Competency-based assessment in nursing education: An umbrella review of strengths and limitations.
TL;DR
CBA domains in nursing provide rich information on complex competencies but are unevenly developed, and integrated, theory-informed, and programmatic assessment systems are required to optimise their contribution to practice-ready graduates.
Abstract
INTRODUCTION Competency-based assessment (CBA) is central to competency-based education (CBE) in nursing, yet the evidence about its effectiveness is fragmented across methods, settings, and outcomes.
Aim
To synthesize the strengths and limitations of CBA approaches in nursing education and to map them onto established educational frameworks.
Methods
An umbrella review of reviews was conducted, including systematic, scoping, integrative, and theoretical reviews of CBA in pre-registration and early-career nursing. Searches of PubMed, CINAHL, Scopus, Web of Science, and ERIC (from inception to November 2025) were conducted in accordance with Joanna Briggs Institute and PRISMA guidance, with eligibility defined using the Population, Concept, and Context (PCC) framework, and data were integrated through narrative synthesis.
Results
Twenty reviews, encompassing more than 700 primary studies, identified six CBA domains: simulation-based and Objective Structured Clinical Examination (OSCE) assessments, workplace-based assessments (WBAs), technology-enhanced assessments, learning-based and reflective assessments, research competency assessments, and program-level CBE evaluations. Across domains, CBAs predominantly targeted higher-order cognitive and performance outcomes aligned with the upper levels of Bloom's taxonomy and Miller's pyramid. Simulations and OSCEs showed strong validity and acceptability but were resource-intensive and often anxiety-provoking. Workplace-based tools captured authentic performance but were constrained by assessor variability and limited psychometric properties. Technology-enhanced and reflective approaches fostered engagement and self-regulation yet frequently relied on heterogeneous, weakly validated measures. Evidence for research competencies and program-level CBE remained limited and methodologically modest.
Conclusion
CBAs in nursing provide rich information on complex competencies but are unevenly developed. Integrated, theory-informed, and programmatic assessment systems are required to optimise their contribution to practice-ready graduates.