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Table of Contents
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 110-115

Near-peer learning in medical education: An evaluation of a student-led, online COVID-19 Course

School of Medicine, University of North Carolina, Chapel Hill, NC, USA

Date of Submission15-Nov-2020
Date of Acceptance02-Jun-2021
Date of Web Publication01-Feb-2022

Correspondence Address:
Ms. Brooke Namboodri Spratte
University of North Carolina, Chapel Hill, 321 S Columbia St, Chapel Hill, NC 27516.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EHP.EHP_38_20

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Background: The coronavirus disease-2019 stressed health science education across many science disciplines. At one public medical school, faculty educators responded with the design and delivery of an online COVID-19 pandemic course for clinical phase students. However, faculty resources were limited, and no official course was offered to preclinical students, despite reported interest. Subsequently, clinical students created an 8-week online, student-run curriculum. We aimed to assess how effectively the course improved medical student knowledge on COVID-19, created community, and improved other professional skills. Methods: Participants and instructors completed four surveys—two pre-course surveys and two post-course surveys. Average ratings for each question were calculated and analyzed using independent sample t tests. Results: Of the 188 students in the preclinical cohort, 143 enrolled in the course with 63.64% attending all, 91% attending ≥7 out of 8, and 96% attending ≥6 out of 8 sessions. Students and instructors reported an overall mean increase in knowledge on all course topics, peer teaching, learning in an online format, and overall preparedness with regards to a public health crisis. Overall, 79.2% of student participants and instructors reported being satisfied with the experience. Conclusion: Peer teaching and learning offers a valuable educational experience for participants and instructors alike. Student-driven curricula may provide an effective teaching model for medical education, contributing to efforts that improve student confidence and leadership skills, provide role models for junior students, and prepare students for their future role as educations.

Keywords: Medical education, near-peer learning, virtual learning

How to cite this article:
Spratte BN, Hollis AN, Hollis ES, Cole YC, Bennett WC, Alexander SM, Parton T, Dallaghan GL. Near-peer learning in medical education: An evaluation of a student-led, online COVID-19 Course. Educ Health Prof 2021;4:110-5

How to cite this URL:
Spratte BN, Hollis AN, Hollis ES, Cole YC, Bennett WC, Alexander SM, Parton T, Dallaghan GL. Near-peer learning in medical education: An evaluation of a student-led, online COVID-19 Course. Educ Health Prof [serial online] 2021 [cited 2022 Jul 4];4:110-5. Available from: https://www.ehpjournal.com/text.asp?2021/4/3/110/336975

  Background Top

The coronavirus disease-2019 (COVID-19) pandemic imposed disruptions upon health science education across many health science disciplines. As clinical sites became unable to accommodate students in healthcare programs, students found themselves at home without a clear curriculum to follow. At the University of North Carolina School of Medicine (UNC SOM), faculty educators responded with the design and delivery of an online COVID-19 pandemic course for clinical phase students. However, for preclinical students (i.e., those in the first half of medical education), standard curriculum was continued online with minimal content cross-covering the pandemic. Despite reported interest in learning opportunities on COVID-19, faculty resources were limited, and no official course was offered to preclinical students.

Absent a formal course on COVID-19 for preclinical medical students (hereafter, “participants”), clinical students (hereafter, “instructors”) were recruited to develop an 8-week, student-led course.[1],[2] Due to physical distancing, the course was implemented online. This course used near-pear learning with the goal to ultimately supplement preclinical curriculum with content on the current medical climate, global news, and updated literature regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Overall, the primary aim of this course was to develop a student-run curriculum that provided comprehensive and up-to-date knowledge on COVID-19, create a sense of community among peers, and promote lifelong learning and public health crisis preparedness––for both student participants and instructors.

Previous literature highlights the benefits of peer teaching on student outcomes,[3],[4] including the provision of educational and emotional support. These studies show the benefits of peer teaching on student confidence in practical teaching skills, public speaking, communication, and academic expertise. Additional studies further show that similar programs improve both student participant and instructor preparedness for roles as medical teachers and improve presentation skills, confidence, decision-making, and teamwork.[5],[6] Although these previous studies show the potential for near-peer learning in medical curriculum, the COVID-19 pandemic presented new challenges in modern curricula development, such as adapating to and integrating multimodal learning techniques into the virtual learning environment. The following prospective study analyzes survey data to assess how effectively a virtual, student-driven course improved medical student knowledge on COVID-19, created community, and improved other professional skills amidst a background of uncertainty and change in medical education.

  Materials and Methods Top

Course design

The course ran from April 3 to May 22, 2020. Seventeen course instructors were recruited by faculty advisors of the Medical Education Scholarly Concentration program. Students were recruited via an email sent to the forty clinical-phase students involved in the program. All students who responded with interest were included. Instructors designed the content and structure of the course under the oversight of a faculty member who directs the Medical Education Scholarly Concentration. The course was offered to all preclinical phase students as an optional, supplementary course to their current curriculum. No credit was rewarded to participating students.

In line with the national Liaison Committee for Medical Education (LCME) guidelines in medical curricula, we provided students ample opportunities to learn about COVID-19 in the context of clinical mimics and differential diagnosis (7.2, 7.4), clinical research throughout the pandemic (7.3), the societal impacts and racial disparities among those infected (7.5, 7.6). In addition, through preparatory work and team-based presentations, students developed problem-solving and communication skills necessary for independent study in life-long learning (6.3, 7.4, 7.8).[7]

Each weekly class was designed as a 1-h session consisting of a variety of lectures, small group discussions, and activities. Small groups were led by two instructors and remained consistent throughout the course. Content was continuously adapted to student-feedback and newly surfacing COVID-19 information. The syllabus is included below:

Week 1––History and epidemiology

Week 2––Basic science and disease ecology

Week 3––Presentation, diagnosis, and treatment

Week 4––Ethical implications

Week 5––Policy and supply chain

Week 6––Social media

Week 7––Practical applications and economic impact

Week 8––Poster presentations

Before each session, students completed preparatory material such as reading short articles, watching video clips, and completing small group assignments. A final presentation on a student-chosen topic relating to COVID-19 was required during the last week of the course. Students were encouraged to use creative modalities to develop and share their projects (i.e., infographics, artwork, and video). This provided students an opportunity to conduct outside research and apply knowledge acquired throughout the course to educate both themselves and their peers.


To evaluate the course, we developed surveys to evaluate both participants and instructors. Participants completed four surveys––two precourse surveys and two postcourse surveys. Similarly, instructors completed two precourse and two postcourse surveys. Surveys ranged from 15 to 18 questions each. Survey questions were developed based on surveys from similar studies in addition to collaboration among instructors.[3],[4],[5],[6] The surveys were administered prior to and on completion of the course. These surveys prompted students to consider their confidence regarding course topics, comfort in preparedness for public health crises, and attitudes toward peer teaching. Scales ranged from 0 (not at all comfortable or interested) to 100 (entirely comfortable or interested). Survey data were collected using Qualtrics, an online survey tool available to all UNC students and faculty.

Data analysis

To compare pre- and post-survey responses, average ratings for each question were calculated. As the surveys were completed anonymously, we were unable to pair surveys in order to examine changes in ratings for specific students. Rather, average ratings were analyzed using two independent sample t tests. All statistical analyses were completed using Statistical Package for the Social Sciences (SPSS) software program, version 12.0 and GraphPad Prism version 7.04. All tests were two-tailed with a 5% significance level.

Participants and ethical review

This study was approved by the Institutional Review Board (Protocol no. 20–0956) at the UNC. All survey participants agreed via written, informed consent.

  Results Top

Although 67 students initially indicated interest, 143 students (76%, 143/188 of the preclinical cohort) attended the first session and enrolled in the course. On course completion, 63.64% attended all, 91% attended ≥7 out of 8, and 96% attended ≥6 out of 8 sessions [Figure 1]. Furthermore, 96% (137/143) of students completed a final project.
Figure 1: Attendance rate of preclinical students throughout a COVID-19 peer-to-peer curriculum. The attendance of 143 preclinical students was tracked during the 8-week period. Requirements for completion included attending 7/8 sessions and completing the final project

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Of the 143 student participants, 101 (71%) completed Pre-Survey 1, 80 (56%) completed Pre-Survey 2, 78 (55%) completed Post-Survey 1, and 65 (45%) completed Post-Survey 2. Of the 17 instructors, 8 (47%) completed Pre-Surveys 1 and 2, 12 (71%) completed Post-Survey 1, and 10 (59%) completed Post-Survey 2. Overall, the range of survey completion was 45%–71%.

Outcomes: knowledge

Students and instructors reported an overall mean increase in knowledge on all course topics, with the largest mean increase in knowledge for resource logistics and supply chain (Δx̄=37.14, 121%, P < 0.000 and Δx̄=42.70, 117%, P < 0.000, respectively) [Table 1]. When asked to rank which topics were most important, students reported the following: clinical presentation and treatment options, public health policy, epidemiology, ethical considerations, and basic science connection. These topics remained consistently highly ranked from the pre- to postclass surveys, although the specific order of the topics changed.
Table 1: Confidence of student participants and instructors toward specific topics related to COVID-19 and public health crises, evaluated on a scale from 0 to 100, with 0 being not at all comfortable and 100 being very comfortable

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Outcomes: peer-to-peer model

Instructors reported an overall mean increase in confidence toward teaching peer students (Δx̄=31.12, P = 0.0001), acquiring and teaching up to date information about a current crisis (Δx̄=34.95, P < 0.0001), and teaching students in an online format (Δx̄=36.42, P < 0.001) [Table 2]. Student participants reported an increase in mean confidence with regard to learning from peers (Δx̄=0.62, P = 0.840), through small group sessions (Δx̄=7.99, P = 0.031) and in an online format (Δx̄=4.29, P = 0.245) [Table 2].
Table 2: Attitudes of student participants and instructors toward peer teaching, evaluated on a scale from 0 to 100, with 0 being not at all comfortable and 100 being very comfortable

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Outcomes: preparedness, community, and overall satisfaction

Student participants and instructors together reported an increase in confidence of a pre-clinical course to help mobilize (Δx̄=9.13, P = 0.004), prepare (Δx̄=7.30, P = 0.23), inform (Δx̄=2.64, P = 0.994), and unite students (Δx̄=2.02, P = 0.059) in the face of a public health crisis [Table 3]. Students also reported significant increases in average confidence to manage outbreaks (Δx̄=34.62, P < 0.000) and analyze articles and vet information (Δx̄=17.66, P < 0.000). Finally, when asked if their education has supported public health crisis management, students reported a significant average increase in confidence (Δx̄=31.06, P < 0.000) [Table 3].
Table 3: Attitudes of participants and instructors toward (1) the ability of a student-led, online class to prepare, inform, and unite students during a public health crisis and (2) individual outbreak management, information seeking, and educational support with regards to a public health crisis

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Overall, 79.2% (n = 61/77) of student participants reported being somewhat or very satisfied with the experience. More specifically, 88.3% reported being somewhat or very satisfied with the leadership of the program, 83.1% with peer-to-peer education, 88.3% with the choices of topics, 72.7% with virtual learning, 84.4% with the interactive learning experience, and 77.9% with how helpful the program was for learning topics related to COVID-19 [Figure 2].
Figure 2: Overall student participant attitudes toward a COVID-19 peer-to-peer curriculum (n = 77)

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  Discussion Top

The COVID-19 pandemic challenged many essential elements of our society, including medical education. This student-developed and student-run online curriculum was created with the primary aim of educating and preparing peers for a pandemic while generating a supportive community for preclinical and clinical phase medical students alike.

Our findings show multiple benefits of near-peer teaching for instructors and learners, alike. Participants and instructors reported an increase in confidence across all course topics. Furthermore, data showed improvement in confidence in the educational utility of peer teaching. Consistent with other peer-led courses, this improvement was particularly notable for instructors, supporting the idea that peer-teaching can reinforce teaching skills and affirm the premise that teaching is a powerful method by which to learn.[3-6],[8],[9]

Students also noted increased confidence to manage and prepare for public health crises and to evaluate sources of information. As the program did not directly teach these skills, they were learned indirectly through practice and experience with course preparation and delivery. The application of these skills will reach beyond this class, complementing academic and professional competencies, such as public speaking, teamwork, and presentation skills. Subsequently, benefits of a peer-taught course likely encompass more than just specific content comprehension.

In the context of limited faculty resources, this course provided a valuable resource for preclinical medical students. Given that the majority of participants were satisfied with the instructors, peer-to-peer teaching style, virtual format, and overall learning experience, this course offers a viable solution for schools with similar demands. Specifically, it meets the growing appeal for small group learning, which can often pose logistical challenges, especially when navigating a large student to faculty ratio.[10]

In developing this curriculum amidst the background of the COVID-19 pandemic, instructors consistently relied on being adaptable. Over its progression, preparatory work changed to focus on student-driven research, whereas in-class seminars more directly required students’ active participation. Weekly lessons were reformed to assign preparatory work from scientific journals rather than news articles and to favor small-group activities versus lectures. This highlights the advantages of continuous feedback with timely responses and adjustments.

Previous research shows variable responses to peer tutoring and it is likely that a variety of personal, professional, and social factors influence this relationship.[11],[12] Literature on peer tutoring has described “near-peer” tutors––students 1 or 2 years in training ahead of the students being taught––as effective due to their proximity to the peer learners’ level of training and content understanding.[11],[12] Such studies predominantly focus on teaching initiatives that directly supplement standard medical curriculum, and specifically highlight the utility of near-peer instructors as recent learners of the same content. Rather than being experts on a curriculum’s content, they are seen as experts on learning that curriculum’s content and compensate for their lack of expertise with greater adeptness to understand learners. This course, however, used near-peer instructors to create and deliver a curriculum that was requested by learners, but not provided by the school. The distinction is important, as it may partially explain some of the feedback from students suggesting that the curriculum was too basic. Unlike second-year medical student peer instructors returning to teach first-year content for which they presumably attained sufficient competency, our instructors generated and delivered an independent, unique, and novel curriculum at this particular institution. Peer learners, understandably, might enter the interaction with more distrust toward their peer instructor’s competency relating to the content at-hand. Additional research should evaluate the perception of near-peer teaching in various settings and whether this perception impacts the value of a peer-to-peer course. In lieu of further data, our analysis suggests future peer instructors should remain considerate of peer learner perceptions.


The results of this study should be interpreted in the context of several limitations. First, study participants were self-selected and likely biased toward teaching and learning from peers. Second, surveys were anonymous and optional. Given the anonymity, survey data were not matched, and therefore results reflect aggregate, rather than individual, changes. Third, survey response rates were around 50%–70%. Although adequate, responding participants may potentially differ from nonresponders. For example, responders may have different motivations and may represent the extremes of those unsatisfied versus satisfied. This phenomenon was shown via the qualitative responses, which were negatively biased overall. This sample size is especially important to consider with regards to student instructors, as it may limit generalizability. Finally, statistically significant findings should be interpreted with caution given the exploratory nature of this study.

  Conclusion Top

This study contributes to the growing body of research that suggests peer teaching and learning offers an effective and valuable educational experience for participants and instructors. Already, many medical schools offer formal opportunities for peer-teaching, including scholarly concentrations in medical education and summer teaching assistant programs. These opportunities are driven by the motivation to improve student confidence and leadership skills, provide role models for junior students, and prepare students for their future role as educators.[8] Overall, this study provides evidence that an innovative student-driven online curriculum provides an effective teaching model for medical education.


We thank our mentor, Dr. Gary L. Beck Dallaghan, PhD, who provided insight and expertise that greatly assisted the development of the course curriculum and its evaluation. We would also like to show our gratitude to Dr. Kurt Gilliland, PhD for leading the Medical Education Scholarly Concentration and, without whose support, this course would not have been possible.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Teaching COVID-19’s Real-Time Lessons––News Room––UNC Health and UNC School of Medicine. Available from: http://news.unchealthcare.org/som-vital-signs/2020/june-4/teaching-covid-192019s-real-time-lessons. [Last accessed on 2020 Aug 19].  Back to cited text no. 1
Students Teaching Students: COVID-19 — News Room - UNC Health and UNC School of Medicine. Available from: http://news.unchealthcare.org/som-vital-signs/2020/may-28/students-teaching-students-covid-19?utm_source=vs-email&utm_medium=email&utm_campaign=22. [Last accessed 2020 Aug 19].  Back to cited text no. 2
Buckley S, Zamora J. Effects of participation in a cross year peer tutoring programme in clinical examination skills on volunteer tutors’ skills and attitudes towards teachers and teaching. BMC Med Educ 2007;7:20.  Back to cited text no. 3
Sobral DT. Cross-year peer tutoring experience in a medical school: Conditions and outcomes for student tutors. Med Educ 2002;36:1064-70.  Back to cited text no. 4
Secomb J. A systematic review of peer teaching and learning in clinical education. J Clin Nurs 2008;17:703-16.  Back to cited text no. 5
Krych AJ, March CN, Bryan RE, Peake BJ, Pawlina W, Carmichael SW. Reciprocal peer teaching: Students teaching students in the gross anatomy laboratory. Clin Anat 2005;18: 296-301.  Back to cited text no. 6
Standards, Publications, & Notification Forms | LCME. Available from: https://lcme.org/publications/. [Last accessed 2020 Aug 19].  Back to cited text no. 7
Manyama M, Stafford R, Mazyala E, Lukanima A, Magele N, Kidenya BR, et al. Improving gross anatomy learning using reciprocal peer teaching. BMC Med Educ 2016;16:95.  Back to cited text no. 8
Ten Cate O, Durning S. Peer teaching in medical education: Twelve reasons to move from theory to practice. Med Teach 2007; 29: 591-9.  Back to cited text no. 9
Steinert Y. Student perceptions of effective small group teaching. Med Educ 2004;38:286-93.  Back to cited text no. 10
Cianciolo AT, Kidd B, Murray S. Observational analysis of near-peer and faculty tutoring in problem-based learning groups. Med Educ 2016;50:757-67.  Back to cited text no. 11
Khaw C, Raw L. The outcomes and acceptability of near-peer teaching among medical students in clinical skills. Int J Med Educ 2016;7:188-94.  Back to cited text no. 12


  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3]


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