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This qualitative study investigated beginning medical students’ use of the Learning Issues process to determine what information they needed to diagnose medical cases. The aim was to assess students’ development of critical thinking, self-direction, and interpersonal competencies recommended in medical education (AAMC, 2016; Crosskerry, 2017). Data consist of audio recordings of 42 LI reports over an 8-week module. Analysis was conducted to determine how many LI’s contained peer-to-peer interactions; how sustained these interactions were; how often critical thinking was employed in the LI process; and the extent which participant roles underwent development. As students took control of the LI process there were substantial increases in numbers and length of peer-to-peer interactions, use of critical thinking, and role development.