Clinical reasoning is a core competency in medical practice; however, deficits in this domain among residents are often difficult to identify and remediate because of its cognitive complexity and the absence of standardized assessment approaches. This scoping review aimed to map and analyze existing evidence on strategies to remediate clinical reasoning skill deficits in underperforming medical residents. Using the Arksey and O’Malley framework as refined by Levac and his colleagues, and reported in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we systematically searched PubMed, Scopus, MEDLINE, Web of Science, SpringerLink, ProQuest, and EBSCOhost for studies published between 2000 and 2024. Definitions of clinical reasoning, underperformance, and remediation were adopted from prior literature. Twenty studies met the inclusion criteria, comprising original research and literature reviews in multiple medical specialties. Methods for identifying clinical reasoning deficits included written, oral, and performance-based assessments, as well as routine workplace-based evaluations. Remediation strategies ranged from structured institutional programs to individualized, case-specific interventions, with coaching, deliberate practice, guided reflection, and structured thinking frameworks frequently employed. Two studies reported positive outcomes following completion of remediation for clinical reasoning deficits. Key enablers included psychological safety, learner engagement, and accessible faculty support, whereas barriers included learner resistance, inadequate baseline knowledge, faculty skill limitations, and institutional resource constraints. Effective remediation requires early identification, comprehensive diagnostic assessment, and tailored, coaching-based interventions supported by institutional commitment. Nonetheless, substantial variability in definitions, remediation protocols, and evaluation methods highlights the need for greater standardization and further research across diverse contexts to inform evidence-based frameworks for clinical reasoning remediation.

Delayed cerebral ischemia (DCI) remains a devastating complication in subarachnoid hemorrhage (SAH), however, there were no present reports that is associated with a ruptured spinal arteriovenous fistula (sAVF). We would like to present a rare case of DCI following embolization of a ruptured perimedullary sAVF. Initially, the patient clinical symptoms mimic a SAH caused by a ruptured intracranial aneurysm. Further evaluation revealed that the SAH was caused by a ruptured perimedullary sAVF and the patient’s condition improved following the embolization procedure. Three days later, the patient developed an acute left-sided facial and motor weakness, which persisted until the patient was discharged on the day-15 onset. A magnetic resonance imaging and angiography is performed 1.5 years after discharge and revealed no signs of cerebral infarction and hemorrhage. In this paper, we reported DCI after embolization in a ruptured sAVF with SAH, supported by evidence from the current literature. We would like to also stress the importance of complete spinal and cerebral vessel imaging to reveal the underlying abnormalities and determine the most appropriate intervention.

PURPOSE: To compare the outcome of two different curriculum in clinical pathology using students' retention capacity. METHODS: A cross-sectional study was conducted in December 2017. There were two groups of students enrolled in clinical pathology course. A retention test therefore was conducted 5 months after the course had finished using 25 multiple choice questions-single best answer. Comparisons of means are determined by Mann-Whitney U-test using SPSS version 23.0 (IBM Corp., Armonk, USA). RESULTS: A total of 280 students participated in the study of a 5-month post-course evaluation, and the average for the first group (n=138) is 10.93±3.57 while the second group (n=142) average is 8.56±3.19. The difference between the first and the second group are statistically significant (p<0.00001). CONCLUSION: The group with longer duration and more number of parallel courses had a higher retention score. Further research using retention test in different courses should be conducted to analyze which curriculum that promotes students' understanding of medical knowledge.
Cross-Sectional Studies ; Curriculum ; Education, Medical ; Humans ; Indonesia ; Pathology, Clinical

PURPOSE: To compare the outcome of two different curriculum in clinical pathology using students' retention capacity. METHODS: A cross-sectional study was conducted in December 2017. There were two groups of students enrolled in clinical pathology course. A retention test therefore was conducted 5 months after the course had finished using 25 multiple choice questions-single best answer. Comparisons of means are determined by Mann-Whitney U-test using SPSS version 23.0 (IBM Corp., Armonk, USA). RESULTS: A total of 280 students participated in the study of a 5-month post-course evaluation, and the average for the first group (n=138) is 10.93±3.57 while the second group (n=142) average is 8.56±3.19. The difference between the first and the second group are statistically significant (p<0.00001). CONCLUSION The group with longer duration and more number of parallel courses had a higher retention score. Further research using retention test in different courses should be conducted to analyze which curriculum that promotes students' understanding of medical knowledge.