Measurement properties of instruments assessing the clinical learning environment in health professions education: a COSMIN-based systematic review

PURPOSE: The clinical learning environment (CLE) is a crucial component of health professions education, providing the foundation for developing profession-specific clinical skills. This systematic review aimed to identify evaluated assessment tools for the CLE in health professions education and to report their measurement properties. METHODS: This systematic review was preregistered (IDESR000098), and its protocol was published previously. Eligible studies were peer-reviewed articles in English that developed and validated tools for assessing the CLE among undergraduate health professions students and followed the COSMIN guidelines for systematic reviews of patient-reported outcome measures. Multiple electronic databases, including MEDLINE, the Cochrane Library, ERIC, Education Research Complete, and CINAHL, were searched; studies were independently screened, and data were extracted. Data were synthesized using best-evidence synthesis according to COSMIN guidelines. RESULTS: Of the 6,236 articles included in title and abstract screening, 55 were eligible for full-text screening. A supplementary search identified 13 additional articles, resulting in 40 included articles. Overall, 28 tools were identified, with 4 tools (PET, PET-Midwifery, DECLEI, and MidSTEP) demonstrating sufficient content validity. Only MidSTEP demonstrated sufficient structural validity. CONCLUSION: Only a minority of the included tools provided sufficient evidence of content and structural validity according to the COSMIN criteria. This finding indicates a systemic need for higher standards in monitoring clinical placements and identifies tools that should be re-evaluated and supported by additional research. Limitations include the exclusion of EMBASE and gray literature and the reliance on studies that predominantly used psychometric-first rather than content-validity-first designs.