Presented By: Madisen Swallow, Yale School of Medicine
Co-Authors: August Allocco, Yale School of Medicine
Ryan Bahar, Yale School of Medicine
Marina Gaeta Gazzola, New York University Langone Medical Center
Guneet Janda, Yale School of Medicine
Darius Mostaghimi, Yale School of Medicine
Divya Ramakrishnan, Yale School of Medicine
Jack Tang, Yale School of Medicine
Tho Tran, Yale School of Medicine
Thilan Wijesekera, Yale School of Medicine

Purpose
Although student feedback is frequently utilized for course improvement, there are few reports of medical student leadership of didactic courses, particularly in clinical reasoning. We developed a novel strategy to increase curricular content, engage students, and provide professional development opportunities through selecting students as associate clinical reasoning course directors (ACDs).

Methods
Since June 2020, 18 students have been selected for the ACD role. ACDs are students in their third or fourth years selected based on their interest in clinical reasoning and background in education for a mutually renewable one-year term by the faculty course director (T.P.W). ACDs have had a range of clinical interests, including internal medicine, emergency medicine, diagnostic radiology, OB/GYN, surgery, pediatrics, dermatology, and anesthesiology. ACDs lead creation of course activities, facilitate didactic sessions for peers and faculty, and provide feedback during curricular development.

Results 
ACDs contributed to the design, development, and facilitation of over 90 hours of new clinical reasoning education reaching over 550 medical students and 250 faculty. Medical student activities included creation of a virtual concept-mapping tool, eight additional didactics, and 22 additional workshops (different types of clinical problem-solving exercises). Faculty development sessions included 16 highly-rated workshops on teaching clinical reasoning, wherein student participation was rated a valuable feature. Satisfaction was high among ACDs, and non-graduating ACDs chose to stay in the role for the subsequent year.

Conclusions 
To our knowledge, this is the first example of student leadership in a medical school clinical reasoning course. It is beneficial to recruit students into leadership roles for clinical reasoning education, in which they offer unique expertise and perspectives as near-peers. Limitations include a small sample size at a single institution. Given the potential to significantly expand student leadership in didactic education, this model can and should be adopted into other courses and institutions.