Effects of digital versus face-to-face peer support on clinical skills: a three-arm randomized trial

Digital interactive peer support may strengthen clinical skills when technology is coupled with pedagogy. This study was designed as a three-arm randomized controlled trial (N = 98) involving medical students and compared a digital peer-feedback platform with face-to-face peer support and routine instructor feedback during training for intravenous injection, suturing/knot tying, and endotracheal intubation. OSCE performance was assessed post-intervention and at 7 weeks; reflection skills were measured with the Groningen Reflection Ability Scale (Turkish version). Reflective journals underwent content analysis and were integrated with quantitative findings. Complete outcome data were available for 82 participants. Post-test and retention OSCE scores varied by group in all skills (Kruskal-Wallis H = 28.95-47.45, all p < 0.001), with the highest and most consistent score observed in the digital arm. Reflective ability scores also favoured the digital arm (all p = 0.001). Qualitative themes identified revisitable video evidence, explicit criteria, and peer coaching as affordances for self-regulation, while technical frictions impeded certain learners. Trial registration: ClinicalTrials.gov; registration number: NCT07186569; date of registration: September 22, 2025.