Table 1 Course description using the template for intervention description and replication (TIDieR)

Brief Name:

1. Therapy Decision Making Course for Medical Students

Why:

2. Therapy decision-making (TDM) is an essential medical skill. However, teaching therapeutic reasoning is challenging

What:

3. Materials: 12 Self-instruction modules with specific contents outlined in Table 2; 12 application videos; 4 60-min faculty symposia; and 4 90-min application seminars

4. Procedures: On a weekly basis, students read the materials on the self-instruction modules and apply their contents to patients they had seen during their clinical rotations. Every 3 weeks, students have a symposium with physicians from different specialties to share their therapy decision making experiences. The course instructor interviews them leaving opportunities for students to share their thoughts and reactions. After these symposia, students meet with preceptors to integrate the contents studied in their self-instruction modules. In these seminars, students follow a clinical case study and make therapy decisions discussing the contents previously reviewed

Who provided:

5. Self-instruction modules and application videos are individual activities. In the faculty symposia a myriad of faculty are interviewed by the course’s instructor, including internal medicine, palliative care, nutrition and diabetes, pediatrics, psychiatry, digestive surgery, orthopedic surgery, intensive care, and emergency medicine physicians. Faculty from different medical specialties, including endocrinology, family medicine, hematology, internal medicine, oncology, otolaryngology, rheumatology, guide application seminars. Students keep the same preceptor during all application seminars

How:

6. Self-instruction modules are posted online on a weekly basis. These modules use problem-based learning. Each module has two or three clinical vignettes that question the student´s knowledge about the module´s contents. Then, the week´s content (summarized in Table 2) is presented. Finally, the questions asked at the beginning of the module are answered, applying the module´s content to the clinical vignettes. In addition, students record weekly application videos that allow them integrating the course´s contents to their clinical experiences. Videos have a maximum duration of 10 min and have to be turned in electronically on the course´s portal. Faculty symposia are held at a large auditorium and all students are invited to attend. The course´s instructor has an interview guide that initiates the conversation. Guest faculty are invited to introduce the types of therapy decisions that they routinely face in their clinical practice, and then reflect on aspects affecting their decision-making processes. Once students begin asking questions and sharing reflections, the discussion is continued from there, focusing on the application of the course contents. At the end of each symposium, guest faculty were invited to give recommendations for comprehensive therapy decision-making. Throughout the session, the course´s instructor highlights the application of the course´s contents by the guest faculty. Application seminars are held in groups of 10–13 students. Students follow a clinical case with therapy questions. Students are asked to share their previous weeks’ learning and apply it to the case. Preceptors have a guide for the session with answers to the discussion questions. In addition, they are invited to share their personal experiences during the seminar focusing on how they apply the course´s contents in their daily clinical practice

Where:

7. To execute the course, we use the university´s online portal with capacity to store course materials and allow uploading the weekly application videos, a large auditorium for faculty symposia, and about 10 small rooms for application seminars

When and How Much:

8. The course is implemented annually during the first semester of the 4th year of Medical School (that has a total of 6 years). The course lasts 16 weeks and has a dedication of 5 h per week

Tailoring and Modifications:

9. Depending on the academic calendar, the order of the self-instruction modules is organized. In addition, after reviewing the student´s evaluation the course is adjusted according to the feedback received. For example, the clinical vignettes of the application seminars have been changed to specific diseases that are known for most students, so the discussion is focused on “how” a treatment is chosen rather than “what” treatment options exist and could be used. Recently, we have included gender perspectives throughout the course. In the application seminars, we have changed the language used, we have had a similar proportion of male and female vignettes. In addition, we have aimed to have a similar proportion of male and female guest faculty during faculty symposia and application seminar preceptors

How well planned and actually implemented:

10. All the courses are very organized, and most students receive a very similar intervention. The self-instruction modules are structured learning materials, and application videos have specific guidelines for students to reflect and apply the course materials. Faculty symposia are initially guided by an interview guide, but follow-up questions are unstructured. Application seminars have a common structure following a clinical case, but each preceptor could add personal reflections or adjust the application of contents according to their medical specialty or clinical experience