Purpose Pharmacology is distributed across organ-system courses and requires consolidation before clerkships. A prescribed sequence may not reflect individual needs. We developed a faculty-mentored, near-peer elective combining a common framework with learner choice over the timing, sequence, and repetition of review. This study evaluated two implementations aligned with the IAMSE theme of growth-oriented assessment, feedback, and learner development. Methods The elective was offered after first-year courses and before clerkships in 2024-2025 and 2025-2026. Near-peer educators cocreated materials with faculty oversight. A 5 Ws framework organized medications around who, what, where, when, and why they are used. Topics included low-stakes quizzes allowing repeated attempts toward an 80% threshold. The first cohort received staggered access; the second received open access, allowing learners to choose when, what, and how often to review. Outcomes included quiz performance, attempts, threshold attainment, and perceptions. Results Across cohorts, 1,640 student-topic quiz records were analyzed. Mean first-attempt scores were 80.1% with staggered access and 83.0% with open access. Mean best-attempt scores were 87.9% and 88.8%; 92.0% and 95.0% of records reached the 80% threshold. Surveys were completed by 154 and 88 learners. Agreement that materials were clearly organized increased from 53.2% to 93.2%. Confidence in determining when medications start and stop working remained the lowest-rated 5 Ws domain. Conclusion This elective combined structure with meaningful choice. Near-peer materials offered a common framework, while open access and repeatable quizzes allowed learners to use feedback to direct consolidation before clerkships. The design makes choice an intentional feature of growth-oriented assessment and learner development. Quiz performance does not establish durable learning, and cohort differences cannot be attributed solely to open access.