Despite well-documented benefits, the effectiveness of some aspects of near-peer (NP) teaching in medical education within anatomy curricula remains unclear. Here, we explored the impact of various permutations of staff/student laboratory-based co-teaching in neuroanatomy by determining the optimal staff and student teaching combination. We assessed student perceptions and knowledge acquisition using three different co-teaching strategies. Second-year medical students at the University of Southampton were co-taught neuroanatomy by faculty staff and third-year medical students (NP teachers). Three cohorts, 2016/2017, 2017/2018, and 2018/2019, were included in the study. Subsequent cohorts experienced increasingly structured NP teaching with more NP teachers. Students completed evaluations for anatomy sessions, which were statistically compared. The 2017/2018 and 2018/2019 cohorts completed lunchtime quizzes matched to the learning outcomes of each practical session, which were analysed. A focus group involving six students was transcribed and thematically analysed. Anatomy practical ratings were significantly higher when both session structure and NP teacher numbers increased from 3 to 5–6 (p = 0.0010) and from 3 to 7–8 (p = 0.0020). There were no significant differences in anatomy practical ratings using 5–6 and 7–8 NP teachers (p > 0.9999). There were no significant differences between the knowledge scores of students who experienced 5–6 and 7–8 NP teachers. Themes detailing the benefits of NP teaching and the importance of faculty involvement were identified, demonstrating that students appreciated NP teaching within a co-teaching environment. Therefore, increased NP teaching may augment students’ perceptions and knowledge acquisition. In this context, the optimal number of NP teachers may sit between 5 and 8.

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