Objective: To explore and evaluate the application effect of post competency-oriented discussion-based case teaching in clinical imaging teaching. Methods: This study was a retrospective analysis. Seventy medical students who were undergoing rotational internships and standardized training in our department were selected as the research subjects and grouped according to time. Medical students from 2020 to 2022 were assigned to the traditional group (35 students), while those from 2023 to 2025 were divided into the discussion group (35 students). The traditional group received the traditional teaching model, while the discussion group received post competency-oriented discussion-based case teaching in addition to the traditional teaching model. The observation period for both groups was 6 months, during which post competency scores were assessed. Results: After 6 months of teaching, the discussion group showed significantly higher scores in clinical post competencies such as knowledge mastery, skill application, clinical thinking, communication and collaboration, and professional qualities compared to the traditional group (P<0.05). The discussion group also achieved significantly higher scores in clinical imaging operation assessments, including imaging equipment usage, image acquisition quality, and diagnostic accuracy, compared to the traditional group after 6 months of teaching (P<0.05). Both groups demonstrated higher scores in humanistic care ability after 6 months of teaching compared to before, with the discussion group showing significantly higher scores than the traditional group (P<0.05). The teaching satisfaction rate after 6 months of teaching was 100.00% in the discussion group and 85.71% in the traditional group, with the discussion group significantly outperforming the traditional group (P<0.05). Conclusion: The application of post competency-oriented discussion-based case teaching in clinical imaging teaching can enhance medical students" post competencies and clinical imaging operation assessment scores, as well as improve their humanistic care ability and teaching satisfaction.