Comparative Evaluation of Perceived Cognitive Load Across Two Academic Cycles in an Undergraduate Obstetrics and Gynecology Course With an Evolving Clinical Tutor Role: Comparative Student Feedback Analysis.

Background  Near-peer teaching in medical education is commonly described as informal, voluntary, or extracurricular, and most often involves senior medical students teaching junior peers. Existing literature demonstrates benefits such as improved learner comfort, engagement, and perceived approachability; however, these findings predominantly arise from student-led or supplementary models. Evidence examining recently graduated doctors or alumni acting as near-peer educators within the formal, compulsory delivery of undergraduate curricula remains limited. In particular, little research has evaluated how embedding graduate near-peer tutors within structured, assessment-aligned core teaching influences learning experiences. An undergraduate Obstetrics and Gynecology (O&G) course at Mohammed Bin Rashid University of Medicine and Health Sciences in Dubai, United Arab Emirates, has previously been evaluated using cognitive load theory, focusing on curriculum design and simulation-based education rather than the instructional role of clinical tutors. That evaluation demonstrated favorable cognitive load outcomes within a stable course framework. Since then, the instructional role of clinical tutors has expanded within the same structure, creating an opportunity to examine whether formally embedded graduate near-peer involvement is associated with differences in perceived cognitive load and learning outcomes. Aim  To compare student feedback and perceived cognitive load across two academic cycles of an undergraduate O&G course and to examine whether observed differences were associated with an expansion in the formal instructional role of clinical tutors.  Methods  This retrospective comparative educational evaluation analyzed routinely collected, anonymized student feedback from scheduled teaching sessions delivered between October and January across two academic cycles. Perceived cognitive load was assessed using a standardized questionnaire measuring intrinsic cognitive load, extraneous cognitive load, and germane cognitive load or self-perceived learning. Descriptive statistics and between-cycle comparative analyses were performed using a t-test. Free-text comments were reviewed descriptively to contextualize quantitative findings, with particular attention to tutor-related and facilitation-related themes.  Results  A total of 102 feedback responses from Cycle A and 130 responses from Cycle B were included. Compared with Cycle A, Cycle B demonstrated higher intrinsic cognitive load and higher germane cognitive load or self-perceived learning scores, while extraneous cognitive load remained consistently low across both cycles. Session-level analyses showed similar directional patterns, with statistical significance varying by session, reflecting differences in sample size and session coverage. Descriptive review of free-text comments indicated increased recognition of clinical tutors' instructional visibility and facilitative role in the later cycle.  Conclusion  Differences in perceived intrinsic and germane cognitive load were observed between academic cycles within a largely stable course structure. These findings are associated with an expanded instructional role of embedded graduate clinical tutors but do not establish causality. The results highlight a gap in the literature regarding formally integrated graduate near-peer teaching models and support further focused investigation of their role within undergraduate medical curricula.