Introduction
Near-peer teaching (NPT) offers a promising approach to teaching high-yield content within a more cognitively aligned learning environment, but its effectiveness in undergraduate medical education remains understudied. This study evaluates the impact of faculty-guided NPT on second-year medical students' performance and perceptions in a web-based, asynchronous pharmacology elective.

Methods
The elective included 35 video lectures (21 hours) on high-yield pharmacology topics, offered on Blackboard one month before a major milestone exam. The course director mentored twelve senior medical students in using Gagne's framework for standardized content creation and developed the assessments. Of the 157 enrolled second-year medical students, (N=154; 98%) completed the required quizzes, and end-of-course survey, which were analyzed to assess performance, and perceived knowledge growth in 5 key pharmacology skills.

Results
Most students (N=108; 70%) chose to complete the Hematology, Neurology, Cardiovascular, Endocrine, and Antimicrobials quizzes, indicating these are core topics. The Hematology Quiz had several perfect scores (N=34; 22%), while the Renal Quiz was more challenging (N=4; 3%), indicating a need for additional support. Students agreed lectures were clear and well-organized (N=147; 95%). Most (N=142; 92%) agreed the videos covered high-yield, exam-relevant points. Compared to faculty-led lectures, (N=91; 59%) found them more engaging and relevant, and (N=86; 56%) felt the elective was more effective than previous first-year courses. High confidence was reported for pharmacology skills like knowing "What the drug does" (N=148; 96%), "Why certain drugs are appropriate" (N=133; 86%), "Where the drug can be administered" (N=109; 70%), and "Who can take the drug" (N=106; 68%). Confidence was lower for "When the drug starts and stops working” (N=71; 46%).

Conclusion
Near-peer teaching is valuable in pharmacology education when combined with well-structured preparation, faculty mentoring, and a focus on exam-relevant content. Integrating NPT with established learning frameworks may provide a scalable strategy to develop near-peer teaching skills and improve outcomes of complex subjects like pharmacology.