Complicated technical skills can be adequately taught to students using the PAL system by STs with limited training. Self-teaching learning strategies are successful in contexts of limited teacher training. However, despite positive objective results, STs still face prejudice from students with regard to competency.

Purpose To assess the use of peer-assisted learning (PAL) of complex manipulative motor skills with respect to gender in medical students. Methods In 2007-2010, 292 students in their 3rd and 4th years of medical school were randomly assigned to two groups [Staff group (SG), PAL group (PG)] led by either staff tutors or student-teachers (ST). The students were taught bimanual practical and diagnostic skills (course education module of eight separate lessons) as well as a general introduction to the theory of spinal manipulative therapy. In addition to qualitative data collection (Likert scale), evaluation was performed using a multiple-choice questionnaire in addition to an objective structured clinical examination (OSCE). Results Complex motor skills as well as palpatory diagnostic competencies could in fact be better taught through professionals than through ST (manipulative OSCE grades/ diagnostic OSCE score; SG vs. PG; male: P = 0.017/ P \ 0.001, female: P \ 0.001/P \ 0.001). The registration of theoretical knowledge showed equal results in students taught by staff or ST. In both teaching groups (SG: n = 147, PG: n = 145), no significant differences were observed between male and female students in matters of manipulative skills or theoretical knowledge. Diagnostic competencies were better in females than in males in the staff group (P = 0.041) Overall, students were more satisfied with the environment provided by professional teachers than by ST, though male students regarded the PAL system more suspiciously than their female counterparts. Conclusions The peer-assisted learning system does not seem to be generally qualified to transfer such complex spatiotemporal demands as spinal manipulative procedures.

It seems that there is great interest in the fields of orthopaedic trauma among both female and male students in the middle portion of their studies. Women, especially, tend to prefer a specialisation in this operative field early in the course of their studies. However, this pool of potential successors decreases dramatically with time, due to personal experiences garnered on the wards, expectations regarding career paths (male-dominated, long hours) as well as concerns about family planning. The most dramatic shift seems to occur during the practical year.

Although deficits in theoretical knowledge cannot be compensated for, basic MSUS content appears to be adequately transferable to students with limited anatomic knowledge. Thus, an early implementation of MSUS during medical school education would be prudent, provided that the training is performed by an experienced MSUS operator.