Introduction:

Clinical reasoning is a core competency in medical education. The Faculty of Medical Sciences at the National University of Asunción implemented a competency-based curriculum innovation, creating the need to evaluate how teaching and assessment strategies contribute to the development of clinical reasoning.

Objective:

To understand how teaching and assessment strategies applied during the medical degree program impact the construction and development of clinical reasoning, from the perspective of students and teachers.

Material and method:

Qualitative study with a hermeneutic-emancipatory approach. Three focus groups were conducted: one with teachers who were tutors in the supervised pre-professional clinical rotation and two with students (midway and at the end of their studies). A documentary analysis of academic programs in the field of health care and recovery was carried out. The information was analyzed using thematic categorization and methodological triangulation.

Results:

A predominance of traditional teaching strategies was identified in basic cycles and greater implementation of active methodologies in clinical cycles, although in a somewhat unstructured manner. Assessments focus mainly on multiple-choice written exams. Students value active methodologies positively but point out a lack of structured feedback. Teachers recognize the importance of case-based learning and simulation, but face resource and time constraints.

Discussion:

There is a discrepancy between the proposed pedagogical discourse and effective teaching practice. Institutional barriers, academic overload, and lack of standardization in assessments limit the development of clinical reasoning.

Conclusions:

Teaching and assessment strategies show a transition toward active methodologies, but require greater systematization and structure. It is necessary to strengthen formative feedback, diversify assessment strategies, and address institutional barriers to optimize the development of clinical reasoning in medical students.

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