Twelve tips for peer teaching by a medical education student society

University societies are student-led organisations which provide excellent opportunities for students to collaborate in a shared interest. Peer teaching is gaining recognition as an effective method of medical education. Peer teaching also provides student tutors with core educational skills and provides students with approachable peer mentors. This article offers practical guidance on organising, planning, executing and sustaining peer teaching via a medical education society at university and outlines the supporting literature.


Introduction
Medical schools aim to ensure that students acquire the knowledge and skills required for clinical training.This entails students spending time on clinical placements with qualified healthcare professions.Doctors must therefore be prepared not only to educate patients but students and peers.Doctors are indeed required by the General Medical Council to develop as an educator (GMC advises doctors as teachers, 1999).Teaching is desirable for post-graduate career progression, consolidating learning and to develop leadership and mentorship skills (Jefferis, 2007).Despite teaching being universally accepted across all medical training programmes, physicians often receive very little formal training (Spencer, 2003).Therefore, teaching is an area of clinical activity that must be developed and supported to sustain and enrich medical education and ensure safe and professional practice amongst health care professionals.The skills of teaching can and arguably should be introduced early and practised regularly in medical school.One method to develop the clinician as an educator is through peer-teaching practices.
Peer teaching has been shown to be comparable to faculty-led teaching in terms of knowledge and skills outcomes (Rees et al., 2016).It contributes positively to the personal and professional development of students and increases selfconfidence and fulfilment (Yang et al., 2022).Despite its benefits, peer teaching has been an underutilised initiative in medical school, therefore structured ways to implement it should be encouraged and explored (Ten Cate & Durning, 2007).One way to do this is through the creation of a university medical education society.Societies are student-led organisations at universities that allow students with a shared interest to collaborate and engage in enriching activities.This article outlines practical and conceptual tips to develop, implement and expand a medical education society focussed on peer-teaching practices.

Tip 1. Find the gap
The current medical curriculum is broad and comprehensive.Therefore, to maximise the educational impact of the society, it is important to focus on areas in the curriculum which might benefit from supplementation by peer teaching.These can be identified from the perspective of students through surveys and focus groups.An effective digital survey is low resource, efficient, easy to complete and accessible through the distribution of QR codes (Nikiforova et al., 2021).The survey should gather information about the year of the student and desired areas for further teaching to provide a broad representation of the student views.The number of respondents allows for a rough indicator of interest.Focus groups provide qualitative and granular information.In-depth focus groups encourage students to reflect on weak areas of learning, discuss where there is disagreement, and explore potential solutions to problems (Stalmeijer et al., 2014).Surveys and focus groups are invaluable to planning potential content.Senior students, the medical curriculum and lecturers should also be consulted to identify gaps in knowledge and skills based on their experience of assessments and clinical practice.

Tip 2. Develop a content plan
Answers to surveys can be organised by topics and subtopics.Depending on the format of the medical school's curriculum, the overarching topic can be organised by system (e.g.cardiovascular), speciality (e.g.cardiology) or presentation (e.g.chest pain), and therefore, the society should aim to be flexible in its approach and tailor to the university and student preference.Once relevant topics have been identified, they can be divided into sub-topics for which 15-25 minute 'stations' each representing an aspect to be covered.For example, if the session topic is chest pain, stations for aspects to cover might be acute myocardial infarction, electrocardiogram interpretation, pneumonia etc.With a list of prospective topics to be covered, a content plan can be created which outlines the topic, date, time and duration of each session and title of each station with the intended learning outcomes.The learning outcomes should then be shared with the peer tutors to ensure that highquality teaching of the relevant topics is provided.

Tip 3. Devise the format
Since topics will have been introduced in the learners' curriculum, sessions should aim to cover high-yield topics in a revision format, as a supplement to lectures delivered by faculty.The attention span of students is commonly referred to as lasting between 15-20 minutes, although this is debated (Bradbury, 2016).As a guide, subtopic stations should therefore last around 15-25 minutes each and have short breaks in between, with the whole session lasting no longer than 2 hours.This allows the core information to be delivered with a summary of the topic at the end.Throughout the station, the tutors should encourage active problem-solving and critical thinking by asking questions.Ideally, students should be able to test their knowledge at the end through a short quiz.This will allow them to identify further areas of improvement.

Tip 4. Teach the teacher
A training session should be held with potential senior student tutors to outline key principles of teaching.Including effective methods of teaching as agreed by the society (e.g.active recall, case based discussions etc), how to reference,

Amendments from Version 1
The manuscript has been updated as per peer-review suggestions.Specifically, the scope of this manuscript has been clarified to state that this provides information to medical students about incorporating peer-teaching practice as an adjunct to faculty led education.Secondly, the tip titles have been amended to closely reflect their respective explanations.Thirdly, the potential use of artificial intelligence has been incorporated.Fourthly, brief clarity on how to utilise data as a quality improvement exercise has been added.Finally, we have expanded on the potential to include the wider healthcare professional community.
Any further responses from the reviewers can be found at the end of the article how to avoid plagiarism and how to ensure learning objectives are met.This means a baseline standard for which teaching is delivered is established as a means of quality assurance and build key academic skills amongst tutors.These sessions should be developed in collaboration with faculty lecturers to incorporate their extensive experience and advice.

Tip 5. Host on an accessible and free platform
Sessions can be done in-person or virtually.There are strengths and limitations to both which are beyond the scope of this article.Briefly, strengths of virtual sessions include accessibility, ability to record sessions for playback and low resource use.Limitations include restriction of ability to teach practical skills, difficulty ascertaining visual cues from students and lack of attentiveness from students' resources are distributed (Mukhtar et al., 2020).Strengths of in-person sessions include visual and verbal discussion whilst there limitations are due to travel, need to book rooms and less sustainable resources (Kumari et al., 2021).For theory best sessions, an online approach is optimal as there is less need to have practical resources.On the other hand, practical based sessions (e.g.Objective Structure Clinical Examinations (OSCE) and anatomy) would benefit from an in-person approach where models and non-verbal skills can be demonstrated, and students are actively encouraged to participate directly through the use of spotter questions or mock OSCE.When choosing a virtual platform, the platform must be accessible, free and simple to use.Platforms for healthcare related teaching such as MedAll are free and easily accessible as long as there is an internet connection.Recordings, feedback forms and certificates can be automatically distributed, and attendance can be monitored.These methods facilitate easier evaluation of the quality of teaching and simple implementation of improvements.

Tip 6. Create accompanying resources
An output from sessions should be resources.This includes the resources directly related to the session (e.g.presentation slides, case discussed, answers to exam questions etc), and resources produced to supplement the session.Comprehensive and accessible resources empower peer tutors to engage in different teaching methodologies and allow another form of interaction with students.Resources allow students to retrospectively view the session and aid in recalling the contents to supplement their revision.This could be a further set of questions, visual aids, condensed notes etc. at the tutor's discretion.All resources should be checked by an independent person, for instance the session lead or society peer-reviewers to ensure the session learning objectives are being met, the resources are high quality, and the work is original and correctly cited.

Tip 7. Advertise and leverage social media
Leveraging social media platforms to promote upcoming events helps to maximize attendance and fosters a sense of community.There are almost 4 billion social media user worldwide.Social media can improve communication between medical educators (at all stages of their career) and flatten hierarchies, contributing to wider outreach (Guckian et al., 2021).Events must be advertised early and proactively re-advertised to allow the target audience to prepare in advance at their discretion, for instance by reviewing faculty-taught material and identifying areas they want further clarification on.Furthermore, this increases the chance of attracting a larger and more diverse audience.Platforms like Facebook, Twitter, and Instagram enable societies to share event details, including date, time and locations of sessions to followers, who can in-turn share the same details, potentially leading to snowballing of audience.

Tip 8. Feedback, feedback, feedback
Feedback underpins the success of the society and is of paramount importance.Feedback should seek to evaluate the performance of the teaching quantitatively and qualitatively against the learning objectives of the session and the learning needs of the student.This should be done for each station and the overall session.Feedback has several benefits.Feedback allows the responder to reflect on their teaching qualitatively, simultaneously outlining to the society what worked well and what could have been better for the student.Feedback allows all stakeholders (teacher, society and student) to determine if the session improved quantitative performance (recommended by a pre and post station quiz for all stations).Feedback allows the tutor to improve their teaching methods where students highlight specific aspects.With common areas of improvement being clearer slides, more concise explanations or more time on a specific area.Finally, feedback allows the society to implement changes to grow and strengthen the quality of teaching (Tuma & Nassar, 2023).For granular analysis of feedback, qualitative answers can be compared to quantitative performance to determine trends associated with an adopted teaching style.For instance, stations centred around cases lead to positive qualitative feedback and high post session quiz scores.Artificial intelligence (AI) tools could also be used to enhance the efficiency of the feedback process and present data comprehensively.However, these tools must be used with caution as we are still in the early stages of implementation of AI.

Tip 9. Recognise the team
Peer tutors should be provided with acknowledged for their teaching contribution.Certificates for peer tutors for their engagement in pedagogical activities recognises their achievement and acts as evidence of teaching experience, thereby contributing to academic portfolios and ability to secure future roles in education.Certificates also promote the value of peer teaching and encourage more students to actively engage in the approach, fostering a supportive learning environment.
Commonly training programme portfolio criteria state that for evidence of teaching to be acknowledged, evidence must be accompanied with a letter which confirms involvement in the teaching programme and the dates of the teaching, signed by a consultant with the consultant's name and national medical registration number ( https://medical.hee.nhs.uk/medical-trainingrecruitment/medical-specialty-training/surgery/core-surgery/core-surgical-training-self-assessment-scoring-guidance-for-candidates).Therefore the society should seek to officially validate certificates by liaising with a staff member that can facilitate this (e.g.medical school or hospital dean).

Tip 10. Develop and improve
Feedback is only useful if acted upon in accordance with the plan-do-study-act cycle (PDSA).Feedback should be gathered immediately after each session and incorporated at the earliest convenience when planning the next session.Attendees are heterogenous as each have their own way of processing and learning interventions.There will be broad areas to improve which will increase quality of sessions for the majority of students.Areas that commonly require attention are the depth of content covered, station times, session times and the method of teaching.Listening to feedback fosters trust between attendees and the society facilitating motivated and granular feedback.

Tip 11. Be active
Multiple sessions should be planned in advance and function in parallel with the curriculum in order to supplement faculty taught sessions.As these sessions will be organised outside of curriculum hours, they will supplement that core teaching that has been provided.Staging regular sessions allows continuity between sessions and a relationship between attendees and the society, facilitates easier re-evaluation of interventions to improve sessions, and allows growth of the society.

Tip 12. Collaborate and broaden scope
Collaboration is key to a thriving student society.Network with other universities, students and faculty to share events, ideas, experiences and promote a rich and better quality of education.As relationships develop, it becomes easier to recruit for teaching and expand the scope of the society by providing sessions other than teaching such as mock knowledge examinations, mock OSCEs and special guest talks.This helps promote the society, empowers students and develops a culture of sustained learning within the community.This can be extended to the wider health professions community.Interprofessional collaboration in sessions such as mock OSCEs through simulation can provide invaluable insight into other healthcare roles such as pharmacy, nursing and physiotherapy.

Conclusions
A medical education student society underpinned by peer teaching practices is a fantastic initiative to foster a medical education student community benefitting both peer tutors and learners.Senior medical student engagement in peer teaching provides them with an excellent opportunity to develop several key teaching skills.Peer tutors learn valuable pedagogy skills and methods.They gain practical experience fundamental for when they will be responsible for teaching peers and students in clinical practice.Peer tutors learn to gather feedback and implement change in their practice to improve their teaching and learn key academic skills such as referencing to deliver their teaching.They gain skills in leadership when leading sessions.Finally, peer tutors develop key relationships as mentors to the students they teach, building a sense of community and a rich learning environment.
For student learners, they gain access to resources to supplement faculty learning in areas where the medical curriculum is felt to need strengthening.Students have positive interactions with peers in the years above, especially with tutors who teach multiple sessions.Peer tutors have already been through the medical school experience of the student learners who are therefore able to obtain tailored advice, feel more comfortable asking questions and most importantly, have multiple mentors invested in their education throughout their journey.Students also get added opportunities to consolidate their learning in an active manner in addition to testing their retention.Importantly, students may well feel inspired to engage in teaching at an early stage in their career which enormous potential benefits later in their career when they are educators in clinical practice.
Medical education student societies' peer education activities can be successfully implemented in medical schools in a variety of settings such as online or in-person and for a variety of content such as theory, practical examinations and clinical skills.The practical tips summarised in this article outlines the aspects of building the foundations of a successful medical education society.Twelve tips for creating a medical education society is well presented and documented.It assumes an already existing and interested group.The article fits well within existing department or group of medical educators who are interested and ready to undertake this work.What I find missing in the article is how to get a group together so that they are cohesive and interested in peer teaching and faculty development.The most difficult part is getting a group together to collaborate, and this is not addressed in this article.However, assuming an existing group the article functions for a well and is very helpful.My experience is getting the group together is more difficult than doing the faculty development.

Are arguments sufficiently supported by evidence from the published literature and/or the authors' practice? Yes
If evidence from practice is presented, are all the underlying source data available to ensure full reproducibility?Partly

Are the conclusions drawn balanced and justified on the basis of the presented arguments? Yes
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: My area of research and interest is in change in health professions organizations in all its levels from local individual through systemic and health systems themselves.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.
Reviewer Report 29 February 2024 https://doi.org/10.21956/mep.21344.r35763Prattama Santoso Utomo 1 Universitas Gadjah Mada, Yogyakarta, Indonesia 2 Universitas Gadjah Mada, Yogyakarta, Indonesia The authors attempt to provide some tips for peer learning that are somewhat underestimated in medical education.Peer learning is important as an educational approach that could be beneficial for better outcomes of medical education.Some suggestions to improve the quality and consistency of the manuscript: 1) The authors might reconsider on the manuscript title.The current title "Twelve tips for creating a medical education society" is not well-aligned to the content of the tips, which focus on peer-learning and peer teaching activity suggestions.I think it will be better if the title is "Twelve tips for advancing peer teaching/education practices".

2) Introduction: the authors might want to ensure paragraphs are well-transitioned, to avoid a gap or jumping of ideas (particularly between the first and second paragraph).
3) The authors should consider supporting all tips with evidence/literature and/or actual experience from the authors.4) Some tips were more conceptual rather than practical (i.e., Tip 4, Tip 10, Tip 11, Tip 12).More realistic examples and suggestions are needed for such tips.

Are arguments sufficiently supported by evidence from the published literature and/or the authors' practice? Partly
If evidence from practice is presented, are all the underlying source data available to ensure full reproducibility?Not applicable

Are the conclusions drawn balanced and justified on the basis of the presented arguments? Partly
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: medical education, general medicine, peer learning I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
Author Response 04 May 2024

SOWMYA PRASANNA KUMAR MENON Reviewer 3
Reviewer comment 1: The authors attempt to provide some tips for peer learning that are somewhat underestimated in medical education.Peer learning is important as an educational approach that could be beneficial for better outcomes of medical education.Some suggestions to improve the quality and consistency of the manuscript.Response: We thank the reviewer for their positive feedback.We provide a point-by-point response to each comment.We hope these improvements enable publication.

Reviewer comment 2:
The authors might reconsider on the manuscript title.The current title "Twelve tips for creating a medical education society" is not well-aligned to the content of the tips, which focus on peer-learning and peer teaching activity suggestions.I think it will be better if the title is "Twelve tips for advancing peer teaching/education practices".Response: We thank the reviewer for their feedback.In the introduction, we outlined that the scope of this article is to provide guidance to medical students and enable them to create a medical education society.The authors Sowmya Prasanna Kumar Menon and Balamrit Singh Sokhal have fulfilled various committee roles (including chair) for their university medical education society.The foundation of this society is built from the philosophy of peer to peer teaching.Since joining, the society has grown to one of the largest at the university, and produced internationally recognised content, with presentation of results at conferences.Therefore this article aims to outline how peerteaching can be optimised in the context of a medical education society, to facilitate peer collaboration and improve the next generation of clinicians and teachers.The manuscript title has been amended to reflect the inclusion of peer-teaching as suggested.Under Title: "Twelve tips for peer teaching by a medical education student society" Under Introduction: "This article outlines practical and conceptual tips to develop, implement and expand a medical education society focussed on peer-teaching practices." Reviewer comment 3: Introduction: the authors might want to ensure paragraphs are welltransitioned, to avoid a gap or jumping of ideas (particularly between the first and second paragraph).Response: We thank the reviewer for their comment.We have amended the introduction to improve coherence between paragraphs.

Under Introduction: "A method to develop the clinician as an educator is through peer-teaching practices."
Reviewer comment 4: The authors should consider supporting all tips with evidence/literature and/or actual experience from the authors.Response: We thank the reviewer for their feedback.We have amended the manuscript to include more citations where appropriate.
Reviewer comment 5: Some tips were more conceptual rather than practical (i.e., Tip 4, Tip 10, Tip 11, Tip 12).More realistic examples and suggestions are needed for such tips.Response: We thank the reviewer for their feedback.The tips are based on what the authors who were heavily involved in their medical education society (Sowmya Prasanna Kumar Menon and Balamrit Singh Sokhal) experience or implemented during their tenure.
There is little evidence to support these actions mainly due to the heterogeneity between educational practices and ever-changing requirements from students receiving sessions.Therefore, these tips should be treated as suggestions for readers wish to initiate a medical education society or further peer-teaching practices, rather than rules to follow.We believe an important aspect of developing a medical is to be flexible with the approach and adapt to the attendees the society is for.We hope this satisfactorily explains the reasons underlying the conceptual approach.
Competing Interests: No competing interests were disclosed.We thank the authors for an interesting manuscript focused on providing learning support for students during medical training through peer teaching in medical education societies.We have the following comments: We suggest that the authors engage with literature a bit more as part of the tips they are providing.Each tip, more or less, could be better supported with relevant literature.

1.
Kindly remove the URL from tip # 12 and include it in the references where it is missing.2.
Tips #8 and #10, though labeled differently, seem to both speak about feedback.We suggest the authors find a way to differentiate the content of #10 from #8 3.
We suggest that the authors review the tip headings and, where possible, revise them to match the content.For instance, I was not expecting Tip #7 to be just about managing the calendar and invitations based on the title.

Zakia Dimassi
1 Khalifa University, Abu Dhabi, United Arab Emirates 2 Khalifa University, Abu Dhabi, United Arab Emirates Peer teaching is indeed a valuable and underutilized resource across the curriculum, and I find the concept behind this article very important and I would want to learn more about it.However, as I read through the 12 tips, I was underwhelmed as the tips came across as common sense, and add little to what medical educators already do as basic steps when introducing a new/novel intervention to the curriculum.Tip 1: how about the perspective of the increasingly tech-savvy generation on how they learn and what grabs their attention?Tips 2 and 3: the eternal struggle is enhancing the content of the curriculum without overcrowding it.There is some attempt to address this here, although not sufficiently.Tip 4: faculty development is a pillar in MedEd and education in general, but how to make it more feasible and acceptable to busy clinicians?Tip 5: Indeed an excellent tip, but the supporting evidence is meager.Should draw from recent literature based on the COVID19 pandemic experiences with online platforms in MedEd.Tip 6: How to create valuable resources that can compete with platforms like Amboss, Osmosis efficiently and cost effectively?this is what I would have liked to see discussed Tip 7: there are few seminal articles on digital scholarship ref [1].and online communities of practice (Gunwardena et al., 2016) that could have been nicely integrated it here to support the argument.Tip 8: how about the use of AI to enhance the usefulness and utility of feedback?Good-quality, curated, and timely feedback can become much easier to provide using tools like natural language processing Tip 9: I highly appreciate this tip.I would want to have it expanded on -certificates as part of CME.Tip 10: how to collect feedback data and how often?Feedback from whom?where to incorporate in the PDSA cycle or the Kern s steps?Tip 11: this is excellent as well, but again, how to fit in these sessions in an ever expanding curriculum?Reviewer Expertise: curriculum development and evaluation, international medical graduates, team based learning, simulation-based education, patient safety in the medical curriculum I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
increasingly proficient in technology and that modern interventions should be incorporated to allow students to take control of their learning.Therefore, we have clarified that the initial 'gap' in students' knowledge should be gathered in the form of digital surveys under tip 1.Furthermore, this tip focuses on how educators can identify topics to teach and not how to gather the audience, which is covered in the latter tips.Additionally, we have incorporated a variety of technological methods to advertise sessions and enhance learning which are not conventionally used.Under Tip 1:"An effective digital survey is low resource, efficient, easy to complete and accessible through the distribution of QR codes." Reviewer comment 3: Tips 2 and 3: The eternal struggle is enhancing the content of the curriculum without overcrowding it.There is some attempt to address this here, although not sufficiently.Response: We thank the reviewer for their comment.We agree that identifying content can be difficult in an institutional curriculum.However, we believe a student-led, medical education society's aim should be to supplement the curriculum and faculty-led teaching.The aim is not to cover the entire curriculum.As stated in tip 1, societies should empower students to identify key topics the majority find difficult.Societies should function to provide extra time and resources dedicated to helping students understand these areas of weakness.
Reviewer comment 4: Tip 4: Faculty development is a pillar in MedEd and education in general, but how to make it more feasible and acceptable to busy clinicians?Response: We thank the reviewer for their comment.These tips are intended for students who would like to develop a medical education society in order to promote peer-to-peer teaching and mentorship.Therefore, although we agree clinicians are a valuable resource to medical education, they are beyond the scope of this article.We have amended tip 4 to reflect this.Under Tip 4: These sessions should be developed in collaboration with faculty lecturers to incorporate their extensive experience and advice.Response: We thank the reviewer for their comment.The scope of this article is to cover creating a medical education society purely for students at the local educational institution.

Reviewer Report 13
February 2024 https://doi.org/10.21956/mep.21344.r35760© 2024 Kebaetse M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Masego B. Kebaetse 1 University of Botswana, Gaborone, Botswana 2 University of Botswana, Gaborone, Botswana Are all factual statements correct and adequately supported by citations?PartlyAre arguments sufficiently supported by evidence from the published literature and/or the authors' practice?No If evidence from practice is presented, are all the underlying source data available to ensure full reproducibility?Partly Are the conclusions drawn balanced and justified on the basis of the presented arguments?Yes Competing Interests: No competing interests were disclosed.Reviewer Expertise: instructional design, teacher professional development, learning development/support I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.Reviewer Report 13 February 2024 https://doi.org/10.21956/mep.21344.r35767© 2024 Dimassi Z.This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Tip 12: what about interprofessional and interdisciplinary per teaching to engrain this level of collaboration early on?Is the topic of the practical tips discussed accurately in the context of the current literature Partly Are all factual statements correct and adequately supported by citations?Partly Are arguments sufficiently supported by evidence from the published literature and/or the authors' practice?Partly If evidence from practice is presented, are all the underlying source data available to ensure full reproducibility?Not applicable Are the conclusions drawn balanced and justified on the basis of the presented arguments?Partly Competing Interests: No competing interests were disclosed.

Reviewer comment 5 :
Tip 5: Indeed an excellent tip, but the supporting evidence is meager.Should draw from recent literature based on the COVID19 pandemic experiences with online platforms in MedEd.Response: We thank the reviewer for their feedback.The evidence we have referenced is contemporary published in 2020 and 2021 and derived from the experience of educators during the pandemic.Under References section: 5.Kumari  S, Gautam H, Nityadarshini N, et al.: Online classes versus traditional classes?Comparison during COVID-19.J Educ Health Promot.2021;10:457.35233404 8826787 6. Mukhtar K, Javed K, Arooj M, et al.: Advantages, Limitations and Recommendations for online learning during COVID-19 pandemic era.Pak J Med Sci.2020;36(COVID19-S4):S27-S31.32582310 10.12669/pjms.36.COVID19-S4.27857306967 Reviewer comment 6: Tip 6: How to create valuable resources that can compete with platforms like Amboss, Osmosis efficiently and cost effectively?this is what I would have liked to see discussed.

Publisher Full Text | Free Full Text NHS Core Surgical Training Portfolio Requirements. 2022
; [cited 2023 Jul 24].Reference Source Nikiforova T, Carter A, Yecies E, et al.:

Publisher Full Text | Free Full Text Stalmeijer
RE, McNaughton N, Van Mook WNKA:

through teaching: peer teaching and mentoring experiences among third-year medical students.
No competing interests were disclosed.

have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Stewart Mennin
1Human Systems Dyndamics Institute, Minneapolis, Minnesota, USA2Human Systems Dyndamics Institute, Minneapolis, Minnesota, USA