Impact of Peer-Led Simulation-Based Medical Education on Knowledge and Confidence in Managing Acutely Ill Patients: A Pilot Study Among Pre-clinical Medical Students.

Background Preparedness to manage acutely ill patients is a critical competency for new medical graduates, yet there are persisting gaps in acute-care management teaching throughout undergraduate training. To address this, we developed the Systematic Approach for the Acutely ill Patient (SAAP) course, a peer-led, simulation-based medical education (SBME) programme designed to give pre-clinical medical students a solid foundation in acute illness management. The course aimed to improve their knowledge and confidence in managing acutely ill patients, thereby better preparing them for the transition into clinical training. Methods This pilot quasi-experimental study employed a pre- and post-test design involving 70 pre-clinical medical students at a UK university. The SAAP course comprised four workshops based on the RATE framework (Recognise, Assess, Treatment, Escalation), followed by simulation scenarios facilitated by near-peer instructors. Students completed knowledge tests and confidence questionnaires before and after the simulation and provided qualitative feedback at the end of the course. Data were analysed using paired t-tests for knowledge scores and Mann-Whitney U tests for questionnaire responses. Results There was a significant increase in knowledge score across the study cohort (mean pre-test score 20.36 to post-test 22.17, p < 0.001). First-year students (19.03 to 21.08, p < 0.001) demonstrated the larger improvement compared to second-year students (22.03 to 23.55, p < 0.001). Confidence scores rose significantly in multiple domains, including ordering appropriate investigations (3.24 to 3.83, p < 0.001), managing patients with breathing difficulties (3.46 to 3.91, p < 0.001), managing hypotension (3.50 to 3.89, p < 0.00), and using the Identify, Situation, Background, Assessment, Recommendation (ISBAR) framework for escalation (3.77 to 4.06, p = 0.004). Overall confidence in acute-care management improved from 3.46 to 3.86 (p < 0.001). Qualitative feedback highlighted the value of near-peer facilitation, the clinical relevance of scenarios, and the psychologically safe learning environment that near-peer educators provided. Conclusions A peer-led acute-care simulation course significantly improved both knowledge and confidence among pre-clinical medical students. The findings suggest that vertically integrated, near-peer SBME can bridge the gap between theory and clinical practice, preparing students for acute-care responsibilities earlier in training. While immediate gains were clear, further longitudinal research is needed to assess retention, scalability, and comparative effectiveness versus faculty-led approaches.