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Background: Despite its crucial importance for physicians, the implementation of diagnostic reasoning (DR) into undergraduate medical education is challenging due to its inherent complexity. Student-led, case-based group learning formats (e.g. [1]) offer promising approaches to support curricular DR integration. At the individual level, the deliberate reflection (DelRef) technique [2] was developed to foster essential DR skills such as differential diagnosis generation, feature evaluation, consideration of absent findings, and focused history-taking. Our aim was to combine these approaches by systematically integrating DelRef into a peer-based DR training format, developing a prototype and evaluating it.

Methods: In September 2024, five medical students and three faculty members co-designed a peer tutoring program for DR. The process involved reviewing case-based learning literature and systematic study of DelRef research. Through iterative discussions, the DelRef approach was adapted to a course setting and three distinct peer-tutor roles (consultant, moderator, case expert) were defined. The format was implemented in five 90-minute sessions from November to December 2024, targeting students in their sixth to tenth semesters. Feedback of tutors and participants was obtained through feedback forms and open discussion and its content analyzed.

Results: The peer-teaching format was piloted with 12 intermediate and advanced medical students and three tutors. The tutors highlighted DelRef’s value in developing DR skills through peer teaching. They reported that students focused on differential diagnosis during history-taking and were able to identify the most likely diagnosis and consider expected but absent findings. With an optimal group size of 6-9 participants, we found one or two tutors to be sufficient. Participants expressed high satisfaction and requested more such formats. The model will be integrated into the elective curriculum for the upcoming academic year, with additional peer tutors in training.

Discussion: Our work demonstrates that integrating DelRef into peer-led case-based learning is feasible and valued by students. Key factors for success include structured reflection and optimal group sizes. The impact on DR skills will be assessed in future iterations. DelRef offers a valuable framework for designing interactive, case-based peer teaching for DR training.

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