Abstract
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Purpose
This study examined tutors’ practices, challenges, and developmental experiences within a structured senior–junior tutoring program implemented at a Korean medical school.
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Methods
Fourteen tutors participated across two one-semester cycles—seven tutors in 2022 and seven in 2023. Each cycle included standardized tutor orientation, weekly one-on-one tutoring sessions, and faculty oversight. Data sources consisted of 24 tutor activity reports and semi-structured tutor interviews, and a survey of tutees was additionally conducted to contextualize the tutoring environment. Qualitative data were analyzed thematically.
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Results
Tutors engaged in five major domains of tutoring practice: diagnostic assessment of learning routines, structured academic coaching, lifestyle and behavioral stabilization, management of communication and relational challenges, and iterative adjustment of goals and strategies. They reported that peer tutoring required substantial emotional and relational work, often addressing broader behavioral patterns rather than isolated content gaps. Consistent with tutors’ accounts, tutees’ survey responses indicated improvements in learning motivation, study strategies, time management, and satisfaction with communication.
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Conclusion
Structured peer tutoring extended beyond academic assistance to encompass academic, behavioral, and emotional guidance. Participation also contributed to tutors’ metacognitive awareness, communication skills, and emerging professional identity. These findings offer implications for developing sustainable peer-led support programs in medical education.
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Key Words: Medical education, Medical students, Mentors, Peer teaching, Professional role
Introduction
Medical students enter training after highly competitive admission processes, yet many experience difficulty adapting to the academic rigor and accelerated pace of medical education. Increased workload, compressed timelines, and continuous assessment challenge students’ capacity for stable self-regulated learning, and elevated stress has been consistently associated with poorer academic performance [
1,
2]. These early academic difficulties often arise from disrupted study routines rather than lack of ability, highlighting the need for structured academic and emotional support during this transition.
Peer-assisted learning (PAL), including peer tutoring, has been widely adopted in medical education to provide individualized and relatable academic support. Students generally perceive PAL as effective in improving learning outcomes, and its educational benefits across health professions are well documented [
3,
4]. Nevertheless, the existing PAL literature has focused predominantly on tutee outcomes. In contrast, far less attention has been given to tutors’ practices, learning processes, and developmental experiences. Prior evidence indicates that only 13.4% of PAL-related studies have examined tutors’ learning outcomes, suggesting that tutors’ roles, strategies, and professional growth remain comparatively underexplored in medical education [
5]. Other studies similarly note that the reasons behind tutors’ engagement and their developmental trajectories within PAL programs remain underexplored [
6].
In this study, the term peer tutoring is used to align with standard medical education terminology, while acknowledging the near-peer (senior–junior) structure of the program. To address gaps in the literature, this study explores how senior medical students enacted tutoring practices in a structured program for academically underperforming juniors and how they interpreted the associated challenges and developmental processes. Analysis of tutors’ activity reports and interview narratives provides an integrated account of tutoring in authentic educational contexts and informs the design of sustainable peer-led academic support programs.
Methods
1. Program overview
The structured peer tutoring program was implemented in 2022 and 2023 in a near-peer (senior–junior) configuration to support academically underperforming medical students. The overall process—from goal setting and planning to selection, preparation, implementation, and evaluation—is summarized in
Fig. 1.
Across two one-semester cycles, 28 students participated in the program, forming 14 tutor–tutee pairs (seven pairs in 2022 and seven pairs in 2023). Tutors were high-achieving students in preclinical or early clinical years and were selected through a competitive review process based on a written application and an interview (
Supplement 1). Tutees were recruited from premedical year 2 and medical year 1. Priority was given to students experiencing academic difficulty, although voluntary applicants were also accepted.
Before beginning tutoring duties, tutors attended a structured orientation led by the Associate Dean for Student Affairs. Orientation covered key principles of peer tutoring, academic coaching strategies, and communication approaches for stressed or low-confidence learners. Tutors were advised to focus on stabilizing daily routines and supporting self-regulated learning rather than offering isolated study tips. Exemplars from prior cycles were used to illustrate common challenges and effective responses.
4. Program implementation
The tutoring program followed a standardized sequence consisting of tutor orientation, individualized matching, weekly meetings, and ongoing faculty oversight. Pairs met at least weekly, with additional sessions near examinations. Tutors submitted activity reports regularly for program monitoring (
Supplement 2).
Tutees completed a 10-item post-program survey using a 5-point Likert scale. The survey assessed perceived changes in motivation, time management, academic confidence, attitudes toward medical school life, communication with tutors, and overall program satisfaction. Tutors participated in semi-structured interviews. Interviews explored tutors’ experiences in supporting tutees, strategies used during sessions, challenges encountered, and their reflections on personal and professional development. In addition, tutors submitted written activity reports for each tutoring cycle, documenting session content, observed changes in tutees’ routines and study behaviors, and tutors’ ongoing plans for subsequent sessions.
6. Data analysis
Quantitative survey data were analyzed descriptively using IBM SPSS Statistics ver. 26.0 (IBM Corp., Armonk, USA). Qualitative data from interview transcripts and activity reports were analyzed separately using thematic analysis following the methodological guidance by Braun and Clarke [
7].
This study was approved by the Institutional Review Board of the Songeui Medical Campus, The Catholic University of Korea (MC22EISI0109). All data were anonymized, and informed consent was waived in accordance with institutional guidelines due to the minimal-risk nature of the study.
Results
1. Tutors’ enacted practices during the tutoring process
Across 24 activity reports, tutors consistently engaged in five major domains of tutoring practice: (1) diagnostic assessment of learning and routines, (2) structured academic coaching, (3) lifestyle and behavioral stabilization, (4) management of communication and relational challenges, and (5) iterative adjustment of goals and strategies. Taken together, these domains illustrate how tutors integrated academic, behavioral, and emotional support throughout the tutoring process (
Table 1).
1) Diagnostic assessment of learning and routines
Tutors reported that tutees’ difficulties often stemmed from unstable routines and ineffective study habits rather than specific content gaps. By reviewing schedules, assessment results, and study processes, tutors identified behavioral, cognitive, and environmental barriers requiring targeted intervention.
2) Structured academic coaching
Tutors observed how tutees engaged with learning tasks and used these observations to guide individualized coaching. Common strategies included concise note-taking, retrieval-based learning, preview–review cycles, and simplifying study methods to match readiness.
3) Lifestyle and behavioral stabilization
Tutors emphasized the importance of helping tutees establish stable daily routines. They highlighted the need for consistent study locations, regular sleep–wake schedules, reduced digital distractions, and repetition of small, sustainable habits. Tutors also frequently implemented light accountability mechanisms—such as arrival confirmation messages or daily task check-ins—to reinforce behavioral consistency.
4) Managing communication challenges
Tutors encountered varying degrees of disengagement, including irregular messaging, cancelled meetings, and reluctance to share study materials. They adapted communication strategies by adopting a more supportive communication style, re-establishing contact gradually, and building rapport to restore engagement. Tutors reported that relational trust was essential for sustaining effective academic support.
5) Iterative adjustment of goals and strategies
Tutors reassessed progress during weekly sessions and modified plans in response to exam schedules, challenges encountered, or fluctuations in motivation. Adjustments included revising study timelines, altering task volumes, adapting review cycles, or resetting expectations. Tutors emphasized balancing structured guidance with flexible adaptation.
2. Tutors’ experiences and professional growth
Tutors reported a broadened understanding of tutoring, shifting from academic assistance to facilitating reasoning, behavior, and emotional support (
Table 2). Relational work—including rapport building and managing discouragement—required interpersonal skills beyond academic competence and fostered empathy and sensitivity to learner diversity. Explaining study strategies promoted metacognitive development. Several tutors identified parallels with future clinical roles, especially communication and behavior-change counseling, contributing to early professional identity formation.
Descriptive findings from the tutee survey are summarized in
Table 3. Overall, tutees reported improvements in effective study methods, time management, motivation, and clarity regarding their academic difficulties. They also indicated increased academic confidence and more positive attitudes toward medical school life. Tutors were rated highly for communication and sincerity, and overall satisfaction with the program was high, with all tutees indicating willingness to recommend the program.
Discussion
This study examined how senior medical students enacted tutoring practices in a structured peer tutoring program and experienced supporting academically struggling juniors. The five identified domains—diagnostic assessment, academic coaching, behavioral stabilization, relational work, and iterative goal adjustment—indicate that peer tutoring functions as a multidimensional educational activity. Tutors perceived juniors’ difficulties as arising primarily from unstable routines, ineffective strategies, and inconsistent engagement, requiring integrated cognitive, behavioral, and emotional support. Descriptive tutee survey findings aligned with these qualitative patterns, showing improvements in study habits, motivation, time management, confidence, and communication. Although not intended to assess program effectiveness, this convergence—particularly regarding structured routines, adaptive strategy modification, and relational work—supports the plausibility and relevance of the qualitative findings. These findings extend prior PAL literature by clarifying how tutors’ developmental gains may emerge through practice. Previous studies have reported reciprocal benefits of tutoring for tutors, including enhanced self-efficacy, communication skills, leadership, and instructional competence, as well as emerging educator identity [
8-
11]. Our study clarifies how such gains occur: articulating personal study strategies promoted metacognitive development, navigating fluctuating motivation and communication demands fostered relational adaptability, and providing emotional support cultivated empathy and early counseling skills. Together, these processes reflect core elements of professional identity formation and highlight peer tutoring as a meaningful context for developing educational and relational competencies.
Taken together, these findings highlight key educational implications. Structured peer tutoring programs can support vulnerable learners while offering senior students opportunities to develop teaching competence, reflective practice, and early educator identity. Programs that emphasize diagnostic assessment, behavioral coaching, and relational skill-building may be particularly effective in enhancing both learner outcomes and tutor development. This study has limitations, including variation in the detail of tutor reports, potential selection bias among interview participants, a small single-institution sample, and reliance on self-reported perceptions. Accordingly, the findings should be interpreted as an in-depth, context-specific exploration rather than as evidence of generalizable program impact.
Supplementary materials
Data sharing statement
Please contact the corresponding author for data availability.
Acknowledgements
None.
Funding
The authors wish to acknowledge the financial support of the Catholic Medical Center Research Foundation made in the program year of 2022.
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Author contributions
Conception and design of the work: SK. Data collection: DMY. Data analysis and interpretation: DMY, ARC. Drafting the article: DMY, ARC. Critical revision of the article: ARC, SK. Final approval of the version to be published: DMY, ARC, SK.
Fig. 1. Program components and operational flow.
Table 1.Domains of Tutors’ Enacted Practices during the Tutoring Process
Table 1.
|
Theme |
Subtheme |
Description |
Illustrative examples |
|
1. Diagnostic assessment of learning and routines |
Identifying routine and behavioral issues |
Tutors identified inconsistent sleep patterns, variable study environments, and the absence of predictable routines. |
“Sleep was unstable and study places changed every day.” |
|
Analyzing study processes |
Tutors examined notes, observed question-solving, and evaluated comprehension. |
“Watching them solve a question revealed the problem immediately.” |
|
2. Structured academic coaching |
Preview–review cycles |
Tutors established lecture-centered review routines. |
“We started doing preview on the same day of the lecture.” |
|
Retrieval-based strategies |
Tutors used spaced repetition, concise summaries, diagrams, and recall practice. |
“We repeated recall practice every few days.” |
|
3. Lifestyle and behavioral stabilization |
Routine and environment regulation |
Tutors prioritized consistent environments and stabilized routines. |
“Studying in the library daily made the biggest difference.” |
|
Accountability mechanisms |
Tutors used low-burden check-ins to support consistency. |
“Send me a message when you arrive at the reading room.” |
|
4. Managing communication challenges |
Addressing disengagement |
Tutors navigated missed sessions and delayed responses. |
“We restarted with small conversations after long silence.” |
|
Rebuilding engagement |
Tutors adjusted tone to encourage openness. |
“I softened my messages to make communication easier.” |
|
5. Iterative plan adjustment |
Weekly progress review |
Tutors assessed what worked and what required revision. |
“We discussed what worked and what needed to change.” |
|
Strategy modification and goal resetting |
Tutors revised study schedules, task volumes, or expectations. |
“We reset goals depending on the week’s challenges.” |
Table 2.Themes of Tutors’ Experiences and Professional Development
Table 2.
|
Theme |
Subtheme |
Description |
Representative quotes |
|
1. Reframing the role of a peer tutor |
Recognizing the complexity of tutee difficulties |
Tutors realized that academic problems often reflected deeper issues in routines, habits, and emotional regulation. |
“I thought I’d be explaining concepts, but I was stabilizing daily routines.” |
|
Shifting from advice-giver to facilitator |
Tutors shifted from giving answers to guiding reasoning processes and observing study behaviors. |
“Giving answers didn’t help. Watching them study did.” |
|
2. Emotional labor and relational work |
Managing discouragement and anxiety |
Tutors supported tutees experiencing fear of failure, self-blame, and repeated setbacks. |
“They were scared of failing again. We talked a lot about anxiety.” |
|
Building trust as foundation |
Tutors found that psychological safety and rapport were prerequisites for meaningful academic discussion. |
“They only opened up when they felt they weren’t judged.” |
|
3. Professional identity development |
Growth in empathy and communication |
Tutors gained insight into how tone, feedback, and interpersonal style affect struggling learners. |
“I learned how to talk without discouraging someone.” |
|
Seeing parallels with clinical roles |
Tutors identified similarities between tutoring and future roles in counseling, patient education, and behavior support. |
“It felt like practicing the counseling I’ll need as a doctor.” |
|
4. Metacognitive gains |
Reflecting on personal study habits |
Teaching others made tutors aware of inefficiencies or assumptions in their own learning strategies. |
“Explaining methods made me notice my own weak spots.” |
|
Translating tacit strategies into teachable steps |
Tutors learned to simplify and structure their own methods into teachable, step-wise guidance. |
“I realized I needed to simplify what works for me.” |
Table 3.Descriptive Tutee-Reported Perceptions Following Participation in the Peer Tutoring Program
Table 3.
|
Category |
Survey item |
Mean±SD |
|
Learning and medical school life |
I was able to develop study methods suited to me. |
4.14±0.90 |
|
I learned how to manage my time effectively for studying. |
4.36±0.63 |
|
My motivation for learning increased. |
4.50±0.52 |
|
I gained a clearer understanding of my academic difficulties. |
4.21±0.70 |
|
I gained academic confidence. |
4.21±0.97 |
|
The program helped me develop a more positive attitude toward medical school life. |
4.50±0.52 |
|
Relationship with tutor |
The tutor communicated with me appropriately. |
4.85±0.38 |
|
The tutor demonstrated sincerity and commitment to the program (e.g., keeping appointments). |
4.85±0.38 |
|
Overall program |
I was satisfied with the overall structure and operation of the program (e.g., timing, frequency, content, activity reports). |
4.71±0.47 |
|
I would recommend this program to my peers or juniors. |
4.64±0.50 |
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