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Background and aims: Aim of the study is to exploit obstacles that peer-student tutors (PST) in medical education face. Existing studies outline experience of students becoming PST, benefits for PST in peer-assisted learning (PAL) settings and chances for PAL-tutors in medical education to develop a professional identity. Still, there is a blind spot regarding the PSTs’ challenges. Those keep the potential of PAL-settings lower than necessary and offer unexploited opportunities for targeted assistance of PST in their professional development by the faculty. Targeted support would not only assist PST, but would lead to higher qualities of small-group skills trainings and better learning outcomes for students. The leading research question explores the challenges PST face in medical education. Furthermore, the students’ own solution strategies are investigated and implications for effective institutional support are concluded.

Methodology: 28 semi-structured written self-reflections by peer-student tutors involved in small group training sessions for health professions students have been analyzed qualitatively using reflexive thematic analysis [1]. The PST were medical (24), dental (2) or pharmacy (2) students from 3^rd to 9^th semester – most of them (16) in their 5^th semester. After a didactic course – for PST involved in simulation-based skills training – they handed in a self-reflection on one of their sessions, focusing on challenges.

Summary of results: Four overarching themes (T) were developed: “Dealing with different perspectives on course content” (T1), “Doubts about own sufficiency” (T2), “Demand to support every participant equally” (T3) and “Dealing with time” (T4). Peer-student tutors need tools to cope with perspectives from practice that do not stick to learning objectives (T1). The PST also give courses for students that were more advanced than themselves, leading to uncertainty about how to identify own knowledge gaps (T2). Wanting to be fair in distribution of attention for individual participants, PST need to gain tools to progress in these skills (T3). PST wished to obtain tools to coordinate and structure their courses with the aim to avoid running out of time (T4).

Discussion: This study highlights the need of effective, pedagogical and organizational support for PST to develop qualities in teaching. Developing further qualification steps to achieve the goal of competent PST focusing on the results of this study are in progress.

Take home message: Peer-student tutors need comprehensive support structures to develop their teaching skills in medical education.

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