Peer-led revision course of the subject ‘Medical Psychology and Sociology’ for preclinical international medical students

Peer-led revision course of the subject ‘Medical Psychology and Sociology’ for preclinical international medical students | 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 Peer-led revision course of the subject ‘Medical Psychology and Sociology’ for preclinical international medical students Julia Sgrott, Christoph Nikendei, Hans-Christoph Friederich, Ivo Dönnhoff This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6368612/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective International students are confronted with various difficulties in their social and academic life when moving to a new country for their university studies. Different projects have been developed to support international students in facing these difficulties, such as peer-assisted learning tutorials. Our goal was to evaluate preclinical international medical students’ objective improvement of knowledge after attending a 3-day peer-led revision course. Methods The sample consisted of n = 30 international students. The objective improvement of knowledge was quantified by the amount of correct answered questions in the post-test compared to the pre-test. Students were randomly separated into groups, based on which test version, A or B, was written in pre-test. For the comparison between pre- and post-times and between groups, a two-way ANOVA was calculated. Results International students significantly improved their knowledge as shown in the post-test compared to pre-test (F 1,22 = 13.470, p = 0.001). Conclusion International students profited from taking part in a peer-led revision course, through which they improved their knowledge. Peer-led tutorial programs for international students should be implemented further in medical faculties as a way to support these students academically and socially. Figures Figure 1 1. Introduction ‘International students’ are defined as students who accomplish their university entry qualification in another country and come to Germany for university education ( 1 ). With around 292 000 international students attending German universities in the year of 2023, Germany continues to be a very attractive country for those who seek to complete their higher education abroad. Around 5% of these international students are enrolled in medicine, representing around 13% of the total of medical students in Germany ( 2 ). Several authors ( 3 – 5 ) have previously described the hurdles that international medical students face and have to overcome when aiming to achieve their university degree. These hurdles range from lack of social and financial support ( 3 , 5 ) and personal distress ( 4 , 6 ), to language and cultural barriers ( 7 , 8 ). These challenges may also contribute to the observed lower academic performance of international medical students in written, oral, and practical examinations ( 9 ). Huhn et al. point out that international students in German-speaking regions achieved lower results in the oral state examination when compared to German students ( 10 ). According to the report of the state examination of autumn 2022 released by the German National Institute for state examinations in Medicine, Pharmacy, and Psychotherapy, 26,7% of international students failed the exam. Comparatively, only 9,5% of the German Students failed the exam ( 11 ). Finally, international medical students are characterised by higher drop-out rates during their studies, which may mirror cumulative burden resulting from the various financial, social, and language difficulties ( 12 ). Taking these difficulties into account, medical faculties have started to design supporting programs for international students, especially in their first years of studies ( 9 , 13 , 14 ). The goal was both to offer a safe space for international students to connect with each other and to improve their academic performance ( 15 ). Some of these programs were based on the method of peer-assisted learning (PAL) ( 4 ). PAL is a well-established teaching method in which a tutor is responsible for a group of tutees. The tutor, also a student, is usually older and/or has e knowledge of the topic ( 16 ). Tutees learn new information from their tutor on how to revise the content taught by university professors’ and apply their knowledge under tutors’ support ( 17 ). Being students themselves, tutors are able to use familiar language while teaching the most relevant topics, which ensures cognitive congruence between tutors and tutees ( 18 ). As tutors have overcome the same difficulties as the tutees, they are able to develop a more empathetic and supportive relationship ( 19 ), increasing social congruence among one another. There are several further benefits of PAL described in the literature, such as the creation of a sense of camaraderie between tutees and a welcoming learning environment, which is supported by tutor’s openness and kindness ( 20 ). The method of PAL has gained traction in recent years. There are a variety of fields PAL has been implemented in. Areas of application in medical education include problem-based-learning ( 21 ), gross anatomy ( 22 ), skills-lab training ( 23 , 24 ), history taking ( 25 ), emergency medicine ( 26 ), as well as mentoring, counselling, and tutoring ( 27 ). In the case of international students, ,,Buddy Programs’’, offered at various universities around the world, pair international students in higher semesters with first semester students, fostering a more personal mentoring environment. ( 28 ). Welcoming programs that focus on orientating international students at the beginning of their studies were evaluated at the University of Cologne and Charité Hospital in Berlin ( 14 , 29 ). Weekly peer-assisted tutorials for preclinical international students, which revise the content taught in university courses, have been proven to be a successful tool in supporting international students in the first year of their studies ( 4 ). From a methodological evaluation perspective, previously conducted studies on the topic of PAL in the field of international students focused mostly on the qualitative perceptions of tutees attending courses and mentoring programs ( 14 , 21 ). In revision courses, students profited from feedback from tutors, teaching materials, and mock exams, leading to an increased perceived confidence and subjective gains in competence ( 4 , 15 ). The social learning experience in general was also an important contributing factor ( 15 , 28 ). The personal experience of tutors working in PAL programs for international students, has also already been analyzed in previous studies ( 30 ). However, there is a lack of research measuring the objective benefits of PAL on international students’ improvement in knowledge. This research gap is even bigger, when different medical subjects are taken into consideration. The importance of psychosocial medicine in medical curricula has steadily increased over time. In Germany during the 1970s, psychosomatic medicine and psychotherapy were introduced as part of the medical approbation, including ‘Medical Psychology and Sociology’ as a pre-clinical subject ( 31 ). Since then, it has set the foundation for the clinical subjects ‘Psychiatry, Psychosomatic Medicine and Psychotherapy’ and also for a more empathetic, patient centered approach ( 32 ). In ‘Medical Psychology and Sociology’, students learn relevant aspects about the doctor-patient-relationship, developmental psychology, social aspects of health and disease, prevention, and more ( 33 ). The relevance of this subject is emphasized by the structure of the first German state examination, in which ‘Medical Psychology and Sociology’ represents one fifth of the questions. In German Medical Faculties, there are various repetition courses for the state examination in subjects such as physiology, biochemistry and anatomy, but few of them focus on ‘Medical Psychology and Sociology’. Only Jena, Marburg, Münster, and Essen University ( 34 – 37 ) offer repetition courses for the university exam and first state examination. Yet, none of these courses focus on international students. When taking the social, language, and cultural difficulties faced by international students into account, it can be expected that they would profit from a PAL program on ‘Medical Psychology and Sociology’. However, to the best of our knowledge, no studies have explored the usage of PAL methods for international students in teaching psychosocial medical subjects. Taking this lack of research into account, we evaluated the effect of a 3-day peer-led revision course on the knowledge level of international preclinical medical students in the subject ‘Medical Psychology and Sociology’. In a comparison of pre- and post-test results, we expected that students were going to show an improvement in their test-results and therefore in their knowledge on the subject. 2. Method 2.1. Design of the revision course First and second year preclinical international medical students at Heidelberg University were invited to take part in a 3-day revision course of the subject ‘Medical Psychology and Sociology’, offered by the ‘Heidelberg’s Tutorial for International Medical Students’ (HeiTiMed) (15). HeiTiMed is a project that uses PAL as the predominant teaching method. HeiTiMed tutors are international students in the fifth term or higher. The aim of the 3-day revision course was to prepare first year students for their upcoming university exam and second year students for the first German Medical State Examination in the subject ‘Medical Psychology and Sociology’. Tutors were responsible for preparing teaching materials and the course itself. It was required that the course comprised the most important topics taught at university lectures and most frequently asked questions in the First German Medical State Examination (33). The topics that were taught can be seen in table 1. An interactive approach to teaching was used, following the sandwich principle of Kadmon, with short lectures including interactive discussion between tutees and tutors (38). At the end of each session, students answered questions from previous state examinations and the answers were discussed together with tutors. ------------------- Table 1 around here -------------------------- Participants The presented study followed a pre-post design. It was conducted during 2023 and 2024 and involved first and second year international medicine students. The course was only offered in the summer semester, so students were either in their second or fourth study semester. Supporting international students with their upcoming tests was the focus of the revision course, but German students were also welcome to take part in it. For the purpose of this study, we defined ‘International students’ as students that have a native language that isn’t German or acquired their university entry qualification outside of Germany. 2.3. Test design Before and after the 3-day revision course participants, took one test including sociodemographic questions and 10 ,,Medical Psychology and Sociology’’ multiple-choice questions taken from previous state examinations. These multiple-choice questions were accessed through the digital medical learning platform AMBOSS, a tool that helps both students preparing themselves for the state examinations and offers specific specialist knowledge to graduated physicians (39). It includes a library and a question bank following USMLE guidelines (40). We accessed the data bank with Heidelberg’s Medical Faculty license. By calculating how often a question is answered either correctly or incorrectly, the platform creates an indicator of the questions difficulty (41). Each question has an attributed difficulty, which is signaled by hammers. These range from: very easy – one hammer (easiest 20% of questions), easy – two hammers (20% of the questions are easier, 50% are more difficult), intermediate – three hammers (50% of the questions are easier, 20% are more difficult), difficult – four hammers (80% of questions are easier, 5% are more difficult), very difficult – five hammers (most difficult 5% of questions). We made use of this system and of the available questions to build two different test versions that have the same amount of questions of each difficulty level: one very easy question, two easy questions, four intermediate questions, two difficult questions and one very difficult question. For the test creation, we sampled four times the necessary amount of questions for each difficulty and at least four questions of each topic of ‘Medical Psychology and Sociology’. Then, we chose at least one question of each topic for both versions of the test. These versions were named A and B. All of the questions had only one correct answer. 2.4. Procedure Students were given a randomly assigned test version as their pre-test. All tests were written on paper. After the revision course, participants took the other version as a post-test. Group 1 was defined as students that wrote version A as pre- and B as post-test, while group 2 consisted of students who wrote version B as pre- and A as post-test. 2.5. Ethics This study was conducted following the principles of the Declaration of Helsinki (64th WMA General Assembly, Fortaleza, Brazil, October 2013). Study participation was voluntary. All participants were informed about the purpose of this study and ensured anonymity of their data. Written informed consent was given by all participants. Ethics approval was granted by the ethic committee of the University of Heidelberg (Ethics Approval No. S-535/2016). 2.6. Statistical analysis Data analysis was conducted using the statistics software R (42). The handwritten tests were corrected by the first author, so that every correct answer was attributed with 1 point. Those were summed up to a total number of correct answers, meaning that a student could reach up to 10 correct answers in the pre- as well in the post-test. To compare the results of the pre- and post-test and investigate a possible difference between group 1 and 2, a two-way ANOVA was calculated. Prerequisites, such as identifying outliers, normality, homogeneity of variances, and covariances, were verified beforehand. The outliers were identified through a box plot. The only outlier in the 11 th semester was left out of the analysis. Normality was verified with the Shapiro’s Test, whereas the homogeneity of variance was verified with the Levene’s Test. For the verification of the homogeneity of covariances, a Box’s M-Test was conducted (43). 3. Results 3.1.Sample description After the exclusion of the participants that had exclusively German as their native language and obtained their university entrance qualification in Germany, there were n = 30 participants left that matched our definition of an ‘international student’. From these 30 participants, 2 participants only took part in the post-test and did not provide us with their sociodemographic data. Four participants did not take part in the post-test, so that their test scores were not considered in the ANOVA calculation. Therefore, 24 international participants (80%) were included in the analysis. Of the 28 international participants that provided us with their sociodemographic data, 20 were female and 8 were male. Mean age was 19.6 1.1 years. 15 participants were in the 2 nd semester (first year) and 13 participants in the 4 th semester (second year). Most international students were from Eastern Europe (10 students), followed by Turkey (6 students), and East Asia (4 students). 3 students came from Russia and 3 from Latin and North America. The remaining 3 students were from Western Europe, the Middle East and Southeast Asia, respectively. 3.2. Comparison of the results between pre- and post-test and between groups As can be seen in table 2 and figure 1, we found a significant difference in correct answered questions between pre- and post-test. On average, post-test results were higher by 1.5 correct answered questions. The mean for the number of correct answers in Group 1 is 3.6 1.4 in the pre-test and 5.1 1.5 in the post-test. For Group 2, the mean is 4.9 2.0 in the pre-test and 6.5 1.3 in the post-test. There is a significant difference between groups. --------------------------- Table 2 about here -------------------------------------------- ------------------------------ Figure 1 about here -------------------------------------- Discussion To our knowledge, there are very few studies that investigated the impacts of PAL on international students’ knowledge. Furthermore, to the best of our knowledge, no other study has investigated psychosocial medicine as the teaching subject for international students. Our results show that international students significantly improved their knowledge after attending a PAL based revision course in medical psychology. These results align with the benefits of PAL described in the literature (20): With the concise and comprehensible learning material provided, together with the tutors’ explanations, tutees received a structured repetition of the previous content, making it easier for them to remember the topics (15). With the tutors’ guidance, international students were able to focus on more important topics, possibly reducing the study load (15). Tutors, being international student themselves, have a greater understanding regarding language difficulties, which leads to a tendency of using less technical terms and therefore more understandable and approachable language (20, 44). Even though tutors and students may have different cultural backgrounds, they share similar experiences by being international students. Therefore, tutors have a deeper understanding of tutees’ needs and difficulties, as they themselves have overcome similar challenges in early stages of their studies (18). By additionally having the knowledge on the topic being taught, tutors may be better equipped to develop teaching strategies that ensure tutees’ best comprehension and therefore enhance the cognitive congruence between them (19). Such strategies show a more understanding and empathetic approach towards tutees’ specific needs and difficulties (18). By having a similar social role as tutees, tutors are able to craft a more friendly and less formal relationship with tutees, so that a more comfortable learning environment can be established (20, 44). Furthermore, international students were encouraged to participate actively by answering tutors’ direct questions. This interaction between tutor and tutees promotes the tutees’ active engagement with the topic by encouraging them to regularly test their own knowledge throughout the course session. This active participation could have helped students in paying attention to the course for longer, which could have facilitated knowledge acquisition (45). At the end of each presentation topic, students answered multiple-choice questions and discussed answers with tutors. This could have helped international students develop a more efficient and successful strategy for answering multiple choice questions (17). Motivating students to actively participate in the course by sharing their knowledge through question answering allowed tutors to act as facilitators of knowledge acquisition. Therefore, the hierarchical relationship can be so attenuated (46). In this context, tutors are not viewed as an authority, but as supporters. This could have encouraged students to feel more confident to ask their questions freely during the course, leading to a better understanding of the contents. Even though there was a difference between group 1 and 2, which can be explained by different individual knowledge levels, both groups objectively improved their knowledge. We were able to objectively show this improvement in the field of psychosocial medicine, with international students learning more about human behaviour, psychotherapy methods, doctor-patient-relationship, and communication. The intense exposure to such topics early in their medical studies, supported by the extracurricular revision course, could be beneficial to international students in their further career and lead to them taking a more empathetic and thoughtful approach to patients. Taking into consideration the fact that medical faculties in Germany have reported challenges in supporting their international students (9), we believe that a broader implementation of PAL based tutorial programs for international students could be an effective way of alleviating these difficulties. Programs such as repetition courses such as the one done in this study, HeiTiMed with weekly tutorials and social gatherings (4), the ‘Buddy Programme’, and language orientation (14) have proven to be effective in supporting international students academically and socially. It would also be interesting to implement PAL as a teaching tool for practical skills, such as drawing blood and performing physical exams. In the field of psychosocial medicine, this method could be even more valuable as a tool to support the development of a more empathetic and patient-centred communication. International students could further develop their practical and communication skills by having the opportunity to obtain more practice sessions with a simulated patient while still being under a tutor’s guidance. Limitations The major limitation of the current study is a missing control group of students who didn’t take part in the revision course. A control group could further support the results, emphasizing the effect of the revision course on international students’ knowledge. Another limitation of our study is that this revision course was taught exclusively by international tutors. As we mostly attribute the success of our results to the social and cognitive congruence between international students and tutors, it would be interesting to replicate our findings with a control group taught by German tutors. Furthermore, the study focused solely on the students’ improvement within the 3-day revision course. Long-term outcome, such as the exam results of the First German Medical State Examination, are missing. Conclusion To our knowledge, there is a lack of research regarding the effects of PAL in settings with international students. This study assessed the objective improvement in international students' knowledge after attending a 3-day peer-led revision course.. During this time, international students significantly improved their knowledge in a psychosocial medical subject. These results align with the benefits of PAL described in the literature. The increased cognitive and social congruence between international students and tutors creates a safe learning environment that contributes to international students’ acquisition of knowledge. However, further research on the effects of PAL in settings with international students is necessary. As done in this study, we suggest an objective approach that quantifies academic development, accompanied by an analysis of the subjective benefits for international students, as previously done by Huhn et. al. (15) . Moreover, further research is needed to evaluate the long-term effects of PAL on international students’ academic career. Abbreviations HeiTiMed Heidelberg’s Tutorial for International Medical Students PAL Peer assisted learning Declarations Ethics Approval : Ethics approval was granted by the Ethics Committee of the University of Heidelberg: No. S-535/2016. Consent for publication : Not applicable. Funding : Heidelberg’s Tutorial for International Medical Students (HeiTiMed) is a project funded by Heidelberg’s Medical Faculty. Availability of data and materials: The datasets generated and analyzed during the current study are available at HeiData under https://doi.org/10.11588/DATA/1STVOK Competing Interests: No conflicts of interest are declared. Clinical trial number : Not applicable. Author contributions CN and ID conceived and designed the study. ID supervised the revision course. JS was a tutor teaching the course. JS and ID carried out the statistical analysis. JS drafted the manuscript, which was revised by ID, CN and HCF. All authors read and approved the final manuscript. Acknowledgments We thank the tutors Andreas Royer, Hagyu Thomas Seong, Elizabeth Tong, Aleksei Smirnov, Isabel Hamm-Teixeira dos Santos and Josefina Arias Alvarado of the Heidelberg’s Tutorial for International Medical Students (HeiTiMed), who were responsible for teaching the revision course. We further thank Molly Beatrix Sutcliffe for revising this manuscript. References SVR - Sachverständigenrat deutscher Stiftungen für Integration und Migration. Vom internationalen Studierenden zum hoch qualifizierten Zuwanderer. Ein Vergleich der rechtlichen Rahmenbedingungen in fünf Staaten der Europäischen Union. Berlin: SVR; 2011. Statistisches Bundesamt. Statistischer Bericht – Statistik der Studierenden – Wintersemester 2023/2024. https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Bildung-Forschung-Kultur/Hochschulen/Publikationen/Downloads-Hochschulen/statistischer-bericht-studierende-hochschulen-endg-2110410247005.html (2024). Accessed 18 Aug 2024. 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Tables Table 1 Table of contents of the 3-day-revision course Behavioral Modeling and Psychodynamic Models Physical Examination and Conversation Methods Prevention and Promotion of Health Learning, Cognition, and Development Emotion and Motivation Personalities and Behavioral Styles Fundamentals of Demography and Sociology Psychotherapy Models Medical Statistics and Test Theories Fundamentals of Scientific Studies Health and Disease Doctor-Patient-Relationship Patient Care and Health Care Systems Table 2 ANOVA for the differences between pre- and post-test results and between groups Effect DF1 DF2 F p Group 1 22 8.569 0.008 Pre and Post (Time) 1 22 13.470 0.001 Group : Time 1 22 0.001 0.974 Additional Declarations No competing interests reported. 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Introduction","content":"\u003cp\u003e\u0026lsquo;International students\u0026rsquo; are defined as students who accomplish their university entry qualification in another country and come to Germany for university education (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). With around 292 000 international students attending German universities in the year of 2023, Germany continues to be a very attractive country for those who seek to complete their higher education abroad. Around 5% of these international students are enrolled in medicine, representing around 13% of the total of medical students in Germany (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Several authors (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) have previously described the hurdles that international medical students face and have to overcome when aiming to achieve their university degree. These hurdles range from lack of social and financial support (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) and personal distress (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), to language and cultural barriers (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). These challenges may also contribute to the observed lower academic performance of international medical students in written, oral, and practical examinations (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Huhn et al. point out that international students in German-speaking regions achieved lower results in the oral state examination when compared to German students (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). According to the report of the state examination of autumn 2022 released by the German National Institute for state examinations in Medicine, Pharmacy, and Psychotherapy, 26,7% of international students failed the exam. Comparatively, only 9,5% of the German Students failed the exam (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Finally, international medical students are characterised by higher drop-out rates during their studies, which may mirror cumulative burden resulting from the various financial, social, and language difficulties (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTaking these difficulties into account, medical faculties have started to design supporting programs for international students, especially in their first years of studies (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The goal was both to offer a safe space for international students to connect with each other and to improve their academic performance (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Some of these programs were based on the method of peer-assisted learning (PAL) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). PAL is a well-established teaching method in which a tutor is responsible for a group of tutees. The tutor, also a student, is usually older and/or has e knowledge of the topic (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Tutees learn new information from their tutor on how to revise the content taught by university professors\u0026rsquo; and apply their knowledge under tutors\u0026rsquo; support (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Being students themselves, tutors are able to use familiar language while teaching the most relevant topics, which ensures cognitive congruence between tutors and tutees (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). As tutors have overcome the same difficulties as the tutees, they are able to develop a more empathetic and supportive relationship (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), increasing social congruence among one another. There are several further benefits of PAL described in the literature, such as the creation of a sense of camaraderie between tutees and a welcoming learning environment, which is supported by tutor\u0026rsquo;s openness and kindness (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe method of PAL has gained traction in recent years. There are a variety of fields PAL has been implemented in. Areas of application in medical education include problem-based-learning (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), gross anatomy (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), skills-lab training (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), history taking (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), emergency medicine (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), as well as mentoring, counselling, and tutoring (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In the case of international students, ,,Buddy Programs\u0026rsquo;\u0026rsquo;, offered at various universities around the world, pair international students in higher semesters with first semester students, fostering a more personal mentoring environment. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Welcoming programs that focus on orientating international students at the beginning of their studies were evaluated at the University of Cologne and Charit\u0026eacute; Hospital in Berlin (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Weekly peer-assisted tutorials for preclinical international students, which revise the content taught in university courses, have been proven to be a successful tool in supporting international students in the first year of their studies (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrom a methodological evaluation perspective, previously conducted studies on the topic of PAL in the field of international students focused mostly on the qualitative perceptions of tutees attending courses and mentoring programs (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In revision courses, students profited from feedback from tutors, teaching materials, and mock exams, leading to an increased perceived confidence and subjective gains in competence (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The social learning experience in general was also an important contributing factor (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The personal experience of tutors working in PAL programs for international students, has also already been analyzed in previous studies (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). However, there is a lack of research measuring the objective benefits of PAL on international students\u0026rsquo; improvement in knowledge. This research gap is even bigger, when different medical subjects are taken into consideration.\u003c/p\u003e \u003cp\u003eThe importance of psychosocial medicine in medical curricula has steadily increased over time. In Germany during the 1970s, psychosomatic medicine and psychotherapy were introduced as part of the medical approbation, including \u0026lsquo;Medical Psychology and Sociology\u0026rsquo; as a pre-clinical subject (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Since then, it has set the foundation for the clinical subjects \u0026lsquo;Psychiatry, Psychosomatic Medicine and Psychotherapy\u0026rsquo; and also for a more empathetic, patient centered approach (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). In \u0026lsquo;Medical Psychology and Sociology\u0026rsquo;, students learn relevant aspects about the doctor-patient-relationship, developmental psychology, social aspects of health and disease, prevention, and more (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The relevance of this subject is emphasized by the structure of the first German state examination, in which \u0026lsquo;Medical Psychology and Sociology\u0026rsquo; represents one fifth of the questions. In German Medical Faculties, there are various repetition courses for the state examination in subjects such as physiology, biochemistry and anatomy, but few of them focus on \u0026lsquo;Medical Psychology and Sociology\u0026rsquo;. Only Jena, Marburg, M\u0026uuml;nster, and Essen University (\u003cspan additionalcitationids=\"CR35 CR36\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) offer repetition courses for the university exam and first state examination. Yet, none of these courses focus on international students. When taking the social, language, and cultural difficulties faced by international students into account, it can be expected that they would profit from a PAL program on \u0026lsquo;Medical Psychology and Sociology\u0026rsquo;. However, to the best of our knowledge, no studies have explored the usage of PAL methods for international students in teaching psychosocial medical subjects.\u003c/p\u003e \u003cp\u003eTaking this lack of research into account, we evaluated the effect of a 3-day peer-led revision course on the knowledge level of international preclinical medical students in the subject \u0026lsquo;Medical Psychology and Sociology\u0026rsquo;. In a comparison of pre- and post-test results, we expected that students were going to show an improvement in their test-results and therefore in their knowledge on the subject.\u003c/p\u003e"},{"header":"2. Method","content":"\u003cp\u003e2.1. Design of the revision course\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFirst and second year preclinical international medical students at Heidelberg University were invited to take part in a 3-day revision course of the subject \u0026lsquo;Medical Psychology and Sociology\u0026rsquo;, offered by the \u0026lsquo;Heidelberg\u0026rsquo;s Tutorial for International Medical Students\u0026rsquo; (HeiTiMed)\u0026nbsp;(15). HeiTiMed is a project that uses PAL as the predominant teaching method. HeiTiMed tutors are international students in the fifth term or higher. The aim of the 3-day revision course was to prepare first year students for their upcoming university exam and second year students for the first German Medical State Examination in the subject \u0026lsquo;Medical Psychology and Sociology\u0026rsquo;. Tutors were responsible for preparing teaching materials and the course itself. It was required that the course comprised the most important topics taught at university lectures and most frequently asked questions in the First German Medical State Examination (33). The topics that were taught can be seen in table 1. An interactive approach to teaching was used, following the sandwich principle of Kadmon, with short lectures including interactive discussion between tutees and tutors (38). At the end of each session, students answered questions from previous state examinations and the answers were discussed together with tutors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003e------------------- Table 1 around here --------------------------\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003e\u0026nbsp;Participants\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe presented study followed a pre-post design. It was conducted during 2023 and 2024 and involved first and second year international medicine students. The course was only offered in \u0026nbsp;the summer semester, so students were either in their second or fourth study semester. Supporting international students with their upcoming tests was the focus of the revision course, but German students were also welcome to take part in it. For the purpose of this study, we defined \u0026lsquo;International students\u0026rsquo; as students that have a native language that isn\u0026rsquo;t German or acquired their university entry qualification outside of Germany.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.3. Test design\u003c/p\u003e\n\u003cp\u003eBefore and after the 3-day revision course participants, took one test including sociodemographic questions and 10 ,,Medical Psychology and Sociology\u0026rsquo;\u0026rsquo; multiple-choice questions taken from previous state examinations. These multiple-choice questions were accessed through the digital medical learning platform AMBOSS, a tool that helps both students preparing themselves for the state examinations and offers specific specialist knowledge to graduated physicians\u0026nbsp;(39). It includes a library and a question bank following USMLE guidelines (40). We accessed the data bank with Heidelberg\u0026rsquo;s Medical Faculty license.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBy calculating how often a question is answered either correctly or incorrectly, the platform creates an indicator of the questions difficulty\u0026nbsp;(41). Each question has an attributed difficulty, which is signaled\u0026nbsp;by hammers. These range from: very easy \u0026ndash; one hammer (easiest 20% of questions), easy \u0026ndash; two hammers (20% of the questions are easier, 50% are more difficult), intermediate \u0026ndash; three hammers (50% of the questions are easier, 20% are more difficult), difficult \u0026ndash; four hammers (80% of questions are easier, 5% are more difficult), very difficult \u0026ndash; five hammers (most difficult 5% of questions). We made use of this system and of the available questions to build two different test versions that have the same amount of questions of each difficulty level: one very easy question, two easy questions, four intermediate questions, two difficult questions and one very difficult question. For the test creation, we sampled four times the necessary amount of questions for each difficulty and at least four questions of each topic of \u0026lsquo;Medical Psychology and Sociology\u0026rsquo;. Then, we chose at least one question of each topic for both versions of the test. These versions were named A and B. All of the questions had only one correct answer.\u003c/p\u003e\n\u003cp\u003e2.4. Procedure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudents were given a randomly assigned test version as their pre-test. All tests were written on paper. After the revision course, participants took the other version as a post-test. Group 1 was defined as students that wrote version A as pre- and B as post-test, while group 2 consisted of students who wrote version B as pre- and A as post-test.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.5. Ethics\u003c/p\u003e\n\u003cp\u003eThis study was conducted following the principles of the Declaration of Helsinki (64th WMA General Assembly, Fortaleza, Brazil, October 2013). Study participation was voluntary. All participants were informed about the purpose of this study and ensured anonymity of their data. Written informed consent was given by all participants. Ethics approval was granted by the ethic committee of the University of Heidelberg (Ethics Approval No. S-535/2016).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.6.\u0026nbsp;Statistical analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData analysis was conducted using the statistics software R\u0026nbsp;(42). The handwritten tests were corrected by the first author, so that every correct answer was attributed with 1 point. Those were summed up to a total number of correct answers, meaning that a student could reach up to 10 correct answers in the pre- as well in the post-test. To compare the results of the pre- and post-test and investigate a possible difference between group 1 and 2, a two-way ANOVA was calculated. Prerequisites, such as identifying outliers, normality, homogeneity of variances, and covariances, were verified beforehand. The outliers were identified through a box plot. The only outlier in the 11\u003csup\u003eth\u003c/sup\u003e semester was left out of the analysis. Normality was verified with the Shapiro\u0026rsquo;s Test, whereas the homogeneity of variance was verified with the Levene\u0026rsquo;s Test. For the verification of the homogeneity of covariances, a Box\u0026rsquo;s M-Test was conducted (43).\u0026nbsp;\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e3.1.Sample description\u003c/p\u003e\n\u003cp\u003eAfter the exclusion of the participants that had exclusively German as their native language and obtained their university entrance qualification in Germany, there were n = 30 participants left that matched our definition of an \u0026lsquo;international student\u0026rsquo;. From these 30 participants, 2 participants only took part in the post-test and did not provide us with their sociodemographic data.\u0026nbsp;Four participants did not take part in the post-test, so that their test scores were not considered in the ANOVA calculation. Therefore, 24 international participants (80%) were included in the analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOf the 28 international participants that provided us with their sociodemographic data, 20 were female and 8 were male. Mean age was 19.6\u0026nbsp;\u003cimg width=\"12\" height=\"22\" src=\"https://myfiles.space/user_files/69519_bce2c0439cd956a6/69519_custom_files/img1746730952.gif\" alt=\"image\"\u003e\u0026nbsp;1.1 years. 15 participants were in the 2\u003csup\u003end\u003c/sup\u003e semester (first year) and 13 participants in the 4\u003csup\u003eth\u003c/sup\u003e semester (second year). Most international students were from Eastern Europe (10 students), followed by Turkey (6 students), and East Asia (4 students). 3 students came from Russia and 3 from Latin and North America. The remaining 3 students were from Western Europe, the Middle East and Southeast Asia, respectively. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.2. Comparison of the results between pre- and post-test and between groups\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs can be seen in table 2 and figure 1, we found a significant difference in correct answered questions between pre- and post-test. On average, post-test results were higher by 1.5 correct answered questions. The mean for the number of correct answers in Group 1 is 3.6\u0026nbsp;\u0026nbsp;\u003cimg width=\"12\" height=\"22\" src=\"https://myfiles.space/user_files/69519_bce2c0439cd956a6/69519_custom_files/img1746730952.gif\" alt=\"image\"\u003e\u0026nbsp;1.4 in the pre-test and 5.1\u0026nbsp;\u003cimg width=\"12\" height=\"22\" src=\"https://myfiles.space/user_files/69519_bce2c0439cd956a6/69519_custom_files/img1746730952.gif\" alt=\"image\"\u003e\u0026nbsp;1.5 in the post-test. For Group 2, the mean is 4.9\u0026nbsp;\u0026nbsp;2.0 in the pre-test and 6.5\u0026nbsp;\u003cimg width=\"12\" height=\"22\" src=\"https://myfiles.space/user_files/69519_bce2c0439cd956a6/69519_custom_files/img1746730952.gif\" alt=\"image\"\u003e\u0026nbsp;1.3 in the post-test. There is a significant difference between groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003e--------------------------- Table 2 about here --------------------------------------------\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003e------------------------------ Figure 1 about here --------------------------------------\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, there are very few studies that investigated the impacts of PAL on international students’ knowledge. Furthermore, to the best of our knowledge, no other study has investigated psychosocial medicine as the teaching subject for international students. Our results show that international students significantly improved their knowledge after attending a PAL based revision course in medical psychology.\u003c/p\u003e\n\u003cp\u003eThese results align with the benefits of PAL described in the literature\u0026nbsp;(20): With the concise and comprehensible learning material provided, together with the tutors’ explanations, tutees received a structured repetition of the previous content, making it easier for them to remember the topics (15). With the tutors’ guidance, international students were able to focus on more important topics, possibly reducing the study load (15). Tutors, being international student themselves, have a greater understanding regarding language difficulties, which leads to a tendency of using less technical terms and therefore more understandable and approachable language (20, 44). Even though tutors and students may have different cultural backgrounds, they share similar experiences by being international students. Therefore, tutors have a deeper understanding of tutees’ needs and difficulties, as they themselves have overcome similar challenges in early stages of their studies (18). By additionally having the knowledge on the topic being taught, tutors may be better equipped to develop teaching strategies that ensure tutees’ best comprehension and therefore enhance the cognitive congruence between them (19). Such strategies show a more understanding and empathetic approach towards tutees’ specific needs and difficulties\u0026nbsp;(18). By having a similar social role as tutees, tutors are able to craft a more friendly and less formal relationship with tutees, so that a more comfortable learning environment can be established\u0026nbsp;(20, 44).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, international students were encouraged to\u0026nbsp;participate actively by answering tutors’ direct questions. This interaction between tutor and tutees promotes the tutees’ active engagement with the topic by encouraging them to regularly test their own knowledge throughout the course session. This active participation could have helped students in paying attention to the course for longer, which could have facilitated knowledge acquisition (45). At the end of each presentation topic, students answered multiple-choice questions and discussed answers with tutors. This could have helped international students develop a more efficient and successful strategy for answering multiple choice questions (17).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMotivating students to actively participate in the course by sharing their knowledge through question answering allowed tutors to act as facilitators of knowledge acquisition. Therefore, the hierarchical relationship can be so attenuated\u0026nbsp;(46). In this context, tutors are not viewed as an authority, but as supporters. This could have encouraged students to feel more confident to ask their questions freely during the course, leading to a better understanding of the contents.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEven though there was a difference between group 1 and 2, which can be explained by different individual knowledge levels, both groups objectively improved their knowledge. We were able to objectively show this improvement in the field of psychosocial medicine, with international students learning more about human behaviour, psychotherapy methods, doctor-patient-relationship, and communication. The intense exposure to such topics early in their medical studies, supported by the extracurricular revision course, could be beneficial to international students in their further career and lead to them taking a more empathetic and thoughtful approach to patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTaking into consideration the fact that medical faculties in Germany have reported challenges in supporting their international students\u0026nbsp;(9), we believe that a broader implementation of PAL based tutorial programs for international students could be an effective way of alleviating these difficulties. Programs such as repetition courses such as the one done in this study, HeiTiMed with weekly tutorials and social gatherings (4), the ‘Buddy Programme’, and language orientation (14)\u0026nbsp;have proven to be effective in supporting international students academically and socially. It would also be interesting to implement PAL as a teaching tool for practical skills, such as drawing blood and performing physical exams. In the field of psychosocial medicine, this method could be even more valuable as a tool to support the development of a more empathetic and patient-centred communication. International students could further develop their practical and communication skills by having the opportunity to obtain more practice sessions with a simulated patient while still being under a tutor’s guidance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe major limitation of the current study is a missing control group of students who didn’t take part in the revision course. A control group could further support the results, emphasizing the effect of the revision course on international students’ knowledge.\u0026nbsp;Another limitation of our study is that this revision course was taught exclusively by international tutors. As we mostly attribute the success of our results to the social and cognitive congruence between international students and tutors, it would be interesting to replicate our findings with a control group taught by German tutors.\u0026nbsp;Furthermore, the study focused solely on the students’ improvement within the 3-day revision course. Long-term outcome, such as the exam results of the First German Medical State Examination, are missing.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTo our knowledge, there is a lack of research regarding the effects of PAL in settings with international students. This study assessed \u0026nbsp;the objective improvement in international students\u0026apos; knowledge after attending a 3-day peer-led revision course.. During this time, international students significantly improved their knowledge in a psychosocial medical subject. These results align with the benefits of PAL described in the literature. The increased cognitive and social congruence between international students and tutors creates a safe learning environment that contributes to international students\u0026rsquo; acquisition of knowledge. However, further research on the effects of PAL in settings with international students is necessary. As done in this study, we suggest an objective approach that quantifies academic development, accompanied by an analysis of the subjective benefits for international students, as previously done by Huhn et. al. (15)\u003cspan lang=\"EN-GB\"\u003e. Moreover, further research is needed to evaluate the long-term effects of PAL on international students\u0026rsquo; academic career.\u003c/span\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003e\u003cspan lang=\"EN-US\"\u003eHeiTiMed\u003c/span\u003e\u003c/strong\u003e\u003cspan lang=\"EN-US\"\u003e\u0026nbsp;Heidelberg\u0026rsquo;s Tutorial for International Medical Students\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan lang=\"EN-US\"\u003ePAL \u003c/span\u003e\u003c/strong\u003e\u003cspan lang=\"EN-US\"\u003ePeer assisted learning\u003c/span\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e: Ethics approval was granted by the Ethics Committee of the University of Heidelberg: No. S-535/2016.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: Heidelberg\u0026rsquo;s Tutorial for International Medical Students (HeiTiMed) is a project funded by Heidelberg\u0026rsquo;s Medical Faculty.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets generated and analyzed during the current study are available at HeiData under https://doi.org/10.11588/DATA/1STVOK\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e No conflicts of interest are declared.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCN and ID conceived and designed the study. ID supervised the revision course. JS was a tutor teaching the course. JS and ID carried out the statistical analysis. JS drafted the manuscript, which was revised by ID, CN and HCF. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the tutors Andreas Royer, Hagyu Thomas Seong, Elizabeth Tong, Aleksei Smirnov, Isabel Hamm-Teixeira dos Santos and Josefina Arias Alvarado of the Heidelberg\u0026rsquo;s Tutorial for International Medical Students (HeiTiMed), who were responsible for teaching the revision course. We further thank Molly Beatrix Sutcliffe for revising this manuscript.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSVR - Sachverst\u0026auml;ndigenrat deutscher Stiftungen f\u0026uuml;r Integration und Migration. Vom internationalen Studierenden zum hoch qualifizierten Zuwanderer. 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Policy Futures Educ. 2018;16(3):346\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003e\u003cspan lang=\"EN-US\"\u003eTable 1\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan lang=\"EN-US\"\u003eTable of contents of the 3-day-revision course\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan lang=\"EN-US\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"EN-US\"\u003eBehavioral Modeling and Psychodynamic Models\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"EN-US\"\u003ePhysical Examination and Conversation Methods\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"EN-US\"\u003ePrevention and Promotion of Health\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan lang=\"EN-US\"\u003eLearning, Cognition, and Development\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan lang=\"EN-US\"\u003eEmotion and Motivation\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan lang=\"EN-US\"\u003ePersonalities and Behavioral Styles\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan lang=\"EN-US\"\u003eFundamentals of Demography and Sociology\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan lang=\"EN-US\"\u003ePsychotherapy Models\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan lang=\"EN-US\"\u003eMedical Statistics and Test Theories\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan lang=\"EN-US\"\u003eFundamentals of Scientific Studies\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan lang=\"EN-US\"\u003eHealth and Disease\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan lang=\"EN-US\"\u003eDoctor-Patient-Relationship\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan lang=\"EN-US\"\u003ePatient Care and Health Care Systems\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan lang=\"EN-US\"\u003eTable 2\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cspan lang=\"EN-GB\"\u003eANOVA for the differences between pre- and post-test results and between groups\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003eEffect\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003eDF1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003eDF2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003eF\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003ep\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003eGroup\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003e22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003e8.569\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003e0.008\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003ePre and Post (Time)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003e22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003e13.470\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003eGroup : Time\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003e22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cspan lang=\"DE\"\u003e0.974\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6368612/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6368612/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eInternational students are confronted with various difficulties in their social and academic life when moving to a new country for their university studies. Different projects have been developed to support international students in facing these difficulties, such as peer-assisted learning tutorials. Our goal was to evaluate preclinical international medical students\u0026rsquo; objective improvement of knowledge after attending a 3-day peer-led revision course.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe sample consisted of n\u0026thinsp;=\u0026thinsp;30 international students. The objective improvement of knowledge was quantified by the amount of correct answered questions in the post-test compared to the pre-test. Students were randomly separated into groups, based on which test version, A or B, was written in pre-test. For the comparison between pre- and post-times and between groups, a two-way ANOVA was calculated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eInternational students significantly improved their knowledge as shown in the post-test compared to pre-test (F\u003csub\u003e1,22\u003c/sub\u003e = 13.470, p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eInternational students profited from taking part in a peer-led revision course, through which they improved their knowledge. Peer-led tutorial programs for international students should be implemented further in medical faculties as a way to support these students academically and socially.\u003c/p\u003e","manuscriptTitle":"Peer-led revision course of the subject ‘Medical Psychology and Sociology’ for preclinical international medical students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-08 19:07:06","doi":"10.21203/rs.3.rs-6368612/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bcc1fedd-42a0-42d4-938a-802f1241d93b","owner":[],"postedDate":"May 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-26T11:09:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-08 19:07:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6368612","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6368612","identity":"rs-6368612","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}