Education programmes on performance-based assessment for allied health and nursing educators: a scoping review

Performance-based assessment (PBA) is the process used during clinical placements to gauge healthcare professional students' readiness for independent practice (Meyer et al., 2019). In real-life, uncontrolled clinical environments, PBA verifies that students can provide safe, effective patient care and meet standardized professional competencies required by outcome-based education (Epstein and Hundert, 2002; Holmboe and Kogan, 2018). Although PBA should ideally serve as a robust indicator of competence, preliminary literature searches have revealed a dearth of evidence-based education programmes designed to train clinical educators in PBA (Trebe et al., 2015; Wu et al., 2017). When assessors are not sufficiently trained or knowledgeable, it casts doubt on the reliability of judgments regarding a graduate's competency (O'Connor et al., 2019).

Assessment within clinical settings is inherently complex because it is influenced by multiple factors: the assessor, the learning environment and the design of the assessment task itself (Seldomridge and Walsh, 2018; Govaerts and van der Vleuten, 2013; Alpine et al., 2021). Clinical educators assume significant responsibility, as PBA outcomes often determine not only student progression within university programmes but may also contribute a substantial portion of the overall final grade (Heaslip and Scammell, 2012; O'Connor et al., 2018). One critical factor is the variability introduced by assessors (Yeates et al., 2013). Differences in how clinical educators interpret tasks, apply assessment criteria and manage dual roles, i.e. serving as both mentor and examiner, can lead to inconsistencies (Meyer et al., 2019; Seldomridge and Walsh, 2018; Yeates et al., 2013; Kilgour, 2011). Furthermore, time pressures, cognitive and cultural biases, and the challenge of converting a complex, dynamic performance into a discrete numerical score further complicate the process (Govaerts and van der Vleuten, 2013; Yeates et al., 2013; Ogden et al., 2008; Gingerich et al., 2011). These issues are particularly acute when assessing an underperforming student (Duffy and Hardicre, 2007).

Adding another layer of complexity, the clinical environment itself introduces challenges beyond the control of the assessor. The presence of multiple, simultaneous clinical demands, the unpredictable nature of a live clinical episode and at times the complexity of patient care may add to the challenge of the assessment process (Meyer et al., 2019; Holmboe and Kogan, 2018; Yeates et al., 2013). As a result, difficulties in ensuring fair and accurate assessment can undermine the validity of PBA, leading to questions about whether graduates are adequately prepared for practice (Seldomridge and Walsh, 2018; Heaslip and Scammell, 2012). Healthcare professionals participating in student supervision and assessment have different titles across nursing and allied health, such as preceptors, mentors, practice educators or clinical teachers (O'Connor et al., 2019; O'Brien et al., 2019; McCarthy and Murphy, 2010; Quigley et al., 2020). In this article, the term “clinical educator” is used when referring to a healthcare professional undertaking a student's clinical assessment.

The literature consistently points to major challenges in PBA related to inter- and intra-rater reliability and highlights the need for adequate training and education for effective assessment processes (Seldomridge and Walsh, 2018; Dudding et al., 2017; Govaerts and van der Vleuten, 2013; Rubenson et al., 2020). Clinical educators who are less confident in their assessment skills and their own clinical competency or are unfamiliar with current assessment practices may inadvertently compromise PBA decisions. Consequently, supporting clinical educators through targeted professional development is critical, not only to ensure fairness in evaluation but also to uphold the integrity of the overall accreditation process (Seldomridge and Walsh, 2018; Heaslip and Scammell, 2012; Quigley et al., 2020). This concern has motivated calls for more robust professional development in assessment practices, so that clinical educators can make sound, defensible decisions when evaluating students in dynamic work environments (Newstead et al., 2017; Quigley et al., 2020; Wu et al., 2017).

Most research on PBA has emerged from medical education, though considerable differences exist in how PBA is implemented across various healthcare disciplines (Ogden et al., 2008; Steinert et al., 2016; Mikkonen et al., 2022). In medicine, clinical rotations are typically brief, involving supervision by clinical educators for short, discrete periods and students are often assessed using tools such as the Mini-Clinical Examination Exercise (Mini-CEX) or Direct Observation of Procedural Skills (DOPS) (Holmboe and Kogan, 2018; Hemmer et al., 2015; Hanson et al., 2013; Regehr et al., 2011; Walsh et al., 2017). These tools focus on specific aspects of performance, often at pre-arranged time points and sometimes without comprehensive verbal or written feedback (Kogan et al., 2017; Swanberg et al., 2022). This segmented approach may not fully capture the integrated, evolving nature of clinical practice or the nuances of patient management over time (Hanson et al., 2013; Regehr et al., 2011).

In contrast, nursing and allied health professions typically employ PBA as a continuous process that unfolds over six to twelve weeks (Barrett et al., 2021; Finstad et al., 2022). Students often work under the supervision of one or two consistent clinical educators, enabling a more thorough, longitudinal evaluation (Barrett et al., 2021). In some professions such as nursing, practice supervisors (clinical educators) facilitate students' learning and contribute to the overall assessment by documenting observations and providing feedback, while dedicated practice assessors evaluate whether learning outcomes and competencies have been reached, supported by academic assessors who collate the evidence and offer feedback (Addis and Loughrey, 2025). Clinical educators in these contexts may conduct multiple daily observations that assess not only clinical reasoning and technical skills but also professional behaviour and communication (England et al., 2017; Brown and Crookes, 2017). Feedback is usually both formative and summative, through multiple sources of observation and documented assessments, which foster ongoing dialogue about performance (Myers et al., 2022). The different implementation contexts between medicine and allied health/nursing suggest that the educational needs of clinical educators must be tailored to the nature of their specific clinical learning environments.

Universities have recognized the need to induct and continuously educate clinical educators. In addition, a growing number of national frameworks and career pathways highlight the need for standardized training and education (NHS Nursing and Midwifery Educatory Framework, AHP Educator Career Framework, The National Health and Social Care Professions Quality Framework for Sustainable Practice Education). Many institutions offer education programmes aimed at preparing new educators for the dual roles of supervisor and assessor, as well as more advanced training for experienced educators looking to refine their teaching and assessment capabilities (McCarthy and Murphy, 2010; Alpine et al., 2021; Bacon et al., 2015; Milne et al., 2022; Wu et al., 2017). These programmes are primarily delivered via formal, instructional methods, including university-based workshops and online courses, and often incorporate training on implementing PBA (Alpine et al., 2021; Bacon et al., 2015; Milne et al., 2022; Ferguson et al., 2010).

Despite these initiatives, certification requirements and training guidelines vary considerably, and there are no universal standards concerning the content, format or frequency of PBA education. In medical education, interventions such as interactive workshops and video-based case vignettes, based on frameworks such as “Performance Dimension Training” or “Frame of Reference Training” have been shown to boost assessors' confidence, skills and knowledge (Holmboe et al., 2004; Kogan et al., 2015). However, improvements in grading accuracy and consistency have been less reliable. Similar approaches in allied health fields underscore the benefits of ensuring that assessors engage in interactive dialogue during the decision-making process, which appears to enhance both transparency and rating accuracy (Alpine et al., 2021; Bacon et al., 2017).

A systematic review by Milne et al. (2011), focusing on clinical educators in mental health professions, found that while a diverse range of topics were covered within training programmes, the specific aspect of assessment was not always explicitly addressed (Milne et al., 2011). More recent scoping and systematic reviews similarly emphasize the need for professional development in assessment practices, yet they fall short of directly addressing PBA-specific training (Tassoni et al., 2023; Wu et al., 2017). Searches in databases such as MEDLINE (Ovid), Best Evidence Medical Education, JBI Evidence Synthesis and the Cochrane Database (July 2022) indicate that explicit scoping review protocols on education programmes for PBA in allied health or nursing are notably absent from the literature.

With rising pressures from accreditation and regulatory bodies, universities are increasingly accountable for ensuring that clinical educators are adequately prepared (NHS Educators Workforce Programme). The pressure to provide credible and defensible PBA outcomes is compounded by the commitment of healthcare managers, who must allocate time and resources to allow clinical educators to participate in these training programmes. Preparing clinical educators to deliver robust assessment practices calls not only for on-the-job experience but also for continuous, focused professional development (Tassoni et al., 2023; Gorman and Rentsch, 2009).

Given the complexities of PBA and the multifaceted challenges of real-world clinical environments, there is a compelling need to comprehensively investigate the existing literature on educational approaches for PBA (Alpine et al., 2021; Immonen et al., 2010). The aim of this scoping review was to map and describe education programmes, targeting the PBA skills of allied health and nursing clinical educators who implement continuous assessment processes during clinical placements. This review is timely and necessary for guiding universities and regulatory bodies in developing standardized, effective training that supports clinical educators’ understanding and implementation of PBA, thus safeguarding both student progress and public trust in new healthcare graduates.

The scoping review was carried out in line with the framework presented by Arksey and O'Malley (Arksey and O'Malley, 2005), and further extended by Levac et al. (2010), Daudt et al. (2013) and Peters et al. (2022). This methodology was also in accordance with JBI scoping review guidance (Peters et al., 2017). The protocol was registered on the Open Science Framework and published in HRB Open (Alpine et al., 2024). The protocol described the planned approach and methods of review, which are described briefly in this paper.

The objectives of this scoping review were to:

1. Explore the extent, range and nature of the literature on PBA education programmes provided to allied health and nursing professionals.

2. Chart specific characteristics related to the context, target population, format, aim, instructional methods/teaching strategies, content, pedagogical approaches, evaluation methods, key findings and/or educational impact of these programmes.

3. Collate, describe and summarize the available evidence on PBA education programmes, and identify any gaps in the existing research.

Led by the research question, the research team generated inclusion/exclusion criteria based on the Population–Concept–Context framework. Peer- and non-peer-reviewed studies in the English language in full-text or report format were included. Primary qualitative, quantitative or mixed methods research studies that reported the design and/or implementation and/or evaluation of PBA education programmes for allied health and nursing clinical educators were considered. Opinion pieces, reviews and conference abstracts that commented on PBA empirical research or had PBA as a primary focus were also included. Literature was searched from the year 2000 recognizing the growth of research and development in the area of work-based assessment in recent decades. Databases were searched from the 1st January 2000 until the 30th October 2022, and an updated search was completed on the 12th August 2025.

Comprehensive search strategies were developed in consultation with a professional medical librarian to identify relevant literature from a broad range of sources using keywords and index terms relevant to this research area. Electronic database searches of EMBASE, ERIC, MEDLINE (Ovid), Web of Science and CINAHL were conducted; publications identified were imported into Covidence, and all duplicates removed.

A grey literature search of Google Scholar, Open Grey, GreyLit and ResearchGate was undertaken using a combination of keywords. A specifically designed search strategy was developed with the librarian for Google Scholar. The first 50 articles identified from the search were transferred to a Microsoft Excel file and duplicates removed. During the grey literature search, it became apparent that GreyLit was no longer available as a database, and it was removed from a revised version of the published protocol (Alpine et al., 2024).

Two reviewers (LA, MOG) independently screened the titles and abstracts of a random sample of 20 retrieved articles and appraised them against the inclusion/exclusion criteria. Any differences in decision-making were discussed to reach a clear understanding of the criteria to ensure consistency between the reviewers before commencing the full review of titles and abstracts. Discussion items were then shared with the research team, as a third author joined the screening process.

All titles and abstracts in Covidence were then reviewed by the lead author (LA), with the two reviewers (MOG, EB) appraising half of the articles each to identify relevant titles for a full text review. Three consultation meetings between the lead author and reviewers took place to finalize inclusion/exclusion decisions and deliberate on any uncertainties that arose during screening. When a decision could not be agreed regarding inclusion/exclusion of a title and abstract, these articles were included for full text review. This review was then completed by two authors (LA, EB). Any disagreements were resolved through discussion to reach consensus.

A data extraction tool based on the extraction fields identified in the protocol was developed and piloted with six articles by two authors (LA, EB). Two tables were created: Table 1 recorded the authors, year and country of publication, study design and the aims of the study. Table 2 captured healthcare discipline, size and type of study, format, duration, number of contacts for the education programmes, teaching context, instructional methods used, content and evaluation of the programmes, and main findings and/or educational impact.

The literature search identified 5,420 records. Following the removal of duplicates, 5,306 records were screened by title and abstract. A total of 5,164 studies were excluded, with reasons for exclusion noted in the PRISMA flowchart in Figure 1. A total of nine studies were included, describing 11 individual training programmes.

The following sections address objective (1) and (3). These objectives are also addressed in Table 1, which describes the general characteristics, study design and overall aims of the included studies.

The majority of the research (n = 4/9) was undertaken in Australia (Ferguson et al., 2010; Bacon et al., 2015, 2017; Milne et al., 2022), with two studies from the United Kingdom (Cross et al., 2001; Durham et al., 2012), and one each from Ireland (Alpine et al., 2021), Canada (Moline et al., 2018) and the USA (Vendrely and Carter, 2004). Most studies (n = 6/9) were published after 2010 (Durham et al., 2012; Bacon et al., 2015, 2017; Moline et al., 2018; Alpine et al., 2021; Milne et al., 2022). Study size varied from a small pilot study with six participants (Durham et al., 2012) to a large multi-centre study with 240 participants (Ferguson et al., 2010). All studies, with the exception of one, reported on a single training programme (Vendrely and Carter, 2004). In contrast, Vendrely and Carter (2004) compared four training options. Two of the training programmes were delivered independently, Clinical Instructor Instrument (CPI) training and Clinical Instructor Education and Credentialing Programme (CIECP), with the third programme combining elements of both, and the fourth involved no training (Vendrely and Carter, 2004).

Studies were of mixed methods (Cross et al., 2001; Ferguson et al., 2010; Durham et al., 2012; Bacon et al., 2015, 2017) or quantitative (Vendrely and Carter, 2004; Moline et al., 2018; Alpine et al., 2021; Milne et al., 2022) in design, with most of the mixed methods studies using uncontrolled before and after design, i.e. pre- and post-training (Cross et al., Ferguson et al., 2010; Bacon et al., 2015; Bacon et al., 2017; Moline et al., 2018; Alpine et al., 2021; Milne et al., 2022). PBA training was the main focus for n = 7/9 studies (Cross et al., 2001; Ferguson et al., 2010; Bacon et al., 2015, 2017; Alpine et al., 2021; Moline et al., 2018; Milne et al., 2022), one of which combined assessment with cultural competency training (Moline et al., 2018). The two remaining studies focused on training programmes designed to educate nurses for a mentor role, and physiotherapists for a clinical instructor role (Durham et al., 2012; Vendrely and Carter, 2004). Study aims were variable but most focused on examining variability in assessment practices including the influence of group discussion on grades (Bacon et al., 2017; Alpine et al., 2021; Milne et al., 2022), the impact of training on assessors' confidence (Bacon et al., 2015, 2017; Moline et al., 2018; Milne et al., 2022) or feedback on new assessment tools (Cross et al., 2001; Ferguson et al., 2010).

The following section addresses objectives (2) and (3). These objectives are also addressed in Table 2, which collates details on PBA programmes, specifically focusing on instructional methods, programme content, primary evaluation methods, key findings and educational impact.

All studies (n = 9) focused on a single profession, with physiotherapists (n = 4/9) (Cross et al., 2001; Vendrely and Carter, 2004; Alpine et al., 2021; Milne et al., 2022) and dietitians (n = 2/9) (Bacon et al., 2015, 2017) being the most common. Seven of the 11 training programmes consisted of a single training occasion (Cross et al., 2001; Vendrely and Carter, 2004; Ferguson et al., 2010; Bacon et al., 2017; Moline et al., 2018; Alpine et al., 2021; Milne et al., 2022) with one programme delivering training over two occasions (Durham et al., 2012), one online programme providing multiple self-directed contacts (Bacon et al., 2015) and one programme which ran over 15 h but did not provide information on the number of training occasions (Vendrely and Carter, 2004). Overall, programme duration ranged from one to 15 h (median: 2.5, IQR: 1.25–6.5). One of the more extensive programmes delivered to physiotherapists required 15 h of education and provided a qualification as a credentialed clinical instructor after completion of a six-station exam. The locations of the training for two programmes were not reported (Durham et al., 2012; Bacon et al., 2017). Five programmes were hosted in a university setting (Cross et al., 2001; Vendrely and Carter, 2004; Ferguson et al., 2010; Alpine et al., 2021; Milne et al., 2022), one programme was hosted in the clinical setting to facilitate attendance of clinical staff (Moline et al., 2018), and one programme was online (Bacon et al., 2015). Where reported, training programmes were delivered by the practice education team (n = 2/9) (Durham et al., 2012; Alpine et al., 2021), university staff (n = 3/9) (Vendrely and Carter, 2004; Ferguson et al., 2010; Moline et al., 2018) and practice education managers (n = 1/9) (Milne et al., 2022).

Direct instructional teaching was utilized as the main approach for three programmes (Cross et al., 2001; Vendrely and Carter, 2004; Durham et al., 2012) or was incorporated as part of the teaching methods for some sections in other programmes (n = 6/9) (Ferguson et al., 2010; Bacon et al., 2015, 2017; Moline et al., 2018; Alpine et al., 2021; Milne et al., 2022). Five studies utilized an interactive workshop to develop PBA knowledge and skills (Ferguson et al., 2010; Bacon et al., 2017; Moline et al., 2018; Alpine et al., 2021; Milne et al., 2022). These workshops included group discussion and reflection as key teaching strategies led by a facilitator. The web-based programme also used group discussion as a teaching approach but in a written forum (Bacon et al., 2015). Three programmes (Ferguson et al., 2010; Durham et al., 2012; Bacon et al., 2015) used written reflections to explore different aspects of the assessment process, one of which was documented as an evidence-based learning portfolio (Durham et al., 2012). Other peer learning strategies such as small and large group activities (n = 1/9) (Ferguson et al., 2010) and peer support groups were identified (n = 2/9) (Durham et al., 2012; Bacon et al., 2015).

All studies bar one (Durham et al., 2012) used simulated assessment of students' performances with video vignettes (Cross et al., 2001; Bacon et al., 2015, 2017; Moline et al., 2018; Alpine et al., 2021; Milne et al., 2022) or written descriptions of students' performance (Vendrely and Carter, 2004; Ferguson et al., 2010). Teaching material was generally delivered in advance of simulated assessment practice (Ferguson et al., 2010; Durham et al., 2012; Bacon et al., 2017; Moline et al., 2018; Alpine et al., 2021; Milne et al., 2022). Three workshops where simulated assessment was used described how participants shared their assessment scores and rationale for their grades, and offered participants an opportunity to change their original grades allocated to students' performances after the group discussion (Bacon et al., 2017; Alpine et al., 2021; Milne et al., 2022).

One programme utilized an online self-directed learning approach, providing participants access to four learning modules on multiple occasions, including additional learning resources such as self-monitoring activities, suggested reading and pre- and post-training knowledge quizzes (Bacon et al., 2015). This study reported designing their web-based programme on a constructivist theory with a learner-centred approach, authentic problem-based learning with metacognitive activities and online collaboration. The pedagogical approach was not specified in most studies (n = 8/9) (Cross et al., 2001; Vendrely and Carter, 2004; Ferguson et al., 2010; Durham et al., 2012; Bacon et al., 2017; Moline et al., 2018; Alpine et al., 2021; Milne et al., 2022).

The training programmes focused mainly on assessment concepts, assessment processes, simulated grading practice and differentiating grading (Table 2). All programmes provided information on using assessment tools and performance criteria. Assessment concepts addressed several areas including the need for clear instructions, comprehensive description of different levels of performance, understanding what is being assessed, managing different levels of performance, explaining features of good and bad performances and evidencing credible and defensible assessment (Cross et al., 2001; Vendrely and Carter, 2004; Ferguson et al., 2010; Durham et al., 2012; Bacon et al., 2015, 2017). Other fundamental constructs such as assessment as learning, and formative and summative assessment were included in two training programmes (Cross et al., 2001; Ferguson et al., 2010). Understanding competency-based assessment was explored in one programme for dietitians which centred on defining, developing and applying performance standards and consideration of how context impacts grading of competence (Bacon et al., 2015). Two longer programmes reviewed the roles and responsibilities of clinical instructors, teaching methods and theory, and legal issues in clinical education (Vendrely and Carter, 2004; Durham et al., 2012).

The most commonly used outcome measure following training was rating of perceived confidence undertaking PBA (N = 4/9) (Bacon et al., 2015; Bacon et al., 2017; Moline et al., 2018; Milne et al., 2022). Three studies appraised pre- and post-ratings of students' clinical performance in video vignettes, with participants' rating one to six videos (Cross et al., 2001; Bacon et al., 2017; Alpine et al., 2021). Two of the three studies compared participants' grades with university academic or practice tutors' scores (Cross et al., 2001; Alpine et al., 2021), and the third compared participants’ own ratings from pre-to post-training (Bacon et al., 2017). Two of the three studies demonstrated an improved alignment of scores post-group discussion (Bacon et al., 2017; Alpine et al., 2021). The third study, which utilised two different assessment tools, showed accordance with academic scores using one assessment tool but more variability using the other assessment tool, particularly with the mid-level student performances (Cross et al., 2001). The training programme delivered online did not receive post-training ratings from participants, and this was not evaluated as part of the study (Bacon et al., 2015). Other outcome measures used in included studies examined self-reported changes in assessment knowledge, understanding and skills following training (Ferguson et al., 2010; Bacon et al., 2015; Milne et al., 2022).

A variety of qualitative methods were used to assess outcomes in four studies (Cross et al., 2001; Ferguson et al., 2010; Durham et al., 2012; Bacon et al., 2015). One study reviewed written learning outcomes created by participants for student scenarios to evidence participants’ understanding of assessment concepts and generic and occupational competencies in a new assessment tool (Ferguson et al., 2010). Another study used written feedback to rationalize clinical educators' preference between two assessment tools (Cross et al., 2001). The other studies evaluated participants' views of the programmes, using either focus groups and online interviews (Bacon et al., 2015) or written feedback on the least and most beneficial aspects of training topics (Durham et al., 2012).

PBA training programmes of long or short duration reported a positive impact on participants’ perceived PBA knowledge, skills (Ferguson et al., 2010; Bacon et al., 2015; Milne et al., 2022) and confidence (Bacon et al., 2015, 2017; Moline et al., 2018; Milne et al., 2022). In addition, studies indicate training assisted clinical educators' understanding of assessment concepts, tools and standards (Ferguson et al., 2010; Alpine et al., 2021; Milne et al., 2022). Positive educational outcomes based on clinical educators’ rating of their knowledge, skills and confidence post-training were provided by in-person interactive workshops (Cross et al., 2001; Ferguson et al., 2010; Bacon et al., 2015, 2017; Moline et al., 2018; Alpine et al., 2021; Milne et al., 2022).

The primary aim of this scoping review was to synthesize the available literature on PBA training for allied health and nursing clinical educators engaged in entry-level professional education programmes. These findings will be discussed with a view to identifying any gaps in the existing research (objective 3).

Only nine studies met the inclusion criteria for this review, indicating a dearth of research in a core area of training for clinical educators. A recent scoping review of rater training in medical education generated only 14 studies (Vergis et al., 2020), also indicating a lack of research on this subject matter in medicine. Considering PBA in the clinical environment is the best way of evaluating professional competence and is a key element in curriculum appraisal; therefore, more training programmes and studies may have been predicted (Govaerts and van der Vleuten, 2013; Kogan et al., 2023a, b). This review identified studies representing only five of the 12 professions outlined in the inclusion criteria, raising concerns about how practitioners across nursing and allied health are prepared to engage in PBA. Studies were limited to Australia, USA, Canada, United Kingdom and Ireland, confining the review to a Western education perspective. Study participant numbers were relatively small, with six of the studies comprising less than 50 participants, including two pilot studies with only six (Durham et al., 2012) and nine participants (Bacon et al., 2015) respectively. As PBA is completed by clinical educators to determine a students' readiness for autonomous practice, training to implement these high-stakes exams is essential for all healthcare professionals to ensure safe, work-ready practitioners (Alpine et al., 2021; Holmboe and Kogan, 2018).

Most studies were of mixed methods or quantitative design, with no randomized control trials (RCTs). Programme evaluation across the studies was variable. In one study, key metrics such as median scores and ranges of programme ratings (Durham et al., 2012) and in the online study using a before-after design, clinical educators were unable to report post-training ratings due to technical issues (Bacon et al., 2015). This contrasts with medical education rater training programmes where nine of the 14 programmes included in the Vergis et al. (2020) scoping review were RCTs (Vergis et al., 2020). In six of the nine RCTs, training showed no effect on grading between the training and control groups. Of the remaining three RCTs, one demonstrated small improvements in grading accuracy. The second showed improvement in the quality of evaluations reported, and the third indicated a significant improvement in inter-rater reliability that persisted for eight months post-training (Holmboe et al., 2004), which consisted of an in-person extensive programme run over four days. The scoping review concluded that overall, the quality of the studies was poor to moderate (Vergis et al., 2020).

In our scoping review, most studies used self-report questionnaires measuring perceptions of assessment practice, confidence and/or knowledge pre- and post-training. Training workshops using video vignettes or written descriptions of student behaviours generally rated pre- and post-training scores of students' performance against an expert or ratings from other participants (Cross et al., 2001; Bacon et al., 2015, 2017; Moline et al., 2018; Alpine et al., 2021; Milne et al., 2022). Studies generally reported a positive impact using video vignettes, with clinical educators' post-training rating scores aligned with those of experts (Bacon et al., 2017; Alpine et al., 2021; Milne et al., 2022). This pre-post appraisal is a commonly used method to assess the impact of training interventions among healthcare professionals; however, the absence of a control group limits interpretation of the training effect, as a known limitation of pre-post studies is their inability to establish causality.

Education programs ranged from 1–15 h, with the longer, more didactic programmes providing participants with qualifications for practice education roles (Vendrely and Carter, 2004; Durham et al., 2012). In our review, five training programmes used a single training intervention of 2.5 h or less, and reported positive impacts on participants' ratings of skills, knowledge or confidence (Cross et al., 2001; Ferguson et al., 2010; Moline et al., 2018; Alpine et al., 2021; Milne et al., 2022). However, there was a wide disparity of evaluation methods used across the five studies, with only one study appraising longitudinal effect (Moline et al., 2018). Variation in the length of training programmes was also evident in the scoping review of rater training programmes in medical education, with programmes running from one hour to four days (Vergis et al., 2020). The optimal length of training programmes is yet to be established, but an important consideration is that they are not prohibitive for busy clinicians due to excessive duration. Previous research reviewing the duration of educational workshops delivered to doctors across Australia concluded a two-hour workshop strikes the optimal balance – sufficient to address educational content while remaining feasible within clinician’ time constraints (Gallagher and Pullon, 2011). Even shorter duration workshops such as a single hour of training offered by Moline et al. (2018), permit “bite sized” interventions which may be particularly useful when implemented in the clinical workplace (Moline et al., 2018). This study demonstrated continued retention of confidence when conducting PBA using a self-report questionnaire at 75 days post-training (Moline et al., 2018). As time is one of the main barriers identified to undertaking training, shorter workshops may provide a useful training option (Sirianni et al., 2020). Further exploration of the length and format of training programmes and how training translates into the workplace environment warrants further attention and evaluation.

Perhaps surprisingly only one study in this review used an online method of delivery, offering participants the opportunity to access learning material based on their availability (Bacon et al., 2015). This is despite evidence to show remote education has grown in popularity over the years and has been proven to have similar outcomes to in-person education (Macznik et al., 2015). Online programmes have been used to deliver PBA training to medical clinical educators with positive results (Kogan et al., 2023a, b) and may be accessed by clinical educators located across wide geographical areas, removing the burden of travel (Bacon et al., 2015). More research is required to explore if this is a feasible option for PBA education across other healthcare educators.

Interactive workshops using simulated assessment practice, preceded by didactic education on a range of assessment concepts, were the most common instructional method used in seven of the nine training programmes (Alpine et al., 2021; Bacon et al., 2015, 2017; Ferguson et al., 2010; Cross et al., 2001; Milne et al., 2022; Moline et al., 2018). Six of these training programmes used one or more video vignettes of scripted clinical encounters, generally developed by the authors and reviewed by clinical experts, providing snapshots of students' performances at different levels, from high performing to failing students (Cross et al., 2001; Alpine et al., 2021; Bacon et al., 2015; Bacon et al., 2017; Milne et al., 2022, Moline et al., 2018). Videos delivered tangible views of authentic clinical interactions, giving clinical educators an opportunity to observe and make a judgment on a student's performance. The use of multiple video vignettes as part of training programmes may result in difficulty recalling the content of each video, but on the other hand, multiple videos provide a persuasive picture of the students' performance. One included study used six videos in a single training session with no recall issues identified (Cross et al., 2001). In this study, Cross et al. (2001) reported persistent variability in clinical educators' ratings of students' performances post-training. However, this study evaluated two different assessment forms when rating the six videos, adding complexity to the rating process which may have impacted rating accuracy (Cross et al., 2001).

PBA workshops with stimulated collaborative dialogue and reflection were found to generally impact positively on participants perceived knowledge, skills and confidence of their assessment practice (Ferguson et al., 2010; Bacon et al., 2015, 2017; Moline et al., 2018; Milne et al., 2022). Collaborative learning fostered a shared “mental model” among clinical educators as they discussed their rationale for grading students with different levels of performance. This enabled clinical educators to hear the perspectives of fellow participants and articulate their own marking standards. Similarly, the online training programmes adopted this instructional strategy in a written format, encouraging engagement and building a community of practice through discussion boards (Bacon et al., 2015). However, it was noted that participation in the discussion forum was lower than anticipated, which may be due to the variable work schedules and time constraints of clinical educators.

During interactive training programmes workshops, the role of the facilitator gained little attention. In most studies, university-based practice education or academic staff experienced in PBA facilitated the workshops (Ferguson et al., 2010; Bacon et al., 2017; Moline et al., 2018; Alpine et al., 2021; Milne et al., 2022). However, further details of their role or approach were not provided, despite evidence that facilitators' knowledge, skills and delivery are essential to successful engagement with training programmes (O'Sullivan and Irby, 2011; Milne et al., 2022).

The specific pedagogy or teaching and learning approach of training programmes was not reported in the majority of included studies (Cross et al., 2001; Vendrely and Carter, 2004; Ferguson et al., 2010; Durham et al., 2012; Bacon et al., 2017; Moline et al., 2018; Alpine et al., 2021; Milne et al., 2022). In medical education, assessment training has been classified into four recognized training approaches: (1) Rater Error Training, (2) Behavioural Observation Training, (3) Performance Dimension Training and (4) Frame of Reference Training (Woehr and Huffcut, 1994). In this review, only one study implemented Frame of Reference Training principles (Alpine et al., 2024); however, other studies appeared to be based on these approaches, but this was not explicitly stated (Bacon et al., 2017; Milne et al., 2022). Describing the specific pedagogical approaches used in these training programmes improves comparability across studies, including clear descriptions of the training methods – such as workshop format, facilitator roles and learning modalities – enabling researchers and programme planners to evaluate effectiveness, replicate successful strategies and tailor programmes to meet evolving clinical and educational needs.

This review specifically sought to explore the literature on PBA training programmes for allied health and nursing clinical educators, however it yielded only nine studies. Only five of the 12 professions included in the eligibility criteria were represented in the studies. Given the variability in education programmes regarding grading during clinical placements, it is possible that PBA training is perceived as a lower priority within clinical educator training, particularly when students are assessed on a pass/fail rather than a numerical basis. This may in part explain the lack of focus on this area of training and highlights the need to review or develop national educator frameworks to ensure PBA training is embedded in educator training programmes across all professions.

The targeted focus of the review eligibility criteria, which required information on the design and/or implementation and/or evaluation of PBA training programmes, may have resulted in a small number of studies, with studies comprising brief descriptions of PBA rejected. The search strategy was limited from the year 2000–2025, excluding older research. However, this timeframe spans over 2 decades during which the majority of focused research on PBA is likely to have occurred. This period coincides with the rapid expansion of medical education research and a shift towards competency-based assessment frameworks and authentic assessment methods.

Several studies lacked details regarding the contents of the training programme, educational framework, length of programme and location of training environment. This limits our understanding of these programme and interpretation of study findings. Furthermore, the use of varied outcome measures across studies makes direct comparison challenging. This contracts with the scoping review by Vergis et al. (2020), where most studies employed inter-rater reliability as a common metric, enabling clearer comparison of results.

PBA training programmes targeting medical clinical educators were not included in this review for a number of reasons articulated in the introduction section (Alpine et al., 2021). Comparisons with PBA training in medical education were integrated into the discussion, noting some similarities in instructional approaches across professions. Despite these similarities, medical education typically provides explicit categorisation of education frameworks, which was largely absent from studies in this review. A clearer description of pedagogical approached in studies may assist reducing the knowledge gap when translating instructional methods into consistent practice.

The overarching purpose of clinical educator training in PBA is to improve the quality of learner assessment. Therefore, preparing healthcare professionals to implement work-based assessment by providing opportunities to engage in training and deliberate practice requires ongoing attention. Despite the limited number of studies identified in this review, it provides important preliminary evidence that may help guide the design and implementation of PBA, as well as highlighting gaps in the existing literature.

This review found that within the current literature, simulated assessment practice using one or more video vignettes delivered using an in-person workshop format was the most consistently used training intervention, supporting clinical educators to develop their assessment knowledge, skills, confidence and rating accuracy (Cross et al., 2001; Ferguson et al., 2010; Bacon et al., 2017; Moline et al., 2018; Alpine et al., 2021; Milne et al., 2022). Online and longitudinal education programmes to develop clinical educators' knowledge of PBA requires further exploration, with recent studies using these formats reporting favourable outcomes.

While short once-off workshops have been shown to have a positive immediate impact on clinical educators' ratings, knowledge, skills and confidence, the extent of retention of this knowledge and the ability to translate classroom or online learning into the workplace environment requires further research. This review highlights other gaps in PBA research, particular regarding optimal programme length, pedagogical frameworks, translational of training into the work environment and longitudinal outcomes.

With the expansion of third level healthcare professional education programmes to meet workforce demands, and ongoing need for reliable and accurate assessment of competency, this review provided a clear synthesis of what is known about PBA training programmes for the allied health and nursing professionals. Considering the significant cost of training and resource investment by universities alongside, time commitment from healthcare professionals, our findings offer valuable insights to support universities in designing effective and sustainable PBA training programme moving forward.