Peer and near-peer learning in undergraduate medical education: a narrative review focused on the impact of the COVID-19 pandemic

Introduction: Peer- and Near-Peer-Assisted Learning (PAL) is a collaborative educational strategy increasingly embedded in undergraduate medical education, delivering cognitive, motivational, and psychosocial benefits for tutors and tutees, aligned with modern competency frameworks. This comprehensive review examines the evolution, scope, and impact of peer and near-peer learning before and during the COVID-19 period. Methodology: A total of 616 studies from 61 countries/territories were analyzed, informed by a scoping strategy. Literature published from January 2017 to December 2022 was reviewed. The search was carried out using various combinations of relevant keywords and covered six databases and additional sources. Results: The review revealed expansion of PAL in virtual and in-person formats across preclinical, clinical, and extracurricular levels. Many changes were directly catalyzed by the COVID-19 pandemic onset. Students now assume multiple roles such as tutor, mentor, collaborator, evaluator, and curriculum co-creator. PAL is applied to core and elective disciplines, procedural and interpersonal skills, psychological safety, metacognition, professional identity, and community engagement. Reported benefits include increased satisfaction, self-confidence, self-efficacy, stress reduction, empathy, peer bonding, and professionalism. However, long-term academic and clinical outcomes, metacognitive gains, and potential benefits for patients remain inconsistently documented. Conclusions: PAL represents a paradigm shift in undergraduate medical education. While its conceptual clarity and methodological rigor are still evolving, structured, theory-driven programs could further strengthen its educational value. Genuine institutional support is essential to prevent opportunistic, futile, or symbolic practices. Further rigorous research on sustained impacts and tutors/mentors lived experiences is needed to optimize PAL integration.