Teaching and Assessing Clinical Reasoning in Health Professions Education: A Systematic Review

Clinical reasoning is a core competency in health professions education, yet evidence regarding effective teaching and assessment strategies remains fragmented across disciplines. This systematic review synthesized evidence on educational strategies and assessment approaches used to develop and evaluate clinical reasoning in medicine, dentistry, nursing, and physiotherapy. Studies published between January 2000 and November 2025 were identified through systematic searches of PubMed, Scopus, Google Scholar, and manual searches of relevant journals, and were narratively synthesized in accordance with PRISMA 2020 guidelines. Twenty-seven studies met the inclusion criteria. Active, learner-centered educational strategies including case-based learning, illness script-based teaching, simulation, and deliberate practice with feedback were generally associated with improved clinical reasoning and diagnostic performance, whereas passive instructional approaches demonstrated limited or mixed effects. Validated assessment tools, including the Script Concordance Test, Key Feature Test, Diagnostic Thinking Inventory, and Reasoning Skills Test, effectively differentiated reasoning ability across learner groups. Clinical experience and guided reflection further supported the development of clinical reasoning. Overall, the findings support integrating interactive teaching approaches with structured assessment to strengthen clinical reasoning in health professions education. Future research should evaluate longitudinal outcomes, cross-disciplinary effectiveness, and greater standardization of assessment methods.