Background: Senior residents are essential to ward team education and supervision, yet heavy clinical demands often limit opportunities to deliberately practice teaching and leadership skills. Meanwhile, early PGY-2 residents face the abrupt transition from intern to supervising resident, requiring rapid adaptation to new responsibilities in team leadership, clinical oversight, and teaching.
Purpose: Near-peer teaching—where advanced trainees instruct those just behind them—benefits both learners and teachers by reinforcing knowledge, improving confidence, and fostering engagement. To address these complementary needs, the PEARL (Peer Education and Resident Leadership) rotation was developed within a large academic internal medicine residency program. The rotation designates a PGY-3 resident as a dedicated teaching senior without direct clinical responsibilities, providing protected time to refine teaching strategies, strengthen knowledge, and practice independent decision-making, while supporting PGY-2 residents’ transition and enhancing education for the entire team.
Description: The PEARL rotation was implemented during the first four months of the 2025–2026 academic year. Each two-week inpatient ward block included two supervising residents (one PGY-3, one PGY-2) and two interns, replacing the traditional single-senior model. Every PGY-3 and PGY-2 participated during this period.PGY-3 responsibilities included providing near-peer teaching during rounds and chalk talks, mentoring PGY-2s, observing and giving feedback to interns and students, and periodically serving as the “attending” on rounds to practice independent decision-making. Weekly sessions with a clinician educator reinforced teaching and feedback techniques.Program impact was evaluated through pre- and post-rotation surveys using a 1–5 scale. PGY-3 surveys assessed confidence in teaching; PGY-2 and PGY-1 surveys evaluated the educational impact of having a PGY-3 teaching senior. These correspond to Level 1 of the Kirkpatrick framework (learner reactions and self-reported outcomes).
Conclusions: To date, 27 PGY-3s, 23 PGY-2s, and 30 PGY-1s have participated. PGY-3s reported increased confidence in teaching (3.7/5 to 4.6/5) and in observing/providing feedback (3.7/5 to 4.4/5). PGY-2s agreed that the presence of a PGY-3 improved their learning (4.4/5) and eased their transition to the senior role (4.4/5) without diminishing leadership opportunities (4.2/5). PGY-1s rated their learning experience highly (4.8/5).Qualitative feedback highlighted that PGY-3s valued the chance to act as attending on rounds, engage in self-directed learning, and receive structured teaching didactics. PGY-2s and PGY-1s appreciated the additional guidance and structured learning provided by the PGY-3, especially when clinical demands limited direct teaching time from the supervising resident.The PEARL rotation enhanced education and professional development across all levels. PGY-3s gained protected time to strengthen teaching and leadership; PGY-2s benefited from mentorship and improved confidence in their new supervisory roles; and PGY-1s enjoyed greater educational support.Overall, the PEARL rotation offers a sustainable, replicable model for residency programs aiming to promote near-peer education, leadership development, and smoother transitions to independent clinical practice.