Copy igh © 2025 Zanjan Uni e si y o Medical Sciences. Published by Zanjan Uni e si y o Medical Sciences.
This wo k is licensed unde a C ea i e Commons A ibu ion-NonComme cial 4.0 In e na ional license (h ps://c ea i ecommons.o g/licenses/by-
nc/4.0/). Noncomme cial uses o he wo k a e pe mi ed, p o ided he o iginal wo k is p ope ly ci ed.
The e ec o nea -pee -assis ed lea ning on sel -e icacy and
clinical pe o mance o unde g adua e nu sing s uden s du ing
clinical in e nship: A quasi-expe imen al s udy
Zoh eh Badiyepeymaiejah omi1, Mohsen Faselehjah omi2, Sasan Rahmanian3* Mohsen Hoja 1
1Depa men o Medical-Su gical Nu sing, School o Nu sing, Jah om Uni e si y o Medical Sciences, Jah om, I an
2Depa men o Communi y Heal h Nu sing, School o Nu sing, Jah om Uni e si y o Medical Sciences, Jah om, I an
3Depa men o Psychia ic Nu sing, School o Nu sing, Jah om Uni e si y o Medical Sciences, Jah om, I an
A icle in o Abs ac
In oduc ion
Nu sing educa ion se es as he ounda ion o
de eloping a skilled wo k o ce capable o mee ing
public heal h needs; he e o e, any sho comings in his
educa ion can signi ican ly impac he quali y o pa ien
ca e [1]. A subs an ial po ion o nu sing s uden s'
aining occu s in clinical se ings. The p ima y goal o
his clinical educa ion is o p epa e s uden s o hei
essen ial p o essional esponsibili ies, enhance hei
accoun abili y, and os e hei abili y o wo k
independen ly [2, 3]. Sel -e icacy in clinical
pe o mance plays a c ucial ole in a s uden 's abili y o
p o ide independen pa ien ca e. Fo nu sing s uden s,
sel -e icacy encompasses hei con idence in execu ing
ou ine nu sing asks, while clinical pe o mance sel -
A icle his o y:
Recei ed 4 Aug. 2024
Accep ed 23 Ap . 2025
Published 13 Jul. 2025
Badiyepeymaiejah omi e al. J Med Edu De . 2025; 18(2): 27-35 Jou nal o Medical Educa ion De elopmen
Backg ound & Objec i e: T adi ional clinical educa ion me hods ha e no been e ec i e in
imp o ing s uden s' clinical pe o mance. Implemen ing nea -pee assis ed lea ning could help
add ess many o he challenges nu sing s uden s encoun e in hei pu sui o e ec i e
lea ning.This s udy aims o de e mine he e ec o nea -pee -assis ed lea ning on sel -e icacy
and clinical pe o mance o nu sing s uden s du ing clinical in e nships.
Ma e ials & Me hods: This s udy u ilized a quasi-expe imen al design wi h a pos - es con ol
g oup. The s a is ical popula ion included all nu sing s uden s pa icipa ing in clinical
in e nships a Jah om Uni e si y o Medical Sciences om 2021 o 2023, o aling 93 s uden s
selec ed h ough a census me hod. The in e en ion g oup, comp ised o 52 s uden s,
pa icipa ed in nea -pee assis ed lea ning, while he con ol g oup o 41 s uden s ecei ed
adi ional ins uc ion om uni e si y ins uc o s. S uden s' sel -e icacy was e alua ed using
he s anda d sel -e icacy in he clinical pe o mance ques ionnai e; hus, clinical pe o mance
was assessed using he Objec i e S uc u ed Clinical Examina ion (OSCE) sco es a he end o
each pe iod. Da a analysis was pe o med using SPSS 22, he - es o mean sco e compa isons,
and Chi-squa e es o quali a i e da a.
Resul s: The mean sel -e icacy sco es we e 139.16 ± 0.57 and 109.65 ± 0.89 o he
in e en ion and con ol g oups in pos - es , espec i ely. The mean OSCE sco es we e 5.09 ±
0.29 and 4.85 ± 0.76 o he in e en ion and con ol in pos - es . The independen - es e ealed
a s a is ically signi ican di e ence in he mean sel -e icacy sco es be ween he wo g oups (p
< 0.001, E ec Size = 0.95). Howe e , no signi ican di e ence was ound in he mean OSCE
sco es be ween he g oups (p = 0.061, E ec Size = 0.43).
Conclusion: The nea -pee assis ed lea ning me hod has a mo e signi ican impac on he sel -
e icacy o nu sing s uden s du ing clinical in e nships compa ed o adi ional eaching
me hods. Fu he mo e, his app oach can be as e ec i e as ins uc o -led aining in enhancing
s uden s' clinical pe o mance. The e o e, i is ecommended o in eg a e his me hod wi h o he
educa ional app oaches o u he imp o e clinical pe o mance among nu sing s uden s.
Keywo ds: clinical educa ion, pee -assis ed lea ning, sel -e icacy, cinical pe o mance,
nu sing s uden s
*Co esponding au ho :
Mohsen Hoja , Depa men o
Medical-Su gical Nu sing, School o
Nu sing, Jah om Uni e si y o
Medical Sciences, Jah om, I an
Email: mohsenhoja [email protected]
O iginal A icle
How o ci e his a icle:
Badiyepeymaiejah omi Z,
Faselehjah omi M, Rahmanian S,
Hoja M. The e ec o nea -pee -
assis ed lea ning on sel -e icacy and
clinical pe o mance o unde g adua e
nu sing s uden s du ing clinical
in e nship: A quasi-expe imen al
s udy. J Med Edu De . 2025; 18(2):
27-35.
[ DOI: 10.61882/edcj.18.2.27 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
1 / 9
Badiyepeymaiejah omi e al
.
: The e ec o nea -pee -assis ed lea ning on sel -e icacy and clinical pe o mance
28 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025
e icacy speci ically e e s o hei belie in hei
capabili y o pe o m a ious clinical skills. The
impo ance o sel -e icacy in clinical se ings is linked
o i s impac on u u e pe o mance [4]. Despi e he
impo ance o he subjec , s udies indica e ha nu sing
s uden s ained h ough adi ional clinical educa ion
me hods o en lack he necessa y p ac ical skills and
e iciency in eal wo k en i onmen s, leading o
challenges in pe o ming hei job du ies. In his model,
s uden s engage wi h ins uc o s in small g oups du ing
an 8-hou clinical shi [5]. E ec i e lea ning equi es
he suppo and collabo a ion o ins uc o s, men o s,
pee s, and o he esou ces, each p o iding unique
oppo uni ies o add ess s uden s' lea ning needs. Gi en
ha eaching is an ac i i y ocused on c ea ing and
acili a ing lea ning o s uden s, i is e iden ha
selec ing e ec i e eaching me hods plays a c i ical ole
in enhancing he lea ning p ocess [6, 7]. The e a e
a ious ypes o mode n aining o nu sing skills using
educa ional models; such as explo a o y educa ion
model, bedside eaching and need-based educa ion,
p oblem-sol ing-based educa ion, coope a i e educa ion
and pee -assis ed lea ning [8]. Nume ous s udies ha e
been conduc ed o imp o e he quali y o educa ion, and
some ha e iden i ied Pee -Assis ed Lea ning (PAL) as
an e ec i e s a egy o add essing challenges and
enhancing lea ning ou comes [9]. PAL is oo ed in social
lea ning heo ies, which asse ha expe iences,
unde s anding, and knowledge a e de eloped h ough
in e ac ions among indi iduals [10]. PAL ollows he
cons uc i is lea ning app oach and is one o he
eaching-lea ning me hods used in a ious academic
p og ams and age g oups [9]. This me hod includes wo
models: using nea pee s o pa ne pee s in educa ion.
Nea pee s a e s uden s who a e always a a highe le el,
academically o in clinical expe ience, by a leas one
yea compa ed o he s uden s hey a e eaching. The
dis inc ion be ween nea -pee -assis ed lea ning and
pa ne pee -assis ed lea ning lies in he ac ha pa ne
pee s a e a he same academic le el as he s uden [11].
Pee -assis ed eaching has been used in heo e ical
ins uc ion, labo a o y se ings, clinical skills cen e s,
and in e nships [12-15]. The ad an ages o his me hod
include enhancing s uden s' ime managemen ,
communica ion, and eaching skills. I deepens lea ning
and p omo es an ac i e, collabo a i e lea ning s yle,
imp o es es sco es, and p epa es s uden s o highe -
le el exams. Addi ionally, i boos s sel -con idence,
educes s ess du ing ques ioning o exams, ein o ces
ime managemen skills, p o ides con inuous access o
educa ional ac i i ies, and gene ally inc eases cos -
e ec i eness and e iciency [16]. In PAL, since s uden s
a e mo e amilia wi h each o he 's educa ional needs and
can be e unde s and each o he 's lea ning p ocesses
compa ed o any ins uc o , hey help each o he mo e
e ec i ely du ing he lea ning p ocess [11]. Each clinical
educa ion expe ience no only in ol es acqui ing
speci ic knowledge o p ac ical skills bu also enhances
s uden s' con idence in hei p o essional abili ies, a
concep known as sel -e icacy. The p ima y goal is o
ele a e s uden s o he highes le el o lea ning, which is
p o essional compe ence. Sel -e icacy a ec s many
impo an aspec s o mo i a ion, such as ac i i y choice,
e o le el, pe sis ence, and emo ional eac ions, and can
be a ac o in s uden s' academic success [17].
Gi en ha he goal o medical educa ion is o enhance
s uden s' clinical sel -e icacy, and in ligh o cu en
challenges in medical acul ies—such as inc eased
s uden admissions, a sho age o a ailable ins uc o s,
and limi ed ins uc o p esence in educa ional se ings—
he e is an u gen need o guidance and suppo o
s uden s by le e aging he capabili ies o senio s uden s.
Employing his me hod appea s o be a iable solu ion o
add ess some o hese challenges. Howe e , despi e he
bene i s o PAL, exis ing s udies p esen con lic ing
esul s ega ding i s impac on s uden s' lea ning [11, 13,
23, 25] and sel -e icacy [4, 17, 21], indica ing a need o
u he esea ch. This s udy aims o de e mine he e ec
o nea -Pee -Assis ed Lea ning (nea -PAL) on he sel -
e icacy and clinical pe o mance o nu sing s uden s
du ing hei in e nships a Jah om Uni e si y o Medical
Sciences.
Ma e ials & Me hods
Design and se ing(s)
This s udy was a quasi-expe imen al s udy wi h a pos -
es con ol g oup design conduc ed a Jah om Uni e si y
o Medical Sciences.
Pa icipan s and sampling
The s a is ical popula ion consis ed o all nu sing
in e nship s uden s a Jah om Uni e si y o Medical
Sciences du ing he i s semes e s o he academic yea s
2021-2022 (52 s uden s in he in e en ion g oup) and
2022-2023 (41 s uden s in he con ol g oup), o aling 93
pa icipan s selec ed h ough a census me hod. Gi en he
limi ed numbe o s uden s, he census me hod was
app op ia e. The s uden s comple ed clinical in e nship
cou ses in adul /elde ly nu sing, nu sing ca e in In ensi e
Ca e Uni s (ICUs), and Ca diac Ca e Uni s (CCUs). To
[ DOI: 10.61882/edcj.18.2.27 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
2 / 9
Badiyepeymaiejah omi e al
.
: The e ec o nea -pee -assis ed lea ning on sel -e icacy and clinical pe o mance
Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 29
mi iga e he isk o in o ma ion leakage, he s udy
ocused on wo g oups o i s -semes e s uden s due o
he small size o in e nship s uden s in each yea . The
inclusion c i e ia we e unde g adua e nu sing s uden s
en olled in clinical in e nships du ing he academic yea s
2021 and 2023, in o med consen o pa icipa e in he
s udy, i s - ime en ollmen in he in e nship cou se, and
no p e ious educa ion o employmen in o he medical
sciences ields. Exclusion c i e ia we e wi hd awal om
he s udy, academic lea e, s uden ans e , and excessi e
absen eeism om he cou se. All s uden s pa icipa ed in
he s udy, and none we e excluded.
Tools/Ins umen s
The clinical pe o mance sel -e icacy ques ionnai e
consis ed o 37 ques ions di ided in o ou domains:
"pa ien assessmen " (12 ques ions), "nu sing diagnoses
and planning" (9 ques ions), "implemen a ion o he ca e
plan" (10 ques ions), and "e alua ion o he ca e plan" (6
ques ions). Responses we e measu ed using a i e-poin
Like scale, anging om "s ongly disag ee" o
"s ongly ag ee." Each ques ion was sco ed om 1 o 5,
wi h he o al sco e anging om 37 o 148, whe e a
highe sco e indica ed be e sel -e icacy. The Clinical
Pe o mance Sel -E icacy Ques ionnai e was de eloped
by Che aghi e al. This ques ionnai e was compiled
based on a quali a i e esea ch and con en analysis o
indi idual and g oup in e iews, as well as a e iew o
a ailable sou ces. Con en alidi y, ace alidi y and
ac o analysis o he da a ob ained in he esea ch we e
con i med. The concu en alidi y o he "clinical
pe o mance sel -e icacy" ool wi h he "gene al sel -
e icacy" ool was con i med (p < 0.01, = 0.73) along
wi h a C onbach's alpha coe icien o 0.96 [17].
The OSCE was designed by cou se ins uc o s p o icien
in he OSCE me hodology, in ol ing se e al sessions o
de elop he exam bluep in , checklis s, passing sco es,
and implemen a ion and supe ision p ocedu es. To
p epa e a bluep in o he es , he a ious dimensions
we e ou lined o add ess he lea ning needs and
capabili ies o in e nship s uden s. Ins uc o s we e
eques ed o submi hei ques ions based on hese
dimensions o he g oup manage , aligned wi h he
designa ed s a ions. All he scena ios we e discussed and
e iewed in he g oup o p o esso s and he inal
app o al was gi en. The exam comp ised six s a ions,
which included he ollowing p ocedu es: inse ing a
nasogas ic ube, u ina y ca he e iza ion, endo acheal
ube suc ioning, in amuscula injec ion, adminis e ing
in a enous medica ion, and changing d essings. Each
s a ion was allo ed i e minu es, wi h scena ios
de eloped by clinical in e nship ins uc o s and e iewed
by he acul y g oup. Scena ios in ol ed pe o ming a
p ocedu e. E alua ion checklis s we e de i ed om
nu sing p inciples and echniques ex books, wi h each
i em sco ed as 0 (no pe o med), 0.5 (pa ially
pe o med), o 1 ( ully pe o med). The o al sco e
anging om 0 o 6, whe e a highe sco e indica ed be e
clinical pe o mance. The exam was conduc ed in one
day, and sco ing was done using he checklis s. One
ins uc o ela ed o he subjec was used o e alua e he
s uden s a each s a ion. A e comple ing all he s a ions,
s uden s es ed in a qua an ine s a ion, whe e hey we e
supe ised by a moni o o con ol any in e ac ions. The
OSCE exam o bo h g oups was held wi h he same
ins uc o s a each s a ion, and o blinding, ins uc o s
o he han he clinical ins uc o s o he clinical
in e nship we e used.
Da a collec ion me hods
Nea -PAL was implemen ed o he in e en ion g oup
a e he esea ch p oposal was app o ed, he e hical
code was ecei ed, and consen om he Nu sing
School's educa ional council was ob ained. S uden s in
he in e en ion g oup we e in o med ha i hey chose
no o pa icipa e in he esea ch, hey could exp ess hei
conce ns and comple e he ele an aining cou se a
ano he hospi al. s uden s we e also eassu ed abou he
lack o e ec o hei decision o pa icipa e/no
pa icipa e in he esea ch on he in e nship g ade. All
s uden s exp essed hei sa is ac ion and in e es in
pa icipa ing in he p ojec . Nea -PAL was used o he
in e en ion g oup, wi h senio nu sing s uden s om he
Mas e 's p og am in medical-su gical nu sing se ing as
nea pee s. Theo e ical and p ac ical educa ional asks
we e gi en o he senio nu sing s uden s wi h he
ag eemen o he g oup manage and p o esso s o he
nu sing depa men . The compe ence o he senio
s uden s in he in e en ion g oup was assessed based on
hei wo k expe ience in clinical depa men s and
h ough obse a ions o hei clinical pe o mance by
p o esso s du ing he ele an in e nships. The clinical
compe ence o he selec ed nea pee s was con i med by
he Nu sing School's G adua e S udies Council. Nea -
Pee Assis ed Lea ning (Nea -PAL) was conduc ed
unde he supe ision o expe ienced ins uc o s who
se ed as esiden educa ional supe iso s a he eaching
hospi als. Be o e s a ing he Nea -PAL, he de ails o he
implemen a ion, such as asks ela ed o nea -pee s, how
o e alua e and supe ise, we e explained in de ail by he
[ DOI: 10.61882/edcj.18.2.27 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
3 / 9
Badiyepeymaiejah omi e al
.
: The e ec o nea -pee -assis ed lea ning on sel -e icacy and clinical pe o mance
30 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025
esea ch eam o he educa ional supe iso s. Also, he
senio nu sing s uden s we e augh how o ea , ain
and supe ise in e nship s uden s in a 2-hou session.
In e nship s uden s we e andomly di ided in o g oups o
3 people by lo e y. The s uden s pa icipa ed in
in e nship cou se in o a ion in he medical, su gical,
ICUs and CCUs o Peymaniyeh and Mo aha i hospi als
a ilia ed o Jah om Uni e si y o Medical Sciences.
These senio s uden s isi ed he clinical wa ds, p o ided
ins uc ion and aining, and conduc ed e alua ions. The
educa ional supe iso s also moni o ed his p ocess and
sol ed i i he e was a p oblem. The con ol g oup
ecei ed adi ional educa ion om nu sing school
ins uc o s. Fo he con ol g oup, adi ional educa ion
was pe o med by ins uc o s; isi ing clinical wa ds
whe e s uden s we e du ing mo ning and e ening shi s,
p o iding ins uc ion and conduc ing e alua ions. A he
end o he educa ional cou se, s uden s' clinical sel -
e icacy was assessed using a sel -e alua ion
ques ionnai e, and hei clinical pe o mance was
e alua ed h ough an OSCE S uden pa icipa ion in he
s udy is shown in Figu e 1.
Da a analysis
Da a analysis was pe o med using SPSS e sion 22. The
no mali y o OSCE and sel -e icacy sco es in he pos -
es s was checked using skewness and ku osis es s.
Independen - es s we e used o compa e quan i a i e
da a (OSCE, sel -e icacy sco es, age, and GPA) and
Chi-squa e es s we e pe o med o pe o med o
quali a i e (ma i al s a us and sex). A signi icance le el
o 0.05 was conside ed.
Figu e1. Flow cha o he s udy
Resul s
The mean age o he s uden s was 20.38 ± 0.029 yea s,
and he mean g ade poin a e age was 16.64 ± 0.94.
Among he pa icipan s, 76.34% we e emale, while
22.3% we e ma ied. The e was no s a is ically
signi ican di e ence be ween he wo g oups in e ms
o demog aphic cha ac e is ics (Table 1). The skewness
es indica ed ha he skewness alues o he OSCE and
sel -e icacy sco es we e 0.66 and 0.71, espec i ely,
bo h alling wi hin he no mal ange.
[ DOI: 10.61882/edcj.18.2.27 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
4 / 9
Badiyepeymaiejah omi e al
.
: The e ec o nea -pee -assis ed lea ning on sel -e icacy and clinical pe o mance
Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 31
Table 1. Compa ison o demog aphic cha ac e is ics be ween in e en ion and con ol g oups
Demog aphic da a
In e en ion g oup
Con ol g oup
Sig.
Age )Mean ± SD(
20.67 ± 3.024
20.890 ± 2.035
p = 0.690, = 0.400
GPA )Mean ± SD(
16.83 ± 0.79
16.91 ± 0.55
p = 0.583, = 0.551
Sex n(%)
Male
Female
12 (23.1)
40 (76.9)
10 (24.4)
31 (75.6)
p =0.882, X2 = 0.022
Ma i al s a us n (%)
Ma ied
Single
2 (3.8)
50 (96.2)
1 (2.4)
40 (97.6)
p > 0.999, X2 = 0.145
No e: Independen - es was used o compa e pa icipan s based on quan i a i e demog aphic a iables o wo g oups. Chi-
squa e es was used o compa e quali a i e demog aphic a iables be ween g oups.
Abb e ia ions: n, numbe o pa icipan s; SD, s anda d de ia ion; GPA, g ade poin a e age; X2, Chi-squa e es ; ,
independen - es ; Sig, s a is ical signi icance; p, p obabili y- alue.
The mean OSCE sco es we e 5.09 ± 0.29 and 4.85 ± 0.76
ou o 6 o he in e en ion and con ol g oups,
espec i ely. Al hough he in e en ion g oup (PAL) had
highe mean sco es, he independen - es e ealed no
s a is ically signi ican di e ence be ween he
in e en ion and con ol g oups ega ding OSCE sco es
(p = 0.061, E ec Size = 0.43). Howe e , he
independen - es did show a s a is ically signi ican
di e ence be ween he wo g oups in o e all sel -
e icacy sco es (p < 0.001, E ec Size = 0.95).
Addi ionally, he esul s indica ed signi ican di e ences
be ween he wo g oups in all dimensions o sel -
e icacy, including pa ien assessmen , nu sing diagnoses
and planning, implemen a ion o he ca e plan, and
e alua ion o he ca e plan (p < 0.05) (Table 2, Figu e 2
and 3).
Table 2. Compa ison o sel -e icacy and OSCE mean sco es be ween in e en ion and con ol
g oups a e he in e en ion
Va iables
In e en ion g oup
)Mean ± SD(
Con ol g oup
)Mean ± SD(
Sig.
Pa ien assessmen
46.88 ± 7.15
33.48 ± 9.09
p < 0.001, = 7.960
Nu sing diagnoses and planning
30.22 ± 11.03
23.49 ± 6.21
p = 0.001, = 3.492
Implemen a ion o he ca e plan
39.98 ± 8.28
34.21 ± 10.38
p = 0.004, = 2.983
E alua ion o he ca e plan
22.08 ± 5.11
18.47 ± 4.21
p < 0.001, = 3.650
To al sel -e icacy
139.16 ± 31.57
109.65 ± 29.89
p < 0.001, = 4.581
OSCE
5.09 ± 0.29
4.85 ± 0.76
p = 0.061, = 1.915
No e: An independen - es was used o compa e quan i a i e a iables be ween he wo g oups.
Abb e ia ions: SD, s anda d de ia ion; , independen - es ; Sig, s a is ical signi icance; p, p obabili y- alue.
Figu e 2. Compa ison o he mean sco e o OSCE in he in e en ion and con ol
g oups a e he in e en ion.
4.7
4.8
4.9
5
5.1
5.2
OSCE Con ol In e en ion
[ DOI: 10.61882/edcj.18.2.27 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
5 / 9

Badiyepeymaiejah omi e al
.
: The e ec o nea -pee -assis ed lea ning on sel -e icacy and clinical pe o mance
32 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025
Figu e 3. Compa ison o he mean sco e o sel -e icacy in he in e en ion and con ol
g oups a e he in e en ion.
Discussion
This s udy aimed o de e mine he e ec o nea -PAL on
he sel -e icacy and clinical pe o mance o nu sing
in e nship s uden s. The esul s indica ed a s a is ically
signi ican di e ence in sel -e icacy sco es be ween he
PAL g oup and he adi ional ins uc o -led g oup. Due
o he ad an ages o PAL, his me hod has been widely
used o educa ion and e alua ion in a ious s udies.
Howe e , he e ha e been ew s udies on sel -e icacy
using his me hod, which we will discuss. The esul s o
a s udy by Pa cheba ieh e al. showed ha PAL
posi i ely a ec ed he clinical sel -e icacy o nu sing
s uden s [4].
Plasson e al. conduc ed a quasi-expe imen al s udy in
Sweden o in es iga e he e ec o PAL on nu sing
s uden s' clinical skills educa ion. In his s udy, he
in e en ion g oup ecei ed aining h ough PAL o
wo weeks, while he con ol g oup ecei ed adi ional
aining unde he supe ision o an ins uc o . The
esul s also indica ed ha PAL was mo e e ec i e in
enhancing he sel -e icacy o nu sing s uden s han
adi ional me hods [18].
S udies by Aus ia e al. and Hells öm-Hyson e al. also
suppo he indings o he p esen s udy, iden i ying
PAL as a ac o ha enhances nu sing s uden s' sel -
e icacy [19, 20]. Acco ding o Bandu a, social
suppo —such as ha p o ided h ough pee lea ning—
is a p ima y sou ce o sel -e icacy [21]. I appea s ha
when s uden s ecei e educa ional con en om pee s
who a e simila o hem bu possess sligh ly mo e
knowledge, hey expe ience less anxie y and s ess. This
en i onmen p o ides mo e oppo uni ies o p ac ice
and ques ions du ing skill acquisi ion, which can
posi i ely impac hei sel -e icacy.
In he s udy conduc ed by B annagan e al., which aimed
o in es iga e he e ec o PAL expe iences on nu sing
s uden s in a clinical labo a o y se ing, no di e ences
we e obse ed be ween he in e en ion and con ol
g oups ega ding imp o emen s in sel -e icacy [22].
While he di e ing esul s compa ed o he p esen s udy
may be a ibu ed o he di e ences be ween clinical
educa ion and labo a o y educa ion, he au ho also ci ed
implemen a ion challenges o he pee me hod and he
insu icien p epa a ion o pee ins uc o s as easons o
he lack o di e ence be ween he con ol and
in e en ion g oups. The e o e, i should be no ed ha
he key o success ul pee educa ion lies in ha ing
su icien knowledge, accu a e obse a ion, p o iding
eedback, emo ional suppo , and collabo a ion among
pee s. Addi ionally, he esul s showed no s a is ically
signi ican di e ence in OSCE sco es be ween he PAL
g oup and he adi ional eaching g oup. This inding
was consis en wi h Haji Hosseini's s udy, which
demons a ed ha he p ac ical skill sco es o s uden s
who used PAL we e simila o hose o he con ol g oup
[12]. Simila ly, he e ec o PAL on den al s uden s'
p ac ical skills in he clinic was in es iga ed in Kimyai's
s udy, and he esul s indica ed ha he p ac ical skills o
s uden s who used PAL we e compa able o hose o he
con ol g oup [23]. Hackman e al. ound no signi ican
di e ence be ween s uden s' sco es on w i en es s and
he OSCE when compa ing PAL o ins uc o -led
eaching du ing hei neu ology cle kship [24]. These
esul s sugges ha his me hod can be as e ec i e as
clinical ins uc o -led eaching. Con a y o hese
indings, Williams's e iew s udy indica ed ha pee
lea ning imp o ed OSCE sco es [25]. Goldsmi h e al.
conduc ed a s udy o de e mine he
[ DOI: 10.61882/edcj.18.2.27 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
6 / 9
Badiyepeymaiejah omi e al
.
: The e ec o nea -pee -assis ed lea ning on sel -e icacy and clinical pe o mance
Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 33
e ec o pee eaching on he p ac ical skills o hi d-yea
nu sing s uden s a he Uni e si y o Sydney. Thei
esul s showed signi ican imp o emen in p ac ical
skills in he PAL g oup o hi d-yea nu sing s uden s
[26]. O he s udies compa ing he e ec o pee and non-
pee lea ning me hods on s uden s' clinical skills ha e
also shown ha pee lea ning is e ec i e [13, 16, 27].
Di e ences in s udy design, pee g oups, in e en ion
implemen a ion, academic disciplines, academic yea s o
he pee s, and he complexi y o he educa ional con en
ela i e o he pee s' abili ies may explain he a ied
esul s ac oss s udies. PAL can be success ully in eg a ed
in o educa ional cu icula, wi h eedback highligh ing
signi ican bene i s o his eaching me hod [11].
Howe e , ully eplacing o mal academic ins uc o s
wi h nea pee s would be p ema u e. The e o e, i is
c ucial o p o ide app op ia e aining o pee educa o s,
moni o he quali y o educa ion hey deli e , and u ilize
nea pee s as a complemen o academic ins uc o s [28].
Addi ionally, his me hod may help add ess he sho age
o ins uc o s a uni e si ies, inc ease s uden
sa is ac ion, and educe he ime and cos o educa ion
[11]. None heless, i is c ucial o conside ha s uden s
gene ally pe cei e o mal ins uc o s as ha ing be e
knowledge, explana o y skills, and communica ion
abili ies. Fu he mo e, in mos s udies, he esul s ha e
been a ibu ed o he in e en ion wi hou much
conside a ion o po en ial in luences om pa icipan s'
de elopmen o o he en i onmen al and educa ional
ac o s. Gi en hese limi a ions, i is essen ial o
cau iously a ibu e ou comes o he in e en ion. In
addi ion among he limi a ions o his esea ch a e i s
single-cen e design, small sample size, lack o a p e- es ,
and he unexamined long- e m e ec s o he in e en ion
on s uden s. Addi ionally, his s udy did no accoun o
po en ial con ounding a iables, such as s uden
mo i a ion o ex e nal suppo sys ems, which could
in luence sel -e icacy and clinical pe o mance.
The indings o his esea ch can be applied in
educa ional se ings by inco po a ing his eaching
me hod, in clinical p ac ice o enhance he quali y o ca e
p o ided by s uden s and nu ses, and in managemen o
planning clinical in e nships and p ac icum cou ses using
his educa ional app oach.
Conclusion
The nea -PAL me hod has a mo e signi ican impac on
he sel -e icacy o nu sing s uden s du ing clinical
in e nships compa ed o adi ional eaching me hods.
Fu he mo e, i can be equally e ec i e as ins uc o -led
eaching in enhancing s uden s' clinical pe o mance.
The e o e, i is ecommended o use his app oach in
conjunc ion wi h o he eaching me hods ha can u he
imp o e clinical pe o mance among s uden s. Gi en he
limi ed numbe o s udies in his a ea, u u e esea ch is
sugges ed o explo e he use o nea -PAL ac oss a ious
nu sing special ies, wi h a ocus on inco po a ing
andomiza ion. Addi ionally, in es iga ing he long- e m
e ec s o nea -PAL on clinical pe o mance and sel -
e icacy in nu sing s uden s is essen ial. Fu he esea ch
combining bo h quan i a i e and quali a i e me hods is
needed o enhance da a eliabili y and o unde s and
o he aspec s o implemen ing his s uden -cen e ed
educa ional app oach. Adop ing he PAL me hod as a
s uden -cen e ed educa ional s a egy could be e
p epa e s uden s o ake on educa ional oles in clinical
se ings.
E hical conside a ions
This esea ch was conduc ed wi h he e hical code
IR.JUMS.REC.1401.098. E hical p inciples, such as
ob aining in o med consen , olun a y pa icipa ion,
explaining he esea ch objec i es, and ensu ing he
con iden iali y o pa icipan s' in o ma ion, we e
obse ed.
A i icial in elligence u iliza ion o a icle
w i ing
The au ho s decla e ha no AI-based ools we e used in
conduc ing he esea ch o p epa ing his manusc ip .
Acknowledgmen
We a e g a e ul o all he s uden s and ins uc o s who
assis ed us in conduc ing his s udy, as well as he
Resea ch Depu y o Jah om Uni e si y o Medical
Sciences o suppo ing his esea ch p ojec .
Con lic o in e es s a emen
The au ho s decla e no po en ial con lic s o in e es .
Au ho con ibu ions
Z.B and M.H concep ualized he s udy. Z.B and S.R
d a ed he manusc ip , while M.H and M.F p o ided
e isions and c i ical eedback. All au ho s app o ed he
inal e sion o he manusc ip o publica ion.
Funding
This s udy was inancially suppo ed by he Resea ch
Depu y o Jah om Uni e si y o Medical Sciences.
[ DOI: 10.61882/edcj.18.2.27 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
7 / 9
Badiyepeymaiejah omi e al
.
: The e ec o nea -pee -assis ed lea ning on sel -e icacy and clinical pe o mance
34 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025
Da a a ailabili y s a emen
The da ase s used and analyzed in his s udy a e a ailable
om he co esponding au ho upon easonable eques .
Re e ences
1. Rahimi Z, Badiyepeymaiejah omi Z,
Taghizadeganzadeh M. 360-deg ee e alua ion o
nu sing s uden s' pe o mance. Shi az E-Medical
Jou nal. 2024;25(11):e148872.
[h ps://doi.o g/10.5812/semj-148872]
2. Chang CY, Gau ML, Tang KY, Hwang GJ. Di ec ions
o he 100 mos ci ed nu sing s uden educa ion esea ch:
a bibliome ic and co-ci a ion ne wo k analysis. Nu se
Educa ion Today. 2021;96:104645
[h ps://doi.o g/10.1016/j.ned .2020.104645]
3. Mon ase i MA, Ja adpou S, Ramezanli S,
Badiyepeymaiejah omi Z. The e ec o blended
educa ion on nu sing s uden s' lea ning and educa ional
clima e in pha macology in e nship. Jou nal o Medical
Educa ion De elopmen . 2023;10;15(48):52-61.
[h ps://doi.o g/10.52547/edcj.15.48.52]
4. Pa cheba ieh S, Sa a i M, Mashou S, Salehi S,
Esmaeilpou Zanjani S, Bakhshandeh H. E ec o using
Pee Assis ed Lea ning app oach on clinical sel -
e icacy o nu sing s uden s in Islamic Azad Uni e si y
o Teh an Medical Sciences b anch. Jou nal o Nu sing
Educa ion. 2018;6(6):8-15.[Online]. A ailable om:
h p://jne.i /a icle-1-748- a.h ml. [Accessed: Augus . 4,
2024].
5. Gha a i S, A ashi V, Taleghani F, I ajpou A, Sabohi
F, Yazdannik A. Compa ison he e ec o wo me hods
o in e nship and app en iceship in he ield on clinical
compe ence o nu sing s uden s. Resea ch in Medical
Educa ion. 2022;14(1):64-72.
[h ps://doi.o g/10.52547/ me.14.1.64]
6. Jang A, Song C. In e ne o hings pla o m echnology
used in unde g adua e nu sing s uden educa ion: a
scoping e iew p o ocol. BMJ Open.
2022;12(4):e058556. [h ps://doi.o g/10.1136/bmjopen-
2021-058556]
7. Mohammadi S, Yazdan Nik AR, Youse y A, A azi
TM. A glimpse in he challenges in I anian
academic nu sing educa ion. I anian Jou nal o Medical
Educa ion. 2014;14(4):323-31. [Online]. A ailable
om: h p://ijme.mui.ac.i /a icle-1-3146-en.h ml.
[Accessed: Augus . 4, 2024].
8. A aghi E, Rezaei M, Behesh i a M, Kal oozi F. The
e ec o pee educa ion on nu sing s uden s’ clinical
d essing skills and pe cei ed s ess sco es a Aja
Uni e si y o Medical Sciences. Mili a y Ca ing
Sciences. 2023;10(3):229-37. [Online]. A ailable om:
h p://mcs.ajaums.ac.i /a icle-1-510-en.h ml.
[Accessed: Augus . 4, 2024].
9. Omidkhoda A, Dehda i ad H, Changizi V. Planning,
implemen a ion and e alua ion o ac i e lea ning-
eaching me hods in in e ed class oom,pee lea ning
and i ual educa ion among s uden s in he school o
allied medical sciences. Resea ch in Medical Educa ion.
2021;13(3):42-54.
[h ps://doi.o g/10.52547/ me.13.3.42]
10. Secomb J. A sys ema ic e iew o pee eaching and
lea ning in clinical educa ion. Jou nal o Clinical
Nu sing. 2008;17(6):703-16.
[h ps://doi.o g/10.1111/j.1365-2702.2007.01954.x]
11. Jau egui J, B igh S, S o e J, Shand o J. A no el
app oach o medical s uden pee -assis ed lea ning
h ough case-based simula ions. The Wes e n Jou nal o
Eme gency Medicine. 2018;19(1):193-197.
[h ps://doi.o g/10.5811/wes jem.2017.10.35319]
12. Hajihosseini F, Izadi A, Mahboobi M,
Mohammad aba R. E ec o pee educa ion on p ac ical
skills lea ning o nu sing s uden s in clinical skill lab o
Mazanda an uni e si y o medical sciences. Medical
Educa ion Jou nal. 2013;1(1):13-17. [Online]. A ailable
om: h p://mededj.i /a icle-1-22- a.h ml. [Accessed:
Augus . 4, 2024].
13. Kayzou i A, Yaghou imoghaddam H, Sadeghi H,
Hoseinzadeh Hesa i M, Haghnaza M. The e alua ion
e ec o pee and non-pee educa ion me hods on
clinical lea ning o anes hesia s uden s in Sabze a
uni e si y o medical sciences 2016-2017. Jou nal o
Sabze a Uni e si y o Medical Sciences.
2019;26(4):487-93. [Online]. A ailable om:
h ps://jsums.medsab.ac.i /a icle_1216.h ml?lang=en.
[Accessed: Augus . 4, 2024].
14. Sa a i M, Yazdanpah B, Mahmoudi F, Yaghobean N.
Compa ing s uden s’ a e o lea ning h ough lec u ing
and pee g oup eaching and s udy hei iewpoin s.
Resea ch in Medical Educa ion. 2018;10(3):24-34.
[Online]. A ailable om:
h ps://doi.o g/10.29252/ me.10.3.24. [Accessed:
Augus . 4, 2024].
15. Eslami Akba R, Hoja M, Badiyepeymaie Jah omi
Z. Compa ison o eaching h ough pee lea ning wi h
he lec u e me hod on he lea ning le el o
anes hesiology s uden s a Jah om uni e si y o medical
sciences in 2013. Jou nal o Nu sing Educa ion.
2015;4(3):56-65. [Online]. A ailable om:
h p://jne.i /a icle-1-541- a.h ml. [Accessed: Augus . 4,
2024].
16. Moaddab F, Ghanba i A, Pa yad E, Jahani M,
Sedighi A. The e ec o using he pee assis ed lea ning
sys em om he pe spec i e o nu sing s uden s: a quasi-
expe imen al s udy. Ho izon o Medical Educa ion
De elopmen . 2020;11(1):26-42.
h ps://hmed.mums.ac.i /a icle_16405.h ml
17. Che aghi F, Hassani P, Yaghmaei F, Ala i Majd H.
De elopmen and psychome ic pe o mance o clinical
e icacy. Payesh. 2009;9(1):51-60. [Online]. A ailable
om: h p://payeshjou nal.i /a icle-1-588-en.h ml.
[Accessed: Augus . 4, 2024].
18. Palsson Y, Ma ensson G, Swenne CL, Adel E,
Engs om M. A pee lea ning in e en ion o nu sing
[ DOI: 10.61882/edcj.18.2.27 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
8 / 9
Badiyepeymaiejah omi e al
.
: The e ec o nea -pee -assis ed lea ning on sel -e icacy and clinical pe o mance
Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 35
s uden s in clinical p ac ice educa ion: A quasi-
expe imen al s udy. Nu se Educa ion Today.
2017;51:81-7.
[h ps://doi.o g/10.1016/j.ned .2017.01.011]
19. Aus ia MJ, Ba aki K, Doig AK. Collabo a i e
lea ning using nu sing s uden dyads in he clinical
se ing. In e na ional Jou nal o Nu sing Educa ion
Schola ship. 2013;10(1):73-80.
[h ps://doi.o g/10.1515/ijnes-2012-0026]
20. Hells öm-Hyson E, Må ensson G, K is o e zon
ML. To ake esponsibili y o o be an onlooke . Nu sing
s uden s' expe iences o wo models o supe ision.
Nu se Educa ion Today. 2012;32(1):105-10.
[h ps://doi.o g/10.1016/j.ned .2011.02.005]
21. Bandu a A. Sel -e icacy: The exe cise o con ol.
F eeman; 1997. [Online]. A ailable om:
h ps://www.academia.edu/28274869/Albe _Bandu a_
Sel _E icacy_The_Exe cise_o _Con ol_W_H_F eem
an_and_Co_1997_pd . [Accessed: Augus . 4, 2024].
22. B annagan KB, Dellinge A, Thomas J, Mi chell D,
Lewis-T abeaux S, Dup e S. Impac o pee eaching on
nu sing s uden s: pe cep ions o lea ning en i onmen ,
sel -e icacy, and knowledge. Nu se Educ ion Today.
2013;33(11):1440–1447.
[h ps://doi.o g/10.1016/j.ned .2012.11.018]
23. Kimyai S, Ja a i Na imipou E, Mohammadi N. The
e ec o pee educa ion on p ac ical skills aining o
den is y s uden s in es o a i e p eclinic. I anian Jou nal
o Medical Educa ion. 2011;11(4):418-424. [Online].
A ailable om: h p://ijme.mui.ac.i /a icle-1-1323-
a.h ml. [Accessed: Augus . 4, 2024].
24. Heckmann JG, Dü sch M, Rauch C, Lang C, Weih
M, Schwab S. E ec s o pee -assis ed aining du ing he
neu ology cle kship: a andomized con olled s udy.
Eu pean Jou nal o Neu olgy. 2008;15(12):1365-70.
[h ps://doi.o g/10.1111/j.1468-1331.2008.02317.x]
25. Williams B, Reddy P. Does pee -assis ed lea ning
imp o e academic pe o mance? A scoping e iew.
Nu se Educa ion Today. 2016;42:23-9.
[h ps://doi.o g/10.1016/j.ned .2016.03.024]
26. Goldsmi h M, S ewa L, Fe guson L. Pee lea ning
pa ne ship: an inno a i e s a egy o enhance skill
acquisi ion in nu sing s uden s. Nu se Educa ion Today.
2006;26(2):123-30.
[h ps://doi.o g/10.1016/j.ned .2005.08.001]
27. Salehi S, Sa a i M, Mashoo S, Pa cheba ieh S,
Fesha aki M. E ec s o pee educa ion on clinical skills
in nu sing s uden s, including in e ns and ainees.
Medical Science Jou nal o Islamic Azad Uni esi y-
Teh an Medical B anch. 2016; 26(1): 36-45. [Online].
A ailable om: h ps:// muj.iau mu.ac.i /a icle-1-1059-
en.pd . [Accessed: Augus . 4, 2024].
28. Jackson TA, E ans DJ. Can medical s uden s each?
A nea -pee -led eaching p og am o yea 1s uden s.
Ad ance in Physiology Educa ion. 2012;36(3):192-6.
[h ps://doi.o g/10.1152/ad an.00035.2012]
[ DOI: 10.61882/edcj.18.2.27 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
Powe ed by TCPDF (www. cpd .o g)
9 / 9