Two Decades of the AssCE Tool: What a Scoping Review Reveals About Assessing Nursing Students in Clinical Practice

Clinical placements are where nursing students stop being classroom learners and start becoming professionals, but judging how well that transformation is going has long depended on whatever assessment instrument a university or hospital happened to have lying around. A new scoping review published in BMC Nursing by Anna Löfmark, Maria Engström and Gunilla Mårtensson of the University of Gävle, with Engström also affiliated with Lishui University in China, takes stock of one of the longest-serving instruments in this space: the Assessment of Clinical Education, known as the AssCE tool. After more than twenty years in circulation, the review offers the most comprehensive picture yet of how the tool is actually used and what the people wielding it think of it.

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