Evaluation of a peer-assisted, simulation-based clinical skills training program in Spain: a prospective single-group before-and-after study

PURPOSE: This study aimed to evaluate the implementation and evolution of a peer-assisted, simulation-based clinical skills program at Miguel Hernández University, Spain, focusing on medical student participation, perceptions, and perceived educational value. METHODS: A prospective quasi-experimental pre-post study without a control group was conducted. Sessions were organized in small groups and led by senior student tutors under faculty supervision. Six workshops were offered during the first academic year and 8 during the second, with the addition of lumbar puncture and introductory clinical ultrasound. Knowledge acquisition was assessed using pre- and post-workshop questionnaires, and satisfaction was evaluated with Likert-scale surveys. RESULTS: A total of 154 students participated, including 77 in 2023-2024 and 77 in 2024-2025, generating 440 workshop attendances. After incomplete questionnaires were excluded, 425 paired pre- and post-workshop evaluations were analyzed. Students reported improved learning, with self-reported knowledge scores increasing significantly from 6.1±2.6 to 8.7±1.6 (Δ=2.5; 95% confidence interval CI, 2.29-2.71; Cohen's d=1.14; P<0.001). Male students showed greater knowledge gain than female students (Δ=2.8 vs. 2.3; 95% CI, 2.17-3.43 vs. 1.91-2.69; Cohen's d=1.17 vs. 1.15; P=0.034), and second-year students improved more than third-year students (Δ=2.9 vs. 2.1; 95% CI, 2.36-3.44 vs. 1.67-2.53; Cohen's d=1.21 vs. 1.11; P=0.001). Satisfaction was high, with mean scores above 4/5. CONCLUSION: Clinical simulation combined with peer tutoring was feasible and well accepted in an undergraduate medical curriculum in Spain, achieving sustained participation over 2 academic years and consistently high satisfaction ratings. The program was associated with significant immediate improvements in workshop-specific knowledge test scores.