Peer Review Report For: Team-Based Analysis for Critical Thinking in Clinical Cases (TACTIC): Development of a new innovative method for teaching clinical reasoning [version 1; peer review: 1 approved with reservations]

Background Clinical reasoning is a core competency in undergraduate medical education, yet many instructional approaches do not fully address its cognitive complexity in a structured or scalable way. Team-Based Analysis for Critical Thinking in Clinical Cases (TACTIC) is a stepwise novel method that mirrors real-world diagnostic reasoning through iterative, team-based engagement with authentic clinical scenarios. This study describes the development of TACTIC using formal consensus methods. Methods We employed a modified Delphi followed by a nominal group technique to reach consensus on the concrete steps for implementing TACTIC. Eight faculty implementers participated in three rounds. Participants rated the importance of proposed steps on a 5-point scale. We summarized central tendency and dispersion (mean, SD; median, IQR) and calculated item-level content validity indices (I-CVI) and the scale-level average (S-CVI/Ave) using a ≥4 (agree) threshold. Results Consensus produced five clearly defined steps for TACTIC. Agreement was high across raters, reflected by high means and medians with low SDs and IQRs. Content validity was excellent: I-CVI for all steps was 1.00 and S-CVI/Ave was 1.00, indicating unanimous endorsement of the finalized steps. Conclusion TACTIC offers a structured, consensus-derived approach to teaching clinical reasoning that is feasible and initially well-received. While resource-intensive, its fidelity and scalability can be enhanced through facilitator training, hybrid/digital delivery (e.g., breakout rooms, simulated-patient substitutes), and selective use of AI for feedback and case branching. TACTIC has the potential to bridge the gap between traditional instruction and the intricate cognitive demands of diagnostic reasoning.