Abstract
BACKGROUND: Clinical reasoning is a fundamental skill for medical students, enabling them to integrate knowledge and make informed treatment decisions. While previous studies have primarily focused on diagnostic reasoning, this study examines the relationship between treatment-focused clinical reasoning, academic performance, and professional commitment. METHODS: A cross-sectional study was conducted with final-year medical students (n = 53). Clinical reasoning skills were assessed using a structured case-based evaluation involving diabetes mellitus and hypertension management scenarios. Professional commitment was measured using the commitment to the profession of medicine scale, and academic performance was determined by cumulative grade point average. Correlation and multiple regression analyses were conducted to examine relationships among these variables. RESULTS: The mean clinical reasoning score was 13.06 out of 54, indicating substantial challenges in treatment-based reasoning. Students performed better in the hypertension case (7.15/28) compared to the diabetes mellitus case (5.91/26). The most frequent difficulties included identifying hypoglycaemia-inducing drugs, recognizing contraindicated medications in renal impairment and heart failure, and selecting appropriate individualized therapies. While academic performance did not show a significant correlation with clinical reasoning scores (p > .05), a strong positive relationship was observed between professional commitment and clinical reasoning ability (r = .722, p < .05). Regression analysis indicated that both professional commitment and academic achievement significantly predicted clinical reasoning performance (R² = 0.560, p < .05), collectively explaining 56% of the variance. CONCLUSION: These findings highlight the need for enhancing treatment-based reasoning education in medical curricula, as students exhibited difficulties in pharmacotherapy decision-making, especially in integrating contraindications and individualized treatment considerations. Professional commitment appears to be a stronger predictor of clinical reasoning than academic performance alone. Medical education strategies that reinforce patient-centred reasoning and professional engagement may improve preparedness for real-world therapeutic decision-making.