Introduction <p>Small-group practice sessions facilitated by peer or faculty monitors are widely used in health professions education to support the integration of theoretical knowledge. However, evidence regarding the optimal organizational model for assigning practice monitors is limited. This study compared fixed versus rotating practice monitor systems in terms of knowledge acquisition and student satisfaction.</p> Methods <p>A prospective experimental study was conducted involving 198 medical students and 58 optometry students. Medical students were allocated to either a fixed or rotating practice monitor system and completed three formative Kahoot! based quizzes at 6 weeks, 4 weeks, and 2 days prior to the final examination. Optometry students experienced both systems, using fixed monitors in the first half of the course and a rotating system in the second half. Student satisfaction was assessed using an online survey in both degree programs.</p> Results <p>Medical students assigned to fixed practice monitors achieved significantly higher scores in the first two formative quizzes; however, no significant differences were observed in the final quiz or final examination results. Similarly, no significant differences in examination performance were found between practice monitor systems among optometry students. Student satisfaction ratings were comparable across both organizational models.</p> Conclusions <p>Fixed practice monitor systems may support more consistent early learning progress, but overall knowledge acquisition and academic performance did not differ between fixed and rotating models. These findings suggest that organizational flexibility in assigning practice monitors can be implemented without compromising learning outcomes, offering practical guidance for curriculum planning in health professions education.</p>