Clinical Reasoning Learning (CRL) is one of the most important methods of active learning in medicine. This instruction is designed for small groups of students.

We conducted a prospective descriptive study with the primary goal of adapting this instruction for large groups of students. The secondary objective was to compare two methods of adapting this instruction (fish bowl technique and whole-group participation), and the comparison was conducted using an evaluation questionnaire with a Likert scale.

Our sample included 130 students, divided into 2 groups: the Fish bowl CRL group (57 students) and the group with the participation of all students (73 students). Strengthening of prior knowledge, the working atmosphere, assimilation of information, and supervision were the strengths of this instruction. The negatives were related to insufficient time. The analysis found a statistically significant difference in averages between the 2 groups, and this difference pertained to the variables of participation and appreciation of the atmosphere, with a p-value of 0.01 for both.

CRL can be adapted for large groups in the form of fish bowl learning. Currently, it is challenging to measure the actual impact of educational activities on the development of clinical reasoning due to the lack of precise measurement instruments. Evaluation questionnaires can be a first step in measuring the impact of these instructions with modified structures. It would be interesting in future studies to create assessment tools for these restructured instructions.