The team followed the widely used scoping review framework of Arksey and O’Malley, which structures the work into five stages: clarifying the purpose and research question, identifying relevant literature, selecting studies, extracting data, and then collating, summarizing and reporting the results. The search surfaced 412 publications, of which 23 met the inclusion criteria. That funnel from hundreds of candidates to a couple of dozen included studies is typical of scoping reviews, but the small final corpus also reflects how specialized the literature on any single assessment instrument tends to be. What the 23 studies revealed, however, was strikingly consistent.

The core finding is that the AssCE tool serves as a systematic and structured vehicle for feedback, mediating both formative and summative assessment of students. In practical terms, the tool is not a single end-of-placement exam but a scaffold stretched across the whole clinical period. The review documents its use for planning the placement in advance, for student self-assessment, for daily follow-up of progress, and for formal assessment discussions with preceptors and the academic lecturer at the midpoint and the end of the clinical period. This rhythm of repeated, structured checkpoints is precisely what assessment researchers have long argued distinguishes learning-oriented evaluation from a one-off grade.

The experiences reported across the included studies were mainly positive, and notably so across all three groups involved in clinical education. Students and preceptors appreciated the tool as a structure for the content of the clinical period, giving shape to what can otherwise be an amorphous apprenticeship. Lecturers, whose perspective is often underreported in placement research, reported that while using the tool was time-consuming, well-prepared preceptors and students enabled deeper-level discussions about the student’s knowledge and performance. In other words, the instrument’s value scaled with the preparation of the people using it, a finding with clear implications for how universities introduce assessment tools at placement sites.

One of the more forward-looking results concerns digitalization. The lecturers in the reviewed studies supported developing the AssCE tool toward digital formats, a sentiment that mirrors the broader shift in health professional education toward electronic assessment platforms that can log progress in real time rather than relying on paper forms completed at intervals. The authors also report that comparisons indicated benefits of the AssCE compared with other equivalent locally developed tools for clinical education, suggesting that a nationally grounded, theoretically derived instrument may outperform the ad hoc checklists that individual institutions tend to produce.

Perhaps the most intriguing strand of the review concerns uses of the tool beyond its original purpose. Alongside clinical education, the research studies showed that the AssCE tool was useful in other areas as well, for example when nurses estimated their own competence. That extension from student assessment to professional self-assessment is significant, because competence estimation among practicing nurses is a persistent challenge for workforce planning and continuing education. A tool designed to make a student’s developing abilities visible apparently also helps seasoned clinicians map their own.

The authors attribute the tool’s durability to its design pedigree. It was created based on experiences of opportunities for dialogue and verification of students’ level of knowledge, which means its architecture was built around conversation and evidence rather than around box-ticking. That lineage helps explain why students and preceptors alike described it as a structure for the placement: the instrument encodes an expectation that assessment is something done with the student, not to the student. In an era when clinical placements are under pressure from staffing shortages and compressed curricula, tools that make dialogue efficient may matter more than ever.

The review is not uncritical. The conclusion notes that the tool has been used in new areas, and that this spread indicates a need for further development and psychometric testing. Psychometric evaluation, the statistical assessment of an instrument’s reliability and validity, is the gold standard for proving that a measurement tool measures what it claims to measure consistently. A tool that has migrated from assessing nursing students in clinical placements to gauging practicing nurses’ self-estimated competence is operating in contexts its original validation may not fully cover, and the authors are transparent that this expansion outpaces the testing.

The stakes of this line of research are easy to underestimate. Clinical practice is perceived as important for students’ learning and professional development, and one prerequisite for optimal learning is having assessment tools that support continuous development and assessment of students’ different abilities. When assessment is vague or inconsistent, students can pass placements without demonstrable competence, or competent students can be failed on the basis of a preceptor’s impression. Structured instruments like AssCE aim to close that gap by anchoring judgments in defined criteria and repeated dialogue, and the review suggests that after two decades the approach has earned its keep.

Published as open access in BMC Nursing on 17 September 2026, the review arrives at a moment when nursing education worldwide is scrutinizing how clinical competence is certified. Its message is twofold: a well-designed assessment tool can structure the entire arc of a clinical placement and foster the deeper discussions that turn supervision into learning, but tools that travel into new territory must be re-validated there. For the universities, hospitals and preceptors who depend on instruments like AssCE, the next chapter will likely be digital, and the evidence base will need to keep pace with the tool’s expanding reach.

Subject of Research: Use and experiences of the Assessment of Clinical Education (AssCE) tool in nursing education

Article Title: Assessment of clinical education (ASSCE): a scoping review of use and experiences of the tool

Article References: Löfmark, A., Engström, M., & Mårtensson, G. (2026). Assessment of clinical education (ASSCE): a scoping review of use and experiences of the tool. BMC Nursing, 25(1), Article 862. https://doi.org/10.1186/s12912-026-05379-0

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05379-0

Keywords: AssCE tool, nursing education, clinical education, assessment tools, scoping review, formative assessment, summative assessment, preceptors, self-assessment, psychometric testing, clinical placements, digitalization

Backward design was first described by Grant Wiggins and Jay McTighe in their influential book Understanding by Design, and it inverts the sequence that most instructors instinctively follow. Traditional curriculum planning typically begins with a topic, moves on to lectures and lesson content, and only afterward defines exams and projects, with learning objectives retrofitted to whatever activities were already built, if they are articulated at all. Backward design forces the planner to start with the end in mind. The first phase asks educators to identify the broad understandings they want learners to retain, described by Wiggins and McTighe as the big ideas that students should carry with them long after the details have faded, and then to translate those understandings into specific, observable, learner-centered objectives. Only after those outcomes are fixed does the planner move to the second phase, determining what evidence would count as proof that the objectives have been achieved, and finally to the third phase, designing the learning activities themselves.

The technical machinery of the first phase leans heavily on Bloom’s taxonomy, the classic hierarchy of cognitive and psychomotor performance that scaffolds verbs from simple recall to creative synthesis. A learner at the lowest level might be asked to list the steps of a predefined process, while a learner at the apex of the taxonomy might be asked to create a novel process to solve a problem. By choosing the verb deliberately, the curriculum designer fixes the level of performance expected and, crucially, sets up the second phase, because the verb chosen for the objective dictates the appropriate form of assessment. If the objective says list, then an acceptable demonstration is an independent listing of the steps; if the objective says create, then learners must be handed a problem and asked to generate a solution. This tight coupling between objective and evidence is what gives backward design its reputation for alignment, ensuring that what is taught, what is tested, and what is intended all point in the same direction.

The assessment phase distinguishes between summative and formative evaluation, two categories with distinct purposes in the learning cycle. Summative assessment places a deadline on learning and lets the learner exhibit the degree to which the larger understandings have been achieved, while formative assessment occurs during learning itself and opens channels for feedback from instructors and peers that can improve later performance. The authors note that formative assessment is already a familiar rhythm in clinical medical education, and that the backward design framework naturally creates feedback moments, particularly when sessions are built to be active. Multiple-choice examinations tend to test recall or recognition, whereas performance tasks are better suited to probing the deeper understandings that the framework prizes, a distinction that matters enormously in a field where the ultimate test is a patient on the table.

The third phase brings active learning to the foreground. Because the objectives were written to demand application rather than memorization, passive lecturing rarely fits, and the framework pushes designers toward methods such as think-pair-share, minute papers, concept mapping, and case-based learning. Active learning, rooted in constructivist theory, requires learners to engage directly in acquiring knowledge and skills and to reflect on the process, and it has been shown to outperform passive lectures across fields including medicine. The authors emphasize that backward design is not a rigid linear checklist but an iterative loop: resource limitations may force a reassessment of which performance tasks are feasible, prompting revisions to objectives and even to the original understandings, and activities may need adjustment once the summative assessment is finalized. Revisiting earlier phases is what keeps outcomes, assessments, and activities tightly aligned.

To show the framework in action, the Baylor team first applied it to a complete redesign of the simulation bootcamp for postgraduate year one residents in the 2025 to 2026 academic year. The existing curriculum had been organized around activities, such as arterial line placement, without clear benchmarks for evaluation. Educational leadership gathered input through anonymous surveys and two focus groups weighted equally from current interns and senior residents, who identified level-appropriate tasks including arterial line placement, central venous catheter insertion, laparoscopic camera driving, and the tasks of the Fundamentals of Laparoscopic Surgery examination. Learners also flagged a key flaw in the old format: prior labs centered on performing an entire procedure rather than mastering discrete component skills. From this input the team defined broad understandings and then task-specific learning objectives that doubled as lab-level expectations, all vetted by simulation leadership before any assessment was considered.

With objectives fixed, assessment design followed logically. Direct observation by instructors during each skills session served as formative assessment, with facilitators given the session objectives to keep feedback consistent, and learners able to use the same objectives for self-assessment during independent practice. The summative capstone took the form of an Olympics-style competition at the final session of the year. Five stations mimicked the five Fundamentals of Laparoscopic Surgery examination tasks using the official scoresheet, while central venous catheter and arterial line stations evaluated each procedure in three segmented phases: ultrasound evaluation, preparation, and vascular access, with points awarded for each correctly completed phase and scored on accuracy and time by senior residents or faculty. Only after this assessment architecture was in place did the team plan the lessons: weekly two-hour skills labs over six weeks, in which facilitators demonstrated each skill by breaking it into parts, reviewing each component, and then showing the whole, before learners performed the skill under direct supervision in a pattern echoing the first two elements of the traditional see one, do one, teach one mantra.

The second example compressed the framework into a single hour, demonstrating its flexibility for short-cycle planning. Departmental leadership had decided to convert general surgery resident didactics from two-hour faculty lectures into large-group case discussions mixing residents of all postgraduate levels in groups of five or six, a shift grounded in literature showing the benefits of active learning for clinical judgment and reasoning. Burke and Boedeker were asked to prepare faculty for the change, and they began not with slides but with desired outcomes: participants should understand why active learning outperforms passive formats, feel supported in the transition, and be able to identify institutional resources, evaluate an active learning session, and describe how a didactic session should be delivered. With roughly ten minutes allocated to a summative large-group discussion and an optional post-workshop survey for self-reflection, the bulk of the hour was devoted to a mock case discussion on pediatric abdominal pain, in which faculty members role-played residents at different postgraduate levels, receiving patient information and debating workup, imaging, operative planning, and complication management. The immersive design flowed directly from the objective that attendees should be able to evaluate an active learning session, illustrating how the framework disciplines even the smallest allocation of scarce time.

The authors are candid about limitations. Backward design demands faculty development before it can be applied faithfully, and its first phase can be more time-intensive than anticipated, although that effort is largely front-loaded and later iterations rarely require a full reapplication of the framework. More fundamentally, the efficacy of backward design in undergraduate and graduate medical education has not yet been formally evaluated, and both curricula described here received positive participant feedback without any evidence that they outperform programs built with other frameworks. The authors also contrast their approach with Kern’s widely used six-step model, noting that Kern begins with formal needs assessments that may be infeasible under time or resource constraints, and places evaluation last, whereas backward design requires no needs assessment and positions assessment design immediately after objective selection. Neither framework guarantees a good curriculum; both merely maximize the chance of one by enforcing alignment. What emerges from the Baylor experience is a pragmatic message for a specialty under pressure from competency-based milestones and entrustable professional activities: by starting with what learners must ultimately be able to do, surgical educators can build shared mental models, consistent feedback, and efficient programs without new resources, simply by planning in reverse.

Subject of Research: Application of backward design curriculum planning to surgical education

Article Title: Design with intention: operationalizing backward design in surgical education

Article References: Burke, E. G., & Boedeker, P. (2026). Design with intention: operationalizing backward design in surgical education. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 131. https://doi.org/10.1007/s44186-026-00534-2

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00534-2

Keywords: backward design, surgical education, curriculum design, Bloom's taxonomy, active learning, simulation training, faculty development, resident didactics, learner-centered outcomes, formative assessment, summative assessment, competency-based medical education