Impact of Peer Instruction Via Textbook Review on Knowledge, Diagnostic Reasoning, and Reactions Among Plastic Surgery Residents: A Quasi-Experimental Study Publisher



Rahmati J ; Alizadeh M ; Abdi M ; Haddady Abianeh S ; Molaei H ; Yavari A
Source: European Journal of Plastic Surgery Published:2026

Abstract

Background : Textbook review sessions are traditionally used in medical residency training; however, their effectiveness has been questioned due to their passive nature and insufficient learner engagement. Peer Instruction (PI), as an active learning method, can enhance the quality of these sessions by increasing learners’ interaction and cognitive engagement. This study aimed to assess the impact of peer instruction in textbook review on knowledge, diagnostic reasoning, and reactions among plastic surgery residents. Methods: This quasi-experimental pretest-posttest study was conducted with 22 plastic surgery residents at Tehran University of Medical Sciences, from 2023 to 2025. The educational program, based on the PI model, was implemented over seven sessions and evaluated according to Kirkpatrick’s model at levels of reaction and learning (including knowledge and diagnostic reasoning). Data were collected using researcher-made questionnaires, multiple-choice question (MCQ) tests, and a standard diagnostic reasoning questionnaire, and analyzed using paired t-tests, repeated measures ANOVA, and effect size indices. Results: The mean knowledge scores increased significantly from 56.1 in the initial pretest (July 2023) to 71.1 in the final session (July 2025) (p < 0.001), with an effect size of η² ≈ 0.68. The diagnostic reasoning score also improved from 151 to 171 (p < 0.001), with an effect size of η² ≈ 0.78. Concurrent improvement in minimum scores and a decrease in standard deviation indicated a reduction in the knowledge gap. The reaction questionnaire results showed that 68.2% of residents had a positive attitude towards the program, and 72.7% reported an enhancement in their academic level. Conclusions: Implementing textbook review sessions using the PI method led to a significant increase in theoretical knowledge and strengthened the diagnostic reasoning skills of plastic surgery residents. The method was evaluated as useful and acceptable by the participants. This method can be employed as an effective educational strategy in other medical specialties. Level of Evidence: not gradable. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2026.