Contemporary medical education emphasizes student-centered approaches that better align with modern learners. Peer-assisted learning (PAL) has proven effective in enhancing knowledge, clinical skills, engagement, and professional development. Although widely integrated into Western European curricula, its implementation remains limited in countries such as Romania. This study aimed to evaluate PAL within undergraduate orthopedic training, focusing on its benefits for both learners and peer instructors, as well as its potential to inform teaching practices. A total of 50 medical students participated in the study. Significant improvements were observed across all assessed domains following the intervention, including increased confidence in procedural skills such as suturing, wound debridement, and cast application, as well as greater understanding of osteosynthesis principles (P < 0.05). Anxiety-related measures significantly decreased, including fear of performing procedures and making technical mistakes. Perceptions of PAL also improved, with higher levels of trust in peer tutors and comfort in peer-led learning environments. No significant gender-based differences were identified. PAL was associated with significant improvements in students’ perceived confidence across key orthopedic procedural skills and a marked reduction in anxiety related to clinical performance. The intervention promoted a supportive learning environment that facilitated active participation, reduced hierarchical barriers, and increased trust in peer tutors. These findings are consistent with existing literature supporting student-centered and experiential learning approaches in medical education. Overall, PAL proved to be an effective and feasible educational strategy, enhancing both technical competence and psychological readiness. Its scalability and high acceptability highlight its potential for broader integration into undergraduate medical curricula.
