Consultation with the University of Manchester’s ethics decision tool [13] revealed that no formal external ethical approval was required for this study. All administered questionnaires outlined how the data gathered would be used and handled, followed by an opportunity to consent to the terms.

Manchester Medical Society page facilitated advertisement of the program to prospective NPTs and NPLs. NPTs expressing interest were added to a group chat, while NPLs followed a link to join a Facebook page. An instructional sheet was sent to all the NPTs. It incorporated reminders to include disclaimers, keep the presentations under 30 minutes, have them completed by a particular date before being sent for quality assurance by the head of clinical teaching, and include an OSCE practice scenario at the end of their presentations to contextualize the taught content. This ensured session standardization and OSCE relevance.

The fourth-year syllabus at Manchester Medical School is split into 2 distinct overarching themes: “families and children” (F&C) and “mind and movement” (M&M). The programs, therefore, consisted of 2 separate weekly, hour-long sessions on Zoom, 1 for each theme. Each session was split into 2 separate 30-minute lessons delivered by 2 NPTs. A total of 42 talks were delivered over 3 months, covering a range of topics within each theme (Table 1). Presentations were reviewed and returned each weekend by the head of clinical teaching so that timely revisions could be made. Formal approval of the teaching program involved drafting a proposal and liaising with multiple members of the senior faculty at Manchester Medical School. Examples of 2 presentations can be seen in Multimedia Appendices 1 and 2.

Anonymized weekly feedback questionnaires, 1 for the M&M and 1 for the F&C theme, were distributed using Google Forms following each session. This functioned as a means of tailoring future sessions toward the needs and wishes of the NPLs.

In addition, 2 separate postcourse questionnaires were distributed to NPLs and NPTs at the end of the program (Multimedia Appendices 3 and 4). The NPL postcourse questionnaire covered a range of questions relating to the perceived overall quality of the sessions, usefulness of the program, usefulness in guiding revision, confidence ratings prior to and after the program (out of 10), and the likelihood of organizing a similar teaching program. A free-text section allowed NPLs to relay any positive comments and advice for future improvement. The NPT postcourse evaluative questionnaire comprised of multiple statements with which the NPTs indicated their level of agreement on a 10-point Likert scale. They included topics relating to enjoyment of the program, its effect on teaching skills, and its benefits for teacher learning. The questionnaire concluded with 2 free-text sections inquiring about the greatest perceived benefit of engaging in the program and providing space for further comments.

A paired 2-tailed t test analysis compared confidence ratings of NPLs prior to and after the course. The remaining items in the NPL and NPT postcourse questionnaires were analyzed by mean and SD.

Two NPTs conducted qualitative analysis of the free-text sections in the NPL and NPT postcourse questionnaires. This involved identifying and agreeing on common themes and categorizing each response appropriately.

The 22 sessions (11 for F&C and M&M each) were attended by a total of 72 different NPLs and taught by 13 NPTs. The F&C weekly session attendance ranged from 8-26 NPLs (mean 14.64, SD 4.41). The M&M weekly session attendance ranged from 11-26 NPLs (mean 14.45, SD 4.63). Overall weekly attendance across the 2 themes ranged from 21-49 NPLs (mean 29.09, SD 8.64).

In total, 37 NPL postcourse evaluative questionnaires were completed equating to a 51.39% feedback response rate. A paired 2-tailed t test analysis demonstrated a statistically significant increase in mean confidence ratings following delivery of the program (t₃₆=–13.71, P<.001). Quality of teaching, usefulness of the OSCE scenarios, and usefulness in guiding revision were all rated highly (Table 2).

There was considerable variation in likelihood of organizing a similar program, with the majority taking a neutral stance (n=23), and the remaining indicating it is either somewhat likely or very likely (n=13), or it is somewhat unlikely (n=1). Of 37 students, 23 (62.16%) left comments in the free-text sections. Qualitative analysis revealed 8 broad themes with some overlap (Table 3).

Of 13 NPTs, 11 (84.62%) completed the NPT postcourse questionnaire. Respondents unanimously agreed that engaging with the program helped them better understand the material taught (mean 9.45, SD 0.86), facilitated long-term retention of the content (mean 9.36, SD 0.81), helped them develop their teaching skills (mean 9.00, SD 1), was rewarding and motivational in engaging in more teaching in the future (mean 9.27, SD 0.79), and was highly enjoyable (mean 9.30, SD 1.15) (Table 4).

Thematic analysis of the 2 free-text sections mostly reinforced findings from these rating questions. When asked what the NPTs felt the greatest benefit of the program was, 3 broad themes emerged, with some overlap (Table 5).

The “any positive comments/areas for improvement” section comprised of 3 comments expressing gratitude for organizing the program. A summary of the key findings from both questionnaires can be seen in Table 6.

In line with the existing body of literature, this study clearly demonstrates the value of undergraduate near-peer programs for both the student and the teacher. Crucially, it demonstrates a significant increase in NPLs’ perceived confidence to sit their OSCE examinations. Simulated OSCE scenarios and the setup of the sessions in helping guide revisions explain this finding. The study also demonstrates numerous benefits obtained by NPTs including enhanced comprehension and retention of the taught materials, development of teaching skills, and increased motivation in engaging with future teaching endeavors.

A variety of reasons can account for the significant increase (P<.001) in NPLs’ confidence in the OSCE performance. Evaluation of the free-text sections in the weekly questionnaires helped tailor future sessions suitably. For instance, the overwhelmingly positive reaction to the OSCE scenarios prompted organization of 2 sessions focusing exclusively on such scenarios for the final week of the program. The perceived benefit of these scenarios was mirrored in the NPL postcourse questionnaires’ average rating of usefulness of the scenarios (mean 8.92, SD 0.95); it also supports the notion that simulation exercises in medical education lead to improvements in knowledge, confidence, and procedural performance upon retesting [14].

Rashid et al [15] adopted a similar methodology in 2011 to evaluate the success of their near-peer program for final year OSCE examinations and similarly found their program to have a positive influence on OSCE preparedness. However, unlike prior comparable studies, this study ensured that all taught materials were quality assured by a relevant senior faculty—the head of clinical teaching and examinations at Manchester Medical School. The exceptionally high ratings of the overall quality (mean 9.30, SD 1.15) are likely attributable to session standardization, facilitated by quality assurance and NPTs’ instruction sheets. This highlights the importance of quality assurance and selection of appropriate individuals to ensure the relevance and accuracy of teaching. Qualitative analysis further consolidates this, with 7 students praising the overall quality, organization, or structure of the sessions. The anecdotal “top tips” provided throughout the sessions were also praised (n=3), further corroborating the notion of “cognitive congruence” and its intrinsic benefit in near-peer teaching [2].

NPTs also obtained multiple benefits, with engagement shown to enable better understanding (mean 9.45, SD 0.86) and long-term retention (mean 9.36, SD 0.81) of the taught material. These findings are supported by multiple prior studies [6,16] and analysis of the free-text sections, where a handful of NPTs (n=6) commented that teaching was beneficial to their learning and revision. Dandavino et al [17] postulate that other than learning, teaching provides the additional benefit of covert familiarization with teaching and learning principles, yielding a more effective learner and teacher. Additionally, the reported positive impact on teaching skills and motivation to teach as a doctor coincides with the United Kingdom’s General Medical Council’s “good medical practice” guidelines, which state that doctors “should be prepared to contribute to teaching and training doctors and students” [18]. The free-text sections complemented this notion, with NPTs outlining how teaching in an informal environment and responding to feedback helped enhance their teaching skills (n=6) and confidence in their teaching ability (n=2).

First, the data collected and interpreted from the questionnaires in this study mostly deal with perceptions and lack objective measures. Future endeavors will look to collect data from tangible objective outcomes (ie, achieved OSCE marks of NPLs). Second, connectivity issues occasionally interfered with the delivery of teaching and our ability to share media and video clips—a drawback also identified by Mageswaran and Ismail [19], and 2 of the students in this study (Table 3). This can be avoided by asking all teachers to host sessions from a location where a stable connection can be ensured and to record sessions for students to play back in their own time if their connection fails during the live session. Third, although this study argues the case for near-peer learning, it fails to compare it to the alternative (ie, teaching by experienced senior faculty). Nevertheless, numerous prior studies have established that students taught by peers perform just as well as those taught by experienced teachers [3,20]. For instance, a randomized controlled trial by Tolsgaard et al [20] in 2007 found that students taught catheterization and intravenous access by student teachers performed just as well as those taught by associated professors in a postcourse assessment.

Numerous studies have established the value of the near-peer model in undergraduate medical education, including facilitation of OSCE preparedness [21,22]. However, this is the first study to evaluate an OSCE program delivered exclusively online. Given that the majority of curricular undergraduate clinical teaching is delivered by senior clinicians, there is scope for implementation of online OSCE-focused programs similar to the one described in this study. Such programs should involve careful review of weekly feedback to fine-tune sessions, practice scenarios to consolidate learning, and session standardization including quality assurance by relevant senior faculty as well as instructional sheets for teachers. Although online teaching is not a substitute to learning in the clinical setting, it is certainly a worthy adjunct that is economically and logistically viable and highly effective in preparing both students and teachers for clinical examinations and future practice. Peers embarking on similar endeavors will uncover novel ideas for delivering similar online programs in the future.