Perceived changes in innovation and entrepreneurship competency among medical students following peer-assisted learning: an exploratory study of implementation fidelity

Abstract

Traditional medical innovation and entrepreneurship (I&E) education faces severe faculty constraints. While Peer-Assisted Learning (PAL) offers a scalable alternative, its impact on complex I&E competencies and the reliability of peer-led instruction remain underexplored. This exploratory study evaluates the association of a structured PAL model with students’ perceived I&E competency and its implementation fidelity. Fifty-four medical students completed a prospective, six-workshop PAL program. Perceived I&E competency was assessed pre- and post-intervention via a validated 53-item questionnaire. Data were analyzed using paired t-tests or Wilcoxon tests (based on normality) with a Bonferroni correction (p < 0.0083). Concurrently, two independent raters evaluated implementation fidelity and instructional consistency using a standardized checklist. Perceived overall I&E competency improved significantly (p < 0.0001, d = 0.673). Following Bonferroni correction, Practical Skills exhibited the most pronounced gain (p < 0.0001, d = 0.687), whereas theoretical domains did not retain statistical significance. Analysis of 324 mentor evaluations indicated highly consistent teaching performance (ANOVA, p = 0.522). Crucially, overall implementation fidelity was excellent (mean = 4.56/5, ICC = 0.87), suggesting highly consistent peer-led delivery, despite minor variability in advanced facilitation skills. PAL is positively associated with improvements in medical students’ perceived practical I&E competencies. Supported by standardized pedagogical training, peer-led instruction can achieve high implementation fidelity and mitigates instructional variability. This exploratory framework offers a potentially adaptable supplement to traditional faculty-led education.