Assessment and Competency-Based Education in Distributed Healthcare Education: A Scoping Review Protocol v1

Introduction Assessment and competency-based education (CBME) are vital for ensuring healthcare learners acquire and demonstrate the necessary skills for safe and effective practice. In distributed healthcare education systems, where learners are trained across multiple, geographically dispersed sites, assessment faces unique challenges: achieving standardization and quality across locations; maintaining fairness so all learners have equal opportunities to show their competence; coordinating high-stakes evaluations remotely; implementing workplace-based assessments consistently with proper faculty training; and applying competency frameworks uniformly despite different site characteristics. A 2023 international survey revealed that 58% of distributed medical programs identified assessment standardization as a major challenge, citing issues such as inter-rater reliability, access equity, and consistency among competency committees across sites. Reliable and valid assessments are crucial for patient safety and public trust, emphasizing the importance of assessment equity in distributed settings. Despite the widespread use of competency frameworks and programmatic assessment, there remains limited systematic evidence on assessment practices, challenges, and solutions specific to distributed education contexts.To systematically explore the literature on assessment and competency-based education within distributed healthcare education systems, this review examines: (1) assessment methods employed across various distributed sites aligned with Miller's assessment framework; (2) the competency domains that are evaluated; (3) the scope and depth of assessment coverage; (4) approaches to standardizing assessments and ensuring quality; (5) equity in assessment practices across different sites; (6) implementation of workplace-based assessments; (7) challenges faced and potential solutions; and (8) the outcomes associated with assessment strategies.This scoping review adheres to JBI methodology and PRISMA-ScR guidelines. We will search MEDLINE, Embase, ERIC, Web of Science, and gray literature from 2000 to 2025. Two independent reviewers will screen and extract data using two frameworks: Miller's Pyramid (Knows, Knows How, Shows How, Does) for assessment methods and a Two-Tier Competency Framework for mapping competency domains (5 universal categories plus specific details). Data collection will cover assessment standardization, equity considerations, workplace assessment implementation, and quality assurance. We will develop a 5×4 assessment matrix (comprising five competency categories and 4 Miller levels) to analyze the scope of the assessment. Results will be presented through a narrative synthesis, accompanied by tables, figures, matrix analysis, and cross-framework comparisons. Objective To systematically map the literature on assessment and competency-based education in distributed healthcare education systems, examining: (1) assessment methods used across distributed sites mapped to Miller's assessment framework; (2) competency domains assessed; (3) assessment coverage breadth and depth; (4) assessment standardization and quality assurance approaches; (5) assessment equity across sites; (6) workplace-based assessment implementation; (7) challenges and solutions; and (8) outcomes related to assessment practices. Methods This scoping review will follow JBI methodology and PRISMA-ScR guidelines. We will search MEDLINE, Embase, ERIC, Web of Science, and gray literature from 2000 to 2025. Two independent reviewers will screen and extract data using two complementary frameworks: Miller's Pyramid for characterizing assessment methods (Knows, Knows How, Shows How, Does) and a Two-Tier Competency Framework for mapping competency domains assessed (5 universal categories plus specific framework detail). Data extraction will include assessment standardization strategies, equity considerations, workplace-based assessment implementation, and quality assurance mechanisms. We will create a 5×4 assessment matrix (5 competency categories × 4 Miller levels) to characterize assessment breadth and depth. Results will be synthesized narratively with tables, figures, quantitative matrix analysis, and cross-framework synthesis.