From Discussion to Demonstration: Read–Teach–Validate–Demonstrate an Innovative Peer-Assisted Learning Model for Teaching Pediatric Central Nervous System Examination to Undergraduate Medical Students

Abstract

Background: Competency-based medical education requires undergraduate learners to participate actively in clinical learning and progressively develop the knowledge, communication, and examination skills needed for safe patient care. Neurological examination in children is particularly challenging because it requires integration of structured examination steps with developmental considerations and interpretation of clinical findings. Traditional demonstration-based sessions may not provide sufficient opportunity for every learner to practice, explain, and receive immediate feedback. The Read–Teach–Validate–Demonstrate (RTVD) model was designed to combine self-directed preparation, peer-assisted teaching, faculty validation, and bedside demonstration within a single structured clinical learning encounter. Objectives: The objectives of the study are to evaluate the effect and feasibility of the RTVD teaching model on knowledge acquisition and self-reported confidence among undergraduate medical students learning components of the pediatric central nervous system (CNS) examination. Materials and Methods: An educational intervention was conducted during undergraduate pediatrics clinical postings. The source teaching plan divided the CNS examination into component areas and used small-group learning, a brief self-directed reading period, peer teaching, faculty validation, and bedside demonstration. The accompanying Excel dataset contained 30 3rd-year MBBS students distributed equally across three analyzed topic groups – cranial nerve examination, motor system, and reflexes. Knowledge was assessed using 20-item pre- and post-intervention scores, while confidence was recorded on a five-point scale before and after the session. Descriptive statistics and paired comparisons were performed. Mean change, 95% confidence interval (CI), paired t-test, Wilcoxon signed-rank test, and within-student effect size were calculated. Results: Mean knowledge scores increased from 9.37 ± 1.40 before the intervention to 15.40 ± 1.04 after the intervention, representing a mean absolute gain of 6.03 marks (95% CI 5.39–6.67; P < 0.001). The paired-samples t-test showed a highly significant improvement (t = 19.31, df = 29, P < 0.001), and the Wilcoxon signed-rank test confirmed the same direction of change (P < 0.001). The standardized within-student effect size was large (dz = 3.52). Mean percentage improvement relative to baseline score was 67.9%, while mean normalized gain was approximately 0.56. Confidence increased from 2.40 ± 0.50 to 4.40 ± 0.50 on the five-point scale, a mean increase of 2.00 points (P < 0.001). Similar knowledge gains were observed across the three analyzed topic groups, with no significant difference in gain between topics (one-way analysis of variance, P = 0.958). Conclusion: In this cohort, the RTVD model was associated with substantial improvement in short-term knowledge and self-reported confidence in selected components of pediatric CNS examination. Its educational value appears to arise from the deliberate sequence of preparation, explanation, correction, and clinical demonstration, which increases learner participation while retaining faculty oversight. RTVD is simple, low-cost, and potentially adaptable to other clinical examination skills. Larger controlled studies with objective bedside performance assessment, retention testing, and longer follow-up are required before definitive conclusions about its comparative effectiveness can be made.