Peer-led examination simulation reshapes psychophysiological and emotional state profiles during problem-based...

Repeated problem-based learning (PBL) sessions are intended to sustain active, collaborative, and self-directed learning, yet evidence is mixed as to whether familiar PBL routines consistently maintain an appropriate level of learner activation over time. This repeated-measures study examined whether embedding a peer-led examination simulation into regular PBL reshapes psychophysiological and achievement-emotional state profiles. Forty-two medical students were assessed during resting reference, regular PBL, and PBL with peer-led examination simulation. Heart rate variability (HRV) was quantified using RMSSD, SDNN, pNN50, and LF/HF, alongside anxiety, perceived stress, achievement emotions, motivation, self-rated performance, and post-session appraisal. Both PBL formats reduced HRV relative to rest, indicating autonomic activation during regular PBL itself. Compared with regular PBL, examination simulation produced additional HRV withdrawal, higher anxiety and perceived stress, and lower boredom. Baseline-adjusted mixed models supported effects for RMSSD and SDNN; pNN50 did not survive false-discovery-rate correction, and LF/HF showed no robust effect. Enjoyment, motivation, and self-rated performance did not differ significantly. Students reported greater perceived benefit from and stronger preference for the simulation format. Peer-led examination simulation thus shifted PBL toward a more salient, assessment-like psychophysiological and emotional state profile.