Objective To investigate the effects of incorporating structured peer assessment into cardiopulmonary resuscitation (CPR) skill enhancement training on medical students' proficiency and long-term retention, and to explore the underlying cognitive mechanisms.

Methods Undergraduate students majoring in clinical medicine, Class of 2018, from the Second Clinical College of Wuhan University were enrolled and randomly divided into a control group (receiving teaching "demonstration-imitation-unidirectional assessment" instruction) and an intervention group (receiving structured peer assessment during practice sessions). Cognitive skills were evaluated using theoretical tests, and operational skills were assessed using standardized performance examinations. Measurements were conducted at three time points: baseline, immediately post-course, and 3 months post-course. The 2 groups were compared regarding magnitude of change in theoretical scores, immediate and delayed operational scores, and skill retention.

Results A total of 168 participants were enrolled, with 84 in each group. No statistically significant difference was observed between the 2 groups in CPR theoretical score improvement (P=0.664). However, at the 3 months delayed operational skills assessment, the median changes from baseline in the intervention and control groups were 1.00 (0.00, 1.00) and -2.00 (-5.00, -0.25), respectively, showing a statistically significant difference (P< 0.001), indicating that the intervention group demonstrated superior long-term skill retention.

Conclusion Integrating structured peer assessment into CPR skill enhancement training did not significantly affect short-term theoretical acquisition, but effectively mitigated skill decay and facilitated long-term retention and deep internalization of operational skills. The core mechanism of this approach lies in role reversal, which stimulates students' deep thinking and activates metacognitive monitoring. This model provides empirical evidence and a practical pathway for optimizing clinical skills teaching and addressing the challenge of skill attrition over time.

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