Arm intervention group:

Participants in the peer-learning intervention group will complete a structured educational program focused on acquiring urinary catheterization skills.

The intervention includes:

• (1) Self-Learning Preparation: Prior to the in-person session, participants will engage in general self-learning preparation (pre-briefing), completed independently outside the simulation center.
• A two-hour in-person (2) Didactic Session will be dedicated to theoretical instruction and demonstration of urinary catheterization by a practical lecturer (ten minutes) and a peer-Guided Practice. Here, Students divided into pairs, will use a comprehensive guide for self-training and practice the procedural skills. This peer-supported practice allows for repeated attempts and immediate feedback. During the didactic session, participants are encouraged to practice as many times as necessary to achieve proficiency. Finally, and after peer-training, each participant's mastery of the skill w

Arm control group:

Participants in the control group will complete a structured educational program focused on acquiring urinary catheterization skills using traditional teaching methods, guided by a practical lecturer.

The control group intervention includes: (1) Self-Learning Preparation: Prior to the in-person session, participants will engage in general self-learning preparation (pre-briefing), completed independently outside the simulation center. (2) Didactic Session: A two-hour in-person class dedicated to theoretical instruction and demonstration of urinary catheterization. A practical lecturer will demonstrate the procedure (20 minutes). There, students will individually practice the procedural skills, supported by the practical lecturer. This allows for repeated attempts and immediate feedback directly from the lecturer. (3) After completing their training, each participant's mastery of the skill will be formally evaluated by a qualified teacher.

Peer learning, also known as peer-to-peer learning, is a collaborative educational strategy where students actively learn from one another. It involves interaction among peers to share knowledge, solve problems, and develop skills. This methodology can take various forms, from peer tutoring, where a more advanced student assists a less experienced one, to study groups where everyone contributes equally. The process fosters critical thinking, effective communication, and the co-construction of knowledge. By explaining concepts to others or discussing ideas, students solidify their own understanding and discover new perspectives. Moreover, it promotes individual and collective responsibility, as each participant plays an active role in their own learning and that of their peers. This approach not only improves academic performance but also develops crucial social and emotional skills, such as empathy, patience, and the ability to collaborate, preparing students for more cooperative work

Each student's baseline knowledge will be assessed before participating in the Internship Experience (IE) Urinary catheterization. To do this, each student will complete an exam covering the content provided in the IE preparatory documentation (delivered via vitual educative platform, ADI) and from the lecture given to the entire class by a professor from the Practical Teaching Unit. The questionnaire, a multiple-choice test designed ad hoc by the researchers, will consist of 10 questions with four response options. Incorrect answers will not be penalized. The total possible score is 10 points. To prevent students from sharing exam content and to make memorization difficult, a bank of 30 questions has been created, from which different versions of the knowledge exam will be generated.

To measure the self-efficay with technical skills, the Learning Self-efficacy Scale for clinical skills (L-SES) was used. Developed by Kang et al. (2019), is a measurement instrument designed to understand the relationship between student self-efficacy and the practice of technical skills. This scale was developed under the framework of Bloom's Taxonomy and has been rigorously tested and validated in medical students. It demonstrated appropriate content validity indices (I-CVI = 0.88-1) and reliability (Cronbach's alpha of 0.931). Furthermore, results indicated that L-SES scores were not affected by gender (t = -0.049; 95% confidence interval [-,115; 0,109], p > 0.05). The L-SES comprises twelve items grouped into three distinct domains: cognitive, affective, and psychomotor. Responses are captured using a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree).

The Learning Engagement Survey, developed by members of the Foundation for the Improvement of Postsecondary Education (U.S. Department of Education, 2003) is designed to measure students' self-perceived engagement with their learning during class. This survey consists of eight items grouped into two domains: Participation and Enjoyment. Responses are collected using a 5-point Likert scale (1 = strongly disagree; 2 = disagree; 3 = neither disagree nor agree; 4 = agree; 5 = strongly agree). The survey has demonstrated adequate validity and reliability, with an overall Cronbach's alpha of 0.881. The two subscales, Participation (five items) and Enjoyment (three items), yielded respective Cronbach's alpha values of 0.807 and 0.873 (Menenga et al., 2013).

To measure satisfaction, the General Satisfaction Survey with the Educational Activity, adapted from Hoseini et al. (2013) was used to collect information on student satisfaction with the training activity. This survey consists of 10 general satisfaction questions. Responses will be recorded using a 5-point Likert scale (1 = strongly disagree; 2 = disagree; 3 = neither disagree nor agree; 4 = agree; 5 = strongly agree).