Fellows and medical students as tutors: Facilitating beginning medical students' clinical reasoning abilities

Clinical reasoning (CR) is a foundational ability for medical students, requiring the integration of analytical and non-analytical (intuitive) approaches. While expert performing clinicians often struggle to articulate their CR, near-peer teaching (NPT) offers a promising approach to facilitate CR development. This study explores how NPT supports beginning medical students in learning CR through small group discussions.

This study was conducted in a U.S. medical school and included four small group discussions led by senior medical students with faculty support or fellows. Video recordings of the discussions were transcribed and analyzed at both entire conversation and episode levels. A combination of thematic analysis and lag-sequential analysis (LSA) was used to identify tutors' discourse moves, sequential patterns, and unique facilitation strategies.

Near-peer tutors employed four key strategies: modeling reasoning processes, preparing students for real-world clinical interactions, sharing test-taking strategies, and creating a conducive learning environment through humility. Sequential patterns revealed that tutors used strategic questioning to scaffold students' diagnostic reasoning, guiding them from basic orientation to complex evaluation. Tutors' relatability, rooted in recent learning experiences, enhanced student engagement and understanding.

To maximize NPT's potential, medical schools should provide targeted professional development and consider co-facilitation with faculty to balance relatability and content expertise.