Near-Peer Transition for Otolaryngology Emergency On-Call Practice: A Mixed-Methods Pilot Evaluation

Background/Objectives: Transitioning junior residents from supervised training to independent emergency on-call practice is a high-stakes stage of postgraduate workforce development. In otolaryngology, this requires rapid clinical judgment, procedural competence, and timely escalation. We evaluated a workplace-embedded Near-Peer Transition Program (NPTP) designed to support progression toward independent emergency duty. Methods: We conducted a single-center, uncontrolled convergent mixed-methods pilot evaluation. The NPTP combined pre-duty workshops with a one-month transition phase in which 10 junior residents were paired with five senior residents during emergency on-call shifts, progressing from observation to assisted and supervised performance. Evaluation included paired junior-resident pre–post surveys, senior-resident and faculty surveys, retrospective faculty readiness ratings, and semi-structured interviews. Results: Twenty participants completed the evaluation (10 junior residents, five senior residents, and five faculty members). Junior residents’ self-rated overall preparedness increased from 3.0 ± 1.15 to 3.8 ± 0.92 on a five-point scale. Exploratory item-level analyses suggested higher perceived readiness in several clinical domains. Senior residents reported perceived improvements in junior performance and benefits to their own teaching and leadership, with low perceived additional workload. Faculty reported favorable perceptions of safety and feasibility; 86% of individual faculty readiness ratings were ≥4 on a five-point scale. Qualitative feedback highlighted progressive confidence building, an enhanced safety net, and reciprocal learning. Conclusions: This small pilot supports the feasibility and perceived educational value of the workplace-embedded NPTP. Graded near-peer supervision may provide a practical workforce development strategy bridging simulation-based preparation and autonomous practice in high-acuity settings. Larger comparative studies are needed to establish effectiveness.