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Background  Collaborative reasoning occurs in clinical practice but is rarely developed during education. The computerized virtual patient (VP) cases allow for a stepwise exploration of cases and thus stimulate active learning. Peer settings during VP sessions are believed to have benefits in terms of reasoning but have received scant attention in the literature.    Objective  The objective of this study was to thoroughly investigate interactions during medical students’ clinical reasoning in two-party VP settings.    Methods  An in-depth exploration of students’ interactions in dyad settings of VP sessions was performed. For this purpose, two prerecorded VP sessions lasting 1 hour each were observed, transcribed in full, and analyzed. The transcriptions were analyzed using thematic analysis, and short clips from the videos were selected for subsequent analysis in relation to clinical reasoning and clinical aspects.    Results  Four categories of interactions were identified: (1)  task-related dialogue,  in which students negotiated a shared understanding of the task and strategies for information gathering; (2)  case-related insights and perspectives  were gained, and the students consolidated and applied preexisting biomedical knowledge into a clinical setting; (3)  clinical reasoning interactions  were made explicit. In these, hypotheses were followed up and clinical examples were used. The researchers observed interactions not only between students and the VP but also (4)  interactions with other resources,  such as textbooks. The interactions are discussed in relation to theories of clinical reasoning and peer learning.    Conclusions  The dyad VP setting is conducive to activities that promote analytic clinical reasoning. In this setting, components such as peer interaction, access to different resources, and reduced time constraints provided a productive situation in which the students pursued different lines of reasoning.

Increasing Reasoning Awareness: Video Analysis of Students’ Two-Party Virtual Patient Interactions