*Result*: Impact of problem-based learning on the development of clinical reasoning skills in esophageal cancer teaching.

*The complexity of diagnostic and therapeutic decision-making in esophageal cancer underscores the need for effective teaching strategies to enhance clinical reasoning skills. This study evaluated the association of a problem-based learning (PBL) approach with clinical reasoning ability, theoretical knowledge acquisition, and learning perceptions among medical interns. In this retrospective study, 132 medical interns completing thoracic surgery rotations were included. A control group (n = 64) taught via conventional lectures was compared to an observation group (n = 68) instructed using structured PBL modules. Baseline comparability was confirmed. Outcomes included standardized assessments of clinical reasoning performance, diagnostic accuracy, differential diagnosis formulation, and case presentation quality. Theoretical knowledge was tested via written examinations, and self-evaluation questionnaires assessed perceived learning gains. Data were analyzed using Welch Student t test, Mann-Whitney U test, and Chi-square tests, with P < .05 considered significant. Compared to the control group, the PBL group demonstrated a higher overall clinical reasoning score (87.4 ± 6.3 vs 79.1 ± 7.2; t = 7.059, P < .001) and greater diagnostic accuracy (92.6% vs 68.8%; χ2 = 12.264, P = .001). The PBL approach was also associated with superior theoretical knowledge scores (85.7 ± 5.9 vs 81.0 ± 6.6; t = 4.319, P < .001) and higher sub-domain scores in pathophysiology, diagnostic interpretation, and treatment principles (all P < .01). Student self-assessments indicated higher satisfaction, stronger self-reported critical thinking, and greater perceived integrative ability in the PBL cohort (all P < .001). The structured PBL model was significantly associated with improved clinical reasoning, theoretical knowledge, and self-perceived competence in esophageal cancer education. These findings suggest the potential value of integrating PBL into competency-based medical training for complex oncological diseases.
(Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, Inc.)*

*The authors have no funding and conflicts of interest to disclose.*