OBJECTIVE: PEER-ASSISTED LEARNING HAS BEEN REGARDED AS AN ADJUNCT TO TEACHING MODALITIES. IT REMAINS INCONCLUSIVE REGARDING THE BENEFITS OF PEER OBSERVATION IN SKILLS LEARNING. HENCE, WE INVESTIGATED WHETHER THE ACTIVE ENGAGEMENT (AE) OF PEER OBSERVATION IN ADDITION TO EXPERT DEMONSTRATION WOULD FACILITATE THE PERFORMANCE IN THE VIRTUAL REALITY (VR) TASKS. SETTING/DESIGN: THE PROGRAMS INVOLVED 4 VR TASKS INCLUDING BASIC (CAMERA TARGETING), INTERMEDIATE (ENERGY DISSECTION AND ENERGY SWITCHING), AND ADVANCED (SUTURE SPONGE) TASKS IN THE DA VINCI SKILLS SIMULATORS, WHICH WERE SET UP IN THE OPERATING ROOM AT TAIPEI MEDICAL UNIVERSITY HOSPITAL. FIFTY MEDICAL STUDENTS PARTICIPATED IN THE STUDY. THE AE OF THE PARTICIPANTS WAS DEFINED AS THE TOTAL NUMBER OF PEER OBSERVATIONS IN ADDITION TO EXPERT OBSERVATION BEFORE THEIR PERFORMANCE. WE ASSESSED THE CORRELATIONS BETWEEN AE AND SURGICAL TASK PERFORMANCE USING PEARSON CORRELATION AND THE CONCEPT OF LEARNING ANALYTICS. PARTICIPANTS: MEDICAL STUDENTS (SIXTH-YEAR STUDENTS IN TAIWAN, EQUIVALENT TO FOURTH-YEAR STUDENTS IN THE US SYSTEM) FROM TAIPEI MEDICAL UNIVERSITY WERE RECRUITED. RESULTS: AE WAS CORRELATED WITH THE ENERGY DISSECTION TASK (R = 0.329, P = 0.02) AND MARGINALLY ASSOCIATED WITH THE ENERGY SWITCHING TASK (R = 0.271, P = 0.057). HOWEVER, AE WAS NOT CORRELATED WITH EITHER TASK SCORES FOR CAMERA TARGETING (R = 0.096, P = 0.509) OR TASK SCORES FOR SUTURE SPONGE (R = 0.091, P = 0.529). CONCLUSIONS: OUR FINDINGS SUGGEST THAT AE OF PEER OBSERVATION MAY FACILITATE LEARNING ENERGY DISSECTION TASK, WHICH IS AN INTERMEDIATE-LEVEL TASK, BUT NOT IN OTHER BASIC OR ADVANCED TASKS IN A VR CONTEXT. THE STUDY HIGHLIGHTS THE POTENTIAL EFFECT OF AE OF PEER OBSERVATION ON SURGICAL LEARNING BASED ON A DISTINCT LEVEL OF TASKS. TASKS THAT FIT THE LEARNERS' LEVEL ARE RECOMMENDED. NEVERTHELESS, THE EFFECTIVENESS OF PEER OBSERVATION ON SURGICAL TRAINING STILL HAS TO BE EXPLORED TO ENSURE FAVORABLE RESULTS AND OPTIMAL LEARNING OUTCOMES. ((C) 2019 ASSOCIATION OF PROGRAM DIRECTORS IN SURGERY. PUBLISHED BY ELSEVIER INC. ALL RIGHTS RESERVED.)