Purpose
Peer instruction (PI) is an evidence-based teaching strategy that promotes learning through peer discussion. Given the diversity of prior learning experiences among incoming medical students, it is crucial to emphasize the value of different teaching modalities. There are no universally accepted ‘onboarding’ procedures to prepare students for new teaching modalities. This project, grounded in a metacognition framework, addresses a significant gap in the literature by evaluating changes in incoming students' perceptions of PI before and after an interactive orientation session.

Methods
We developed a 1-hour informational session for incoming medical students, which defined PI, presented evidence of its efficacy, and included interactive demonstrations. A pre-session survey assessed students’ prior knowledge, perceptions, and expectations of PI. A post-session survey evaluated changes in perception of PI and student satisfaction with the session. Students reported perceived efficacy of teaching modalities and their comfort applying them on a 5-point Likert scale.

Results
105 students attended the PI orientation session and participated in pre- and post-session surveys. Most students had not heard of PI (64%, n=67/105), despite 96% (n=101/105) of students experiencing some form of active learning in their prior education. Post-session, students were more likely to choose the top Likert option for each question. Students felt that active learning strategies were effective (+20pp), particularly PI (+27pp). The intervention increased confidence in applying new modalities (+12pp) and discussing in-class questions (12pp). Students reported high satisfaction with the session, increased perceived effectiveness of PI, and more comfort in discussing questions with peers following the intervention.

Conclusion
Our data demonstrate that PI is unfamiliar to most of our incoming medical students. We found that a newly implemented interactive orientation session was effective in demonstrating the value and efficacy of PI to students. Institutions undergoing curricular change or using active learning modalities may find similar interventions beneficial for encouraging student preparedness and success.