Peer instruction improves comprehension and transfer of physiological concepts: a randomized comparison with self-explanation

Comprehension of physiology is essential for development of clinical reasoning. However, medical students often struggle to understand physiological concepts. Interactive learning through Peer instruction (PI) is known to stimulate students’ comprehension, but its relative efficacy and working mechanisms remain to be elucidated. In this study, we investigated if and how PI could optimize comprehension of physiological concepts and transfer relative to Self-explanation (SE) which is considered a lower-order type of overt learning. First-year medical students (n = 317) were randomly assigned to either PI or SE in a pre-post test design, followed by a set of near and far transfer questions. In both PI and SE groups post-test scores were significantly improved (p < 0.0001) with PI outperforming SE (+ 35% vs. + 23%, p = 0.006). Interestingly, a substantial number of students with initial incorrect answers even had enhanced scores after discussion with an incorrect peer. Both methods showed higher transfer scores than control (p = 0.006), with a tendency for higher near transfer scores for PI. These findings support PI as a valuable method to enhance comprehension of physiological concepts. Moreover, by comparing the effects of interactive PI with constructive SE we have established new insights that complement educational theories on overt learning activities.