Background: Clinical reasoning is a core competency in medical practice, yet its development in resource-constrained settings is not well understood. This study evaluated the clinical reasoning skills of medical students at Zahedan University of Medical Sciences using the Diagnostic Thinking Inventory (DTI) to identify key patterns and disparities.
Methods: This cross-sectional study involved 330 clinical medical students (172 clerks and 158 interns) from the 2021-2022 academic year. Participants completed the validated DTI questionnaire, which assesses two domains: Flexibility in Thinking and Memory Structure. Descriptive statistics, independent t-tests, and Pearson correlations were used to analyze associations between reasoning scores and demographic/training variables.
Results: Male students significantly outperformed females across all DTI domains (p < 0.001), with the largest difference observed in Flexibility scores (51.82 vs. 44.14). Single students scored higher than married peers (Total DTI: 106.97 vs. 94.65, p < 0.001). Interns showed marginally higher but non-significant scores compared to clerks (104.57 vs. 102.96, p = 0.506). Weak but significant positive correlations emerged between age and Memory Structure (r = 0.176, p = 0.001) and between academic term progression and Flexibility (r = 0.267, p = 0.001).
Conclusion: The study identifies significant demographic disparities in clinical reasoning skills and limited progression during clinical training. These findings highlight the need for curriculum reforms that explicitly teach reasoning strategies, promote equity in learning opportunities, and integrate evidence-based educational interventions. Future research should employ longitudinal designs to better understand the developmental trajectory of clinical reasoning competence.