Perceptions and Examination Performance After the Addition of a Near-Peer Simulation Programme in Physiotherapy Education: A Retrospective Quasi-Experimental Cohort Study

Objectives: to evaluate physiotherapy students’ perceptions of an adjunct near-peer simulation (NP-simulation) programme, examine the preliminary psychometric properties of three evaluation instruments, and compare practical examination performance with historical cohorts. Design: Retrospective quasi-experimental cohort study with an embedded post-intervention survey. Setting: Undergraduate entry-level physiotherapy programme in Singapore. Participants: Three consecutive Year 2 cohorts (2024–2026, n = 464) completing cardiorespiratory physiotherapy; 59 of 144 students (41%) in the 2026 intervention cohort completed the survey. Interventions: The 2026 cohort received NP-simulation facilitated by Year 4 students alongside the usual teaching (including standardised-patient simulation), whereas historical comparison cohorts (2024–2025) received the usual teaching alone. Main Outcome Measures: Post-intervention Confidence Visual Analogue Scale (CVAS), Clinical Teaching Preference Questionnaire (CTPQ), Perceived Knowledge Transferability scale, thematic analysis of open-ended feedback, and first-attempt practical examination scores. Results: Among the 59 respondents, Perceived Knowledge Transferability correlated moderately with Confidence (ρ = 0.49, p < 0.001). Instructor-Led and Peer-Led CTPQ domains were nearly identical and moderately correlated (ρ = 0.68, p < 0.001). Internal consistency was high across scales (Cronbach’s alpha of 0.92 to 0.95). Practical examination scores did not differ significantly between the 2026 cohort and historical cohorts (all students, p = 0.28; exploratory first-attempt-pass analysis, p = 0.111), whereas first-attempt pass rates varied across cohorts (97.5%, 89.3%, 93.1%; p = 0.013). Students described feeling comfortable with senior students, valued feedback they perceived as clinically credible, and described a shift from checklist-following toward clinical reasoning. Conclusion: Students perceived supplementary NP-simulation favourably, with higher confidence corresponding to greater perceived knowledge transferability. However, it did not produce detectable gains in summative practical examination scores over historical cohorts.