026-05-06T07:21:37+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T16:17:03+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-14 16:17:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9401177","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9401177","identity":"rs-9401177","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}