Purpose
Clinical reasoning, a cornerstone of medical education, is systematically introduced to medical students (MS1s) during the pre-clerkship curriculum. As a multi-dimensional, complex construct, faculty encounter numerous obstacles in preparing students. Exercises primarily focus on integrating foundational sciences and physical exam skills to train students in the intrinsic work-up required for systematic diagnostic reasoning. This study aims to determine how to effectively introduce clinical reasoning to enhance diagnostic accuracy in MS1s.

Methods
Biweekly small-group sessions with 8-10 MS1s reviewed clinical cases using the Think-Pair-Share (TPS) approach, facilitated by clinical instructors. Faculty, emphasized developing students' proficiency in interview techniques and physical exam skills. The effectiveness of these small-group case exercises combined with TPS activities was evaluated as a supplement to a core practice of medicine course.

Results
Post-session assessments revealed significant improvements in MS1s’ baseline understanding of clinical reasoning. Additional outcomes included enhanced awareness of primary care diagnostic frameworks and increased engagement with the learning process essential for medical practice.

Conclusion
Combining case-based learning with TPS strategies shows promise for teaching clinical reasoning. Clerkship faculty observed increased student confidence and improved interview and clinical skills. Greater peer collaboration emerged during the program, though variability in student performance persisted due to differences in preparation and engagement. The integrated case and TPS exercise offers a structured and engaging method for teaching clinical reasoning effectively to MS1s. This approach may also be generalizable to enhance clinical reasoning instruction at other medical schools.