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Recent reforms of nursing education have led to calls for assessment of clinical performance to contribute to academic qualifications that incorporate professional awards. Questions then follow concerning the psychometric quality of methods available for assessing competence and performance and the ability of the methods to distinguish between different levels of practice. The purpose of this review of the literature is to analyse methods of assessing competence to practise in nursing and draw conclusions on their reliability and validity. The methods reviewed include questionnaire rating scales, ratings by observation, criterion-referenced rating scales, simulations including the objective structured clinical examination (OSCE), Benner's model of skill acquisition, reflection in and on practice, self-assessment and multi-method approaches. Methodological challenges to competence assessment are raised.

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