Leveraging near-peer teaching: the impact of cognitive and social congruence on naloxone training

Background: Equipping future clinicians to recognize and reverse opioid overdoses requires experiential training and access to naloxone. Near-peer instruction may leverage cognitive and social congruence to enhance learning compared with traditional faculty-led models. This study evaluated whether near-peer teaching yields superior knowledge gains and attitudes in a naloxone training workshop. Methods: Preclinical medical students completed a 60-minute session comprising a high-fidelity inpatient opioid overdose simulation and hands-on naloxone administration practice. Immediately pre- and post-workshop, participants completed the Opioid Overdose Knowledge Scale (OOKS) and Opioid Overdose Attitudes Scale (OOAS). We compared near-peer–led versus faculty-led sessions using descriptive statistics and independent t-tests. Using an explanatory sequential design, 10 students completed semi-structured interviews exploring preferences for near-peer teaching. Interviews were transcribed and analyzed using grounded theory, applying the concepts of cognitive and social congruence as an analytical lens. Results: From 2019 to 2022, 537 students attended the workshop, and 288 students provided complete survey data. Near-peer facilitation was associated with higher OOKS scores (84.5% ± 0.09 vs 80.2% ± 0.10 correct; p < 0.001) and more favorable OOAS totals (105.5 ± 8.4 vs 102.4 ± 13.7; p = 0.02) compared with faculty-led sessions. Interviewees highlighted a shared knowledge framework, familiar language/explanations, and understanding of learning challenges. Additionally, interviewees noted informal communication, reduced anxiety, and interest in near-peer students’ experiences. Conclusion: A brief, near-peer–led overdose simulation and naloxone skills workshop was associated with an improvement in medical students’ knowledge and attitudes compared to faculty-led delivery. Integrating trained near-peer educators into preclinical curricula may accelerate acquisition of overdose recognition and response skills while promoting clinical readiness. Programs seeking scalable strategies to expand skill-based, practical competencies should consider near-peer models that benefit from students’ diverse prior experiences.