The document discusses using electronic voting or "clickers" to improve clinical reasoning skills in large medical school lecture groups. It describes a pilot project between two Dutch universities that implemented clickers to present clinical cases to 350 students at a time. Students would use clickers to vote on diagnostic and treatment decisions. Professors could then see voting results in real-time and guide discussion. The goals were to practice more clinical reasoning cases each year with less professors, provide immediate feedback, and evaluate students' reasoning skills. Initial pilot results found that students and professors felt clickers were an engaging supplement to traditional small group learning.