Structured peer-assisted learning improved OSPE scores in MSK anatomy.

Greater gains were observed in application-based questions.

Faculty oversight and multimodal learning supported deeper engagement.

Students reported high satisfaction and enhanced confidence.

PAUL offers a replicable model for modern anatomy education.

Peer-assisted learning enhances conceptual understanding in anatomy education; however, its impact on structured cognitive outcomes remains unclear. We evaluated the effect of the Peer-Assisted Uniform Learning (PAUL) program on musculoskeletal (MSK) anatomy objective structured practical examination (OSPE) performance.

We used a cross-sectional, controlled, observational design to analyse the OSPE scores of 304 students. Seventy-nine students who attended at least two PAUL sessions formed the exposure group, while 225 served as the control group. The PAUL participants alternated between tutor and tutee roles during the sessions. The OSPE items were divided into Cluster 1 (identification/recall) and Cluster 2 (application/analysis). A validated survey was used to assess the participants perceived learning outcomes and satisfaction.

PAUL participants outperformed non-participants in Cluster 1 (78.4 vs. 73.7, p = 0.01) and Cluster 2 (87.2 vs. 82.8, p = 0.02). The relative gain was greater for application-based items (interaction effect: F = 8.37, p = 0.004), supporting the program’s effect on higher-order reasoning. Survey responses (91 % response rate) showed high satisfaction (mean 4.3 ± 0.6) and perceived learning gains (mean 4.1 ± 0.7); 85 % of students reported improved understanding of the subject.

The PAUL program, grounded in social constructivist principles and supported by faculty oversight, improved performance in both recall and application of MSK anatomy OSPE items, with the strongest impact on application-based learning.

Peer-assisted learning

Applied anatomy education

Constructivism

OSPE

Cognitive domains

Medical students

© 2025 The Authors. Published by Elsevier GmbH.