Evaluating Clinical Reasoning in Prescribing: A Systematic Review of Assessment Tools and Approaches in Medical Education and Training

<ns3:p> Introduction Clinical reasoning is a critical component of prescribing competency. As medical education transitioned to competency-based frameworks and digitalisation of learning and assessment, there is an urgent need to evaluate tools capable of assessing clinical reasoning in prescribing. This systematic review aimed to identify and explore assessment tools for clinical reasoning, with a focus on their effectiveness, digital adaptability, and application to prescribing clinical reasoning. Methods A comprehensive search of six databases was conducted using PRISMA 2020 guidelines. Studies were screened for inclusion based on a set of predefined inclusion and exclusion criteria, and the quality of the included ones was assessed using the MERSQI instrument. Results A total of 101 studies were included, identifying 61 assessment tools. They were categorised as written indirect assessment (62.3%) or performance-based direct assessment (37.7%). Script Concordance Tests (SCTs) and Objective Structured Clinical Examinations (OSCEs) were the most frequently used tools. Only a small number of tools, such as the Prescribing Safety Assessment (PSA), eDrugCalc, and McMaster Prescribing Competency Assessment (MacPCA), were developed specifically for prescribing but are not specifically for the assessment of clinical reasoning. Most included studies demonstrated moderate-to-high MERSQI. Digital adaptation was feasible for many written tools, but for performance-based tools, it may be different due to resource challenges. Conclusions Although the identified tools can be adapted for assessing clinical reasoning in prescribing, a gap remains in validated prescribing-specific assessment. Future research should focus on developing and validating tools tailored to assessing clinical reasoning during the prescribing process, ensuring scalability and digital compatibility. Practice Points <ns3:list list-type="bullet"> <ns3:list-item> <ns3:p>• Clinical reasoning is a vital yet under-assessed component of prescribing competency in medical education.</ns3:p> </ns3:list-item> <ns3:list-item> <ns3:p>• Most current tools assess general reasoning skills, not reasoning specific to prescribing tasks.</ns3:p> </ns3:list-item> <ns3:list-item> <ns3:p>• Script Concordance Tests (SCTs) and OSCEs are the most commonly used assessment, but rarely contextualized for prescribing.</ns3:p> </ns3:list-item> <ns3:list-item> <ns3:p>• Many written assessment tools are adaptable for digital formats, supporting remote or scalable delivery.</ns3:p> </ns3:list-item> <ns3:list-item> <ns3:p>• Future development should focus on validated, prescribing-specific tools that align with digital and competency-based education frameworks.</ns3:p> </ns3:list-item> </ns3:list> </ns3:p>