Peer-assisted learning combined with problem-based learning enhances clinical reasoning and knowledge application among medical students

Problem-based learning (PBL) and peer-assisted learning (PAL) have been progressively incorporated into medical education to promote active learning methodologies. Nevertheless, PBL implementation is frequently hampered by practical challenges, such as excessive faculty workload that consumes limited resources, while PAL efficacy can be constrained by ambiguities in learning objectives and the proficiency of peer tutors. This study trialed a model integrating PAL and PBL—Peer-Assisted Problem-Based Learning (PA-PBL)—problem-based learning facilitated by peer tutors, and evaluated PA-PBL for enhancing clinical reasoning and the application of knowledge among medical students. A non-randomized controlled trial was conducted. A total of 523 undergraduates taking the mandatory module “Infection and Immunity” for second-year clinical medicine major students in Shantou University Medical College were enrolled in this study, of which 134 were in the experimental group, and PA-PBL was used to supplement lecture-based learning; 389 students were designed as the control group, receiving the lecture-based learning. Learning outcomes were assessed through quizzes, final examinations and student surveys, structured according to the Kirkpatrick model to evaluate reaction and learning levels. Non-parametric test, χ 2 test, and statistical description were used to analyze the data. The quiz scores of the experimental group were increased by 12.3%, 12.8%, 9.8% and 6.8% respectively ( P < 0.05). The scores of knowledge-recall MCQs, case-based MCQs, and MEQs in the experimental group were all higher than those in the control group, and the difference was statistically significant ( P < 0.05). Following four rounds of study, students in the experimental group achieved a higher academic ranking than after two rounds ( P < 0.05). The results of the questionnaire showed that the average scores of the experimental group on reaction and learning level of Kirkpatrick model were higher than 4.7 points (5-point Likert Scale). PA-PBL is shown to improve knowledge mastery, enhance skills in case analysis, and cultivate clinical reasoning and knowledge application abilities. Moreover, it may reduce educational expenditures, indicating that PA-PBL is a valuable methodology deserving broader implementation.