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Review sessions before examinations are an effective method to reduce anxiety and improve understanding of exam material in first-year undergraduate medical education (UGME). This study investigates the effectiveness of peer-assisted learning (PAL) for small-group preexam physiology review sessions led by second-year students (MS2) compared with faculty-led, large-group review sessions. In this study, the authors sought to combine both PAL and small-group approaches to complement the existing faculty-led physiology preexam review sessions to improve student mastery of the material, student perceptions of their education, and reduction of exam anxiety. In an ideal comparison, faculty-led, small-group sessions would be compared with PAL small-group sessions. Although faculty-led, small-group sessions are extremely effective, the cost and resources needed for hiring multiple faculty often make it difficult in practice. The authors detail conceptualization, implementation, and evaluation of a small-group format PAL tutorial session, which can be broadly applied throughout the medical curriculum. It is believed this is the first study that combines small-group learning with PAL and compares it to larger faculty-led review sessions in medical physiology education.