Evaluation of a One-on-One Near-Peer Tutoring Program for Medical Students

Purpose: Few studies have examined efficacy of near-peer, 1 one-on-one tutoring programs in medical school basic science courses. An early study reported that 84% of first-/second-year (M1/M2) students tutored in dyads received passing grades. 2 More recently, studies have reported: statistically significant changes in academic grades in tutored courses among osteopathic medical students most at risk of failing, 3 improved in-course assessment scores among tutored allopathic students who had previously failed, 4 and overall reduced failure rates in allopathic medical school. 5 The current study seeks to evaluate a one-on-one near-peer tutoring program open to all M1 students in 3 basic science courses at an allopathic medical school over 3 consecutive academic years (2016–2017, 2017–2018, and 2018–2019). Methods: Student scores (n = 639) on all in-course examinations were collected for each of the 3 academic years in the following courses: Gross Anatomy (5 exams), Histology/Cell Biology (5 exams), and Medical Physiology (4 exams). These data were electronically linked to admissions data (Medical College Admission Test [MCAT] scores, grade point average [GPA], multiple mini-interview and CASPer scores, demographics) and scores on the United States Medical Licensing Examination (USMLE) Step 1. Within each academic year, scores on each in-course assessment were standardized (i.e., z-scores). Separate repeated measures ANOVAs were conducted to compare students who received tutoring with those who did not with respect to changes in relative performance (i.e., z-scores) across assessments within each course. Step 1 scores were statistically regressed onto MCAT scores, and residual values (i.e., actual minus predicted Step 1 score) were compared by t tests between groups. Student t tests, chi-square statistics, and Pearson correlation coefficients were calculated to examine the relationships between admissions data, Step 1 scores, and participation in tutoring. Results: Tutored students had significantly lower MCAT and Step 1 scores; they were more likely to be female (77% vs 47%) and underrepresented in medicine (URiM; 23% vs 14%). There were no statistically significant differences among groups on the basis of undergraduate GPA, multiple mini-interview scores, or CASPer situational judgment test scores. The number of students receiving tutoring in each course over the 3 years studied were: Gross Anatomy (n = 103), Histology/Cell Biology (n = 68), and Medical Physiology (n = 66). When studied by academic year, with the exception of Histology/Cell Biology (P = .10) in 2017–2018, statistically significant gains in performance on exams over time, relative to peers in the same course, were observed for students who received tutoring. Nevertheless, mean final grades in each of these courses were significantly lower (P < .05) for tutored students than nontutored students. Overall, small but statistically significant correlations were observed between MCAT and Step 1 scores (only available for students tutored in 2016–2017 and 2017–2018; old MCAT: r = 0.35, P < .001; new MCAT: r = 0.27, P < .001). Analysis of residuals from regression analyses demonstrated that tutored students scored, on average, 3–5 points lower on Step 1 than was predicted by MCAT score, while nontutored students, on average, scored approximately 2 points higher than predicted based on MCAT. Discussion: Results suggest that near-peer tutoring was effective in improving student performance relative to classmates within courses in Anatomy, Histology/Cell Biology, and Medical Physiology. However, students tutored in these courses received significantly lower course grades and Step 1 scores. Female sex, URiM status, and lower MCAT scores were associated with greater likelihood of seeking tutoring. Significance: In a one-on-one near-peer tutoring program that is equally available to all students, lower-performing students were more likely to use services. While tutored students saw improved exam scores within courses, their overall performance was significantly lower than students who were not tutored. This suggests that tutoring programs support the improvement of lower-performing students within courses, but earlier and longer-term interventions need to be explored.