Making learning visible in the 21st Century: Examining the use of digital assessment tools in Montessori education

The integration of digital assessment tools into the educational process emphasized the significance of assessing the knowledge and skills of teachers and teacher candidates in designing, utilizing, and benefiting from these tools. Therefore, it is very important to analyze the competencies of final-year teacher candidates who will serve as teachers in visual arts education, an essential area within education. This study aims to reveal the experiences of senior visual arts teacher candidates in designing digital assessment tools. Designed as a case study, which is one of the qualitative research methods, the present study employs a single-case design. Participants were selected through criterion sampling, a purposive sampling method. The criteria for participation included being a senior undergraduate student, volunteering to participate, and having completed the courses “Visual Arts Education Programs”, “Material Design in Visual Arts Teaching”, and “Assessment and Evaluation in Education” within their degree program. This study was carried out with 26 visual arts teacher candidates (21 female and 5 male) studying in the Department of Art Education at a state university in Türkiye. Data collection was performed using digital assessment tools designed by the participants, besides the structured interview forms. Before the application, participants received an introductory briefing on the identified digital assessment tools and their integration into visual arts education, based on a review of the literature. Participants were given the freedom to choose the digital platform they would use and were tasked with designing a digital assessment tool. After a three-week preparation period, the visual arts teacher candidates who had designed digital assessment tools were asked, “Would you use digital assessment tools in Visual Arts lessons when you become a teacher? Why?” The collected data were categorized under specific themes and subcodes, with participants coded as K1, K2, K3, …. Data analysis was conducted using the qualitative data analysis software MAXQDA, resulting in tabular, visual, and descriptive interpretations. It was observed that participants designed digital assessment tools aligned with the learning areas and achievements of the Visual Arts Course Curriculum. It was found that participants predominantly preferred 5th-grade middle school level in their digital assessment tool designs. Among the learning areas in the Visual Arts Course Curriculum, the most frequently addressed achievements were related to “Cultural Heritage”, and the Wordwall digital platform was the most commonly utilized tool. Grouping was the preferred question type for the assessment tools. All participating visual arts teacher candidates expressed their intention to use digital assessment tools as teachers but noted facing challenges due to a lack of technical knowledge during the preparation process. This research highlights the need for similar studies involving larger groups and deeper investigations. Accordingly, the present study recommends conducting long-term studies to monitor the development of a higher number of participants, investigating the challenges visual arts teacher candidates face in technology usage, and exploring additional digital application examples for use in visual arts education.

In this dissertation the effects of digital formative assessment tools on teaching quality and student achievement was investigated. An increasing number of schools use a digital system to process, organize, summarize, and analyze student assessment data. Such digital systems might support teachers in the process of translating student assessment data into informed instructional decisions. In this dissertation the term digital formative assessment tool refers to a digital tool that supports teachers during instruction planning by providing feedback to teachers based on student assessment data. The dissertation consist of three studies. In the first study a randomized experimental design was used to examine the effects of a digital formative assessment tool on mathematics achievement and motivation (n schools = 79, n students = 1808), and on spelling achievement (n schools = 69, n students = 1605) in grade three primary education. In the second study the relationship between differentiated instruction and student achievement was examined. Classroom observations (n = 144) were used to measure teachers’ differentiated instruction practices and to predict the mathematical achievement of second and fifth grade students (n = 953). In the third study the effect of digital formative assessment tools have been examined through a meta-analysis of the results of relevant experimental studies (n = 14). The results of the first study and of the third study show that digital formative assessment tools can have an effect on teaching quality and student achievement. However, the results of the second study and of the third study show that effects can not always be shown. Important characteristics of a DFAT for their effectiveness seem to be frequent and immediate teacher feedback, detailed and concrete teacher feedback and easily accessible and easy to interpret feedback to teachers. These characteristics may make a digital formative assessment tool suitable for improving teachers’ daily instructional planning and make it easier to integrate into teachers’ teaching practices.

The rapid expansion of digital connectivity has provided youth with wide-ranging access to digital platforms for communication, entertainment, and education. In light of this profound shift, there have been growing concerns about online safety, data privacy, and cybersecurity. A critical factor influencing the ability of youth to responsibly navigate digital platforms is digital literacy. While digital literacy programs have been implemented in various regions worldwide, significant disparities remain not only in overall digital literacy levels, but also the assessment of digital literacy initiatives. To address these challenges, an environmental scan and literature review were conducted to identify existing digital literacy programs in Canada developed specifically for youth, as well as digital literacy assessment tools, respectively. The search encompassed peer-reviewed articles, organizational curricula, and assessment measures indexed in various databases and organization websites. The environmental scan identified 15 programs targeting key components of digital literacy such as data safety, cyberbullying, and digital media. The literature review identified 12 digital literacy assessment tools. Based on the findings, data were synthesized from shortlisted programs and assessment tools to inform the development of both a new digital literacy program and assessment tool to complement the youth-focused program. The new program focuses on four key components: (1) digital fluency, (2) digital privacy and safety, (3) ethics and empathy, and (4) consumer awareness. A 15-item assessment tool was also developed consisting of 4–5 questions specific to each program component. Given the growing importance of digital competencies, a youth-focused program and assessment tool are crucial for understanding and addressing digital literacy among this vulnerable cohort. This program's adaptability allows for customization across sociodemographic target groups, including culturally diverse and geographically remote communities—an aspect that has the potential to enhance digital literacy across settings. Implementing digital literacy programs can better prepare youth for an increasingly digital world, while minimizing potential risks associated with technology use.

BackgroundDespite the rapidly growing number of digital assessment tools for screening and diagnosing mental health disorders, little is known about their diagnostic accuracy.ObjectiveThe purpose of this systematic review and meta-analysis is to establish the diagnostic accuracy of question- and answer-based digital assessment tools for diagnosing a range of highly prevalent psychiatric conditions in the adult population.MethodsThe Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) will be used. The focus of the systematic review is guided by the population, intervention, comparator, and outcome framework (PICO). We will conduct a comprehensive systematic literature search of MEDLINE, PsychINFO, Embase, Web of Science Core Collection, Cochrane Library, Applied Social Sciences Index and s (ASSIA), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for appropriate articles published from January 1, 2005. Two authors will independently screen the titles and abstracts of identified references and select studies according to the eligibility criteria. Any inconsistencies will be discussed and resolved. The two authors will then extract data into a standardized form. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool, and a descriptive analysis and meta-analysis will summarize the diagnostic accuracy of the identified digital assessment tools.ResultsThe systematic review and meta-analysis commenced in November 2020, with findings expected by May 2021.ConclusionsThis systematic review and meta-analysis will summarize the diagnostic accuracy of question- and answer-based digital assessment tools. It will identify implications for clinical practice, areas for improvement, and directions for future research.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42020214724; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020214724.International Registered Report Identifier (IRRID)DERR1-10.2196/25382

This study evaluated the effectiveness of traditional teaching methods in developing students’ practical skills in the Laboratory Practice in Indirect Restorations (LPIR) course at the School of Dentistry, Universidade Federal de Minas Gerais (FAO-UFMG). A qualitative before-and-after study was conducted with 25 fifth-semester undergraduate dental students to assess the quality of cavity preparations for indirect esthetic onlay restorations performed on mannequin teeth. Preparations were evaluated twice during the academic semester. The first evaluation occurred after a professor-led demonstration, and the second followed a supervised practical repetition period. A digital assessment tool was used to compare preparation characteristics and monitor student progress. The results demonstrated a significant reduction in preparation errors over time, indicating that the traditional teaching methods applied effectively enhanced the students’ clinical performance. Furthermore, the digital tool was found to be a useful supplement to instructor evaluations, identifying frequent errors and enabling more precise, personalized feedback. These findings indicate that integrating digital assessment tools and traditional teaching strategies is a promising approach for improving dental education and student learning outcomes.

This study aimed to examine the opinions of Montessori educators on the digital assessment tool they use in terms of 21st-century teacher skills. The study sample covered 14 Montessori educators working in early childhood classes in public and private preschool educational institutions, located in Barcelona and Istanbul, where the Montessori educational approach is applied. In the study, the experiences of the Montessori educators with the digital assessment tool they use as the assessment tool were examined in terms of the identified 21st-century teacher skills. To this end, the research was designed with a phenomenological approach in the qualitative research method. The data were obtained through the personal information form and structured interview questions prepared for the digital assessment tool used by the Montessori educators. In the analysis of this data, the phenomenological study of Moustakas (1994) was introduced through the steps of the analysis. The perspectives of the Montessori educators concerning digital assessment, their application experiences regarding the digital assessment tool, and their views on their experiences were discussed in terms of utilization of the digital tool applications, as well as to use and evaluate information, their skills regarding collaborative work and communication, and finally their communication skills with the parents, which are among the 21st-century teacher skills. It was concluded that different factors influenced the opinions of the Montessori educators, where there were positive and negative expressions within the scope of these skills regarding the digital assessment tool.

This paper presents the results of research aimed at identifying and assessing the impact of the innovative educational program "Teaching Chemistry in Secondary Schools: Fostering Digital and Scientific Literacy." The programme aimed to help chemistry teachers develop digital competence in accordance with the European Framework for the Digital Competence of Educators (DigCompEdu) requirements. The research sample consisted of secondary school chemistry teachers combined (N=15) from three Slovak regions. The research was conducted during the first term of the 2024/2025 school year. The innovative educational programme consisted of 6 modules, covering a total of 50 hours. This innovative educational programme aimed to provide teachers with access to knowledge on teaching chemistry, with a focus on fostering digital competence through activating methods such as inquiry-based teaching, digital technology-supported teaching, and the use of digital summative and formative assessment tools. The research instrument was the DigCompEdu Check-in Questionnaire, completed by the teachers before and after finishing the educational programme. A comparison of the pre-test and post-test results indicated an overall improvement in teachers’ digital competence, moving from explorers to integrators. The analysis of their results in the area of Teaching and Learning indicated an increased frequency of teachers using digital tools to implement various teaching methods focused on developing students’ independent learning and group cooperation. The analysis of their results in the Assessment area indicated an increase in teachers’ monitoring of students’ progress and their analysis of information and feedback gathered about students. However, teachers still opted to use digital assessment tools less frequently. Therefore, it is necessary to make various digital assessment tools, addressing specific chemistry topics, accessible to teachers.

The capacity for effective utilization of technology is increasing in importance in the scholarship of teaching and learning practice in agricultural education. There is scarce literature exploring students’ perceptions of the use of digital assessment tools (DATs). This study aimed to explore the experiences and perceptions of graduate students enrolled in a teaching and learning course towards DATs while investigating how the experimental active learning space impacted the way participants experienced DATs. Participants were divided into two focus groups, which, due to the COVID-19 pandemic, were conducted via Zoom. The research used phenomenology as the qualitative approach to answer the research questions. Thematic Analysis was utilized as the method of data analysis. DATs were experienced by participants as new opportunities to enhance their assessment practice in educational settings. While recognizing the advantages of DATs, participants perceived new challenges in implementing them, particularly concerns over technology requirements. Participants reported a mixed educational experience in the new classroom. Whereas some participants felt the space was overwhelming and confusing, some students considered that the experimental classroom features made the space more collaborative. Finally, utilizing DATs in an experimental classroom was experienced as a new and enhanced way to adopt assessment tools.

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related deaths in the United States. National guidelines recommend germline genetic testing (GT) for all PDAC patients, but only 6.8-19% obtain GT. Current GT barriers include under-referral and genetic counselor shortage. Our goal was to improve uptake of GT among PDAC patients using a novel delivery model for genetic education and testing. Methods: The Genetic Information for Treatment Decisions (GIFTD) Initiative at Moffitt Cancer Center was created to streamline education and GT for PDAC patients. A Genetic Risk Education Coordinator (GREC), trained by licensed, board-certified genetic counselors, was hired to identify eligible patients and facilitate GT during clinician appointments. In partnership with Nest Genomics, a digital point-of-care tool was developed to collect personal and family history information, provide education about GT, and assess interest in GT. Patients receive a link from Nest ahead of their appointment via text and/or email to invite them to provide information and view education via mobile device. An auto-generated summary report with an indicator regarding GT interest is created in real-time for the GREC. Results: Seventy patients were invited to the Nest tool over the six-week launch period. Of those who opened the link, 83% (35/42) logged into their Nest account. Of these patients who logged into Nest, 71% (25/35) completed Nest’s GT education. The GREC met with 68% (17/25) of the patients that completed the education. 76% (13/17) of these patients were consented to GT. There were 2 patients who initially indicated that they were not interested in genetic testing in Nest but changed their mind after meeting with the GREC. Conclusion: Moffitt's collaboration with Nest through the GREC has successfully facilitated prompt germline genetic testing for PDAC patients, aiding in informed treatment decisions and family screening. Our preliminary findings suggest that the scalable Nest tool successfully captures PDAC patients who may be interested in GT, but follow-up with the GREC may further increase GT rates. Future directions for increasing uptake of GT and adhering to national guidelines include additional personalization and enhancement of the Nest tool. Citation Format: Jennifer B. Permuth, Sophie Moravec, Laura V. Barton, Revathy Suresh, Susan T. Vadaparampi, Jessica Rivera Rivera, J. Kevin Hicks, Teresa Ho, Dae Won Kim, Russel Palm, Pamela J. Hodul, Tara Schmidlen, Moran Snir, Laura Hayward. Implementing timely germline genetic testing for patients with pancreatic cancer via a point-of-care digital education and health assessment tool [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB145.

This research aims to analyze the challenges of using digital tools in education for children who tend to spend time playing online games at MI AT-Tarbiyah Banjarsari, Banjarsari District. Sumberasih. In the digital era, the use of digital tools in learning is becoming increasingly important. However, children's tendency to spend time playing online games can be a barrier to the effective use of digital tools in educational settings. This research method uses a qualitative approach with data collection techniques through observation, interviews and documentation studies. The research subjects were teachers, parents and students of MI AT-Tarbiyah Banjarsari District. Sumberasih has a tendency to spend time playing online games. The research results show that there are several challenges in using digital tools in children's education at MI AT-Tarbiyah Banjarsari. Factors such as parents' lack of understanding of the benefits of digital tools in education, limited access to technology, and the strong appeal of online games are the main obstacles. This research recommends the need to increase parents' understanding of the benefits of digital tools in education, the active involvement of teachers in developing interesting educational content, and the development of school policies that support the positive use of digital tools. In this way, it is hoped that we can overcome challenges and increase the effectiveness of the use of digital devices in improving the quality of education for children who tend to spend time playing online games.

Virtual versus reality: Assessing the accuracy of a digital cancer risk assessment tool in a gynecologic oncology clinic.

In the current study, academic research on the application of digital tools in math education was analyzed via bibliometric analysis methods and general trends, structural evolution, and thematic concerns in the subject under analysis. Using the keyword term 'application of digital tools in math education' from the Web of Science database, 486 articles till January 2025 were systematically analyzed. Throughout the research, open-source RStudio and R software bibliometric were used in bibliometric analysis. The study shows that research on the use of digital tools in mathematics teaching has had a tremendous surge in recent years. It has been found that interest in digital tools has grown particularly after 2006, and this growth has been enhanced after 2014. Due to the COVID- 19 pandemic, the use of digital tools in education has become a necessity and this has caused studies after 2020 to grow significantly. ZDM-Mathematics Education and Computers & Education journals are particularly notable among the journals in which the studies were published most frequently. Among the most contributing nations are the USA (186 articles), Spain (98 articles), Germany (78 articles) and China (65 articles). In author collaboration analysis, it was discovered that the most active author was Drijvers P. According to results from keyword analysis, the most frequent words were 'mathematics' (f = 52), 'education' (f = 38) and 'digital tools' (f = 30). Evidence based on bibliometric findings suggests that computer tools possess attributes such as concretization of abstract mathematics, improvement in pupil outcomes and the creation of interactive learning environments. However, by studying publication variation between countries, it has been observed that research funding and collaborative academic publications influence the productivity of publications. Additionally, keeping in view the limitations of bibliometric analysis, it is suggested that future studies must investigate more rigorously the adoption of artificial intelligence-based digital tools in the education of mathematics.

BackgroundDigital assessment tools in health care are increasingly used to aid clinicians in diagnosing mental health conditions. Particularly since the quarantine and isolation guidelines of the COVID-19 pandemic moved much of health care online, there has been an accelerated adoption of digital assessment tools. The diagnostic accuracy of digital mental health assessment tools for a range of psychiatric conditions has yet to be fully explored, especially for their use in populations of older adults and children.ObjectiveThis systematic review aims to (1) summarize recent studies on digital self-report question-and-answer–based mental health assessment tools for use in all ages across a range of psychiatric conditions (eg, the type and number of questions, if available; reference tests; timing; and blinding procedures), (2) present their validity (ie, diagnostic accuracy), and (3) assess study quality and applicability.MethodsThe PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guided the development of this protocol. The protocol has been registered with PROSPERO. The searches were guided by the PICO (population, intervention, comparator, and outcome) framework. A systematic search was conducted of the following databases of literature published since 2021: MEDLINE, Embase, Cochrane Library, ASSIA, Web of Science Core Collection, CINAHL, and PsycINFO. Searches of clinical trial databases and hand searching of reference lists will be completed. Two authors have independently screened titles and abstracts of identified papers and selected studies according to eligibility criteria, resolving inconsistencies through discussion. Full texts were screened following the same process. The authors extracted data using the Covidence data extraction tool (Veritas Health Innovation Ltd; eg, sensitivity and specificity). Two authors will use the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool to assess risk of bias for each full-text inclusion.ResultsScoping for this review began in December 2024. Searches of databases were completed in January 2025. Full-text screening and identification of the relevant gray literature were completed by the end of August 2025, and the final review is expected to be completed by December 2025.ConclusionsThe review aims to present the validity and quality of the diagnostic accuracy of digital mental health assessment tools across different ages (including children and older adults), particularly following the COVID-19 pandemic due to the exponential increase in development and use of such tools. This review will provide evidence for the wider deployment of digital mental health assessment tools across a wide age range. There will also be a discussion about future research for digital tools and avenues for policy around digital mental health assessments.

<p dir="ltr">Introduction<br>Clinical education is a cornerstone of undergraduate nursing programs, traditionally situated in hospitals and other care facilities. However, the rising demand for placements highlights the need for alternative learning environments. The Emergency Medical Services (EMS) represents an underutilized, but valuable context that exposes undergraduate nursing students (UNS) to diverse patient encounters, fosters interprofessional collaboration, and strengthens rapid decision-making skills in unpredictable situations. Despite its potential, assessing UNS in EMS is complex due to brief patient interactions, multiple supervisors, and dynamic clinical conditions. Traditional assessment instruments, developed for hospital context, may not capture the unique competencies required in EMS, such as adaptability, rapid clinical reasoning, and teamwork. Moreover, reliance on summative assessments can limit opportunities for ongoing learning. Consequently, there is a need to explore innovative feedback approaches that supports formative assessment, promote objectivity, and ensure alignment with intended learning outcomes (LO`s) and national curriculum standards. This thesis addresses this gap through three studies exploring UNS learning experiences and assessment processes during clinical education in the EMS, focusing on the use of digital assessment tool (DAT) and Multi-source feedback (MSF) to enhance formative and assessment.</p><p dir="ltr"><br></p><p dir="ltr">Methods<br>A mixed-methods approach was employed in study I were 50 clinical supervisors assessed four simulated scenarios using two different instruments with similar LOs, followed by 28 qualitative interviews. Quantitative data were analysed using descriptive statistics and logistic regression, while qualitative data were analysed using thematic analysis. Study II used a qualitative design, with group interviews including 16 UNS and individual interviews including 13 supervisors, focusing on their experiences using a DAT in EMS for formative feedback purposes. Data were analysed using Graneheim and Landman’s method for content analysis. Study III adopted a qualitative, inductive approach, conducting four focus group interviews with 31 final-semester UNS who received MSF facilitated by a digital tool during EMS placements. Data were analysed using reflexive thematic analysis according to Braun and Clark.</p><p dir="ltr"><br></p><p dir="ltr">Results<br>Study I demonstrated that while the two assessment instruments produced equivalent pass/fail outcomes, supervisors reported challenges with subjectivity, ambiguous phrasing of LOs, and inconsistent grading scales. These factors contributed to arbitrary judgments, limited day-to-day use, and difficulties in providing formative feedback. Supervisors emphasized the potential of team-based assessments and repeated evaluations to improve validity.</p><p dir="ltr">Study II found that both UNS and supervisors experienced DAT as supportive of learning, reflection, and transparency. The Likert scale enabled visualization of progress, and the digital format facilitated communication compared to traditional paper-based methods. UNS valued its clarity and structure, while supervisors noted improved opportunities for formative feedback. However, participants requested greater integration with university systems and stronger links to course objectives.<br>Study III highlighted UNS positive experiences with MSF in EMS. Feedback from supervisors and peers fostered self-awareness, professional growth, and reflective practice, while input from patients and health care professionals provided diverse perspectives despite contextual and logistical challenges. UNS appreciated the breadth of insights offered through MSF but stressed the need for structured implementation and digital support to ensure relevance and manage workload constraints.</p><p dir="ltr"><br></p><p dir="ltr">Conclusion<br>This thesis demonstrates that assessment in EMS requires approaches that extend beyond traditional summative instruments and adapt to the unique challenges of the prehospital environment. While existing tools may yield consistent grading outcomes, their formative value is limited by subjectivity, unclear definitions, and contextual constraints. The findings show that DAT can enhance transparency, structure, and communication, offering UNS clearer insight into their learning progress. Similarly, MSF enriches professional development by incorporating diverse perspectives, fostering self-reflection, and supporting collaborative learning, although patient and interprofessional input can be challenging to obtain. Supervisors emphasized the potential of team-based approaches to mitigate subjectivity and strengthen validity, highlighting the importance of structured support in the assessment process. Collectively, the three studies underscore the need for innovative, context-sensitive feedback frameworks that align with curriculum standards while capturing competencies central to EMS practice, such as adaptability, rapid clinical reasoning, and teamwork. By integrating DAT and MSF into EMS education, clinical placements can evolve into structured, high-quality learning environments that not only enhance formative assessment but also prepare UNS for safe, effective, and patientcentred care.</p><h3>List of scientific papers</h3><p dir="ltr">I. <b>Tomas N</b>, Italo M, Eva B, Veronica L. Assessment during clinical education among nursing students using two different assessment instruments. BMC Med Educ. 2024;24(1):852. <a href="https://doi.org/10.1186/s12909-024-05771-x" rel="noreferrer" target="_blank">https://doi.org/10.1186/s12909-024-05771-x</a></p><p dir="ltr">II. <b>Nilsson T</b>, Masiello I, Broberger E, Lindström V. Digital feedback during clinical education in the emergency medical services: a qualitative study. BMC Med Educ. 2023 Mar 14;23(1):156. <a href="https://doi.org/10.1186/s12909-023-04138-y" rel="noreferrer" target="_blank">https://doi.org/10.1186/s12909-023-04138-y</a></p><p dir="ltr">III. <b>Nilsson T</b>, Masiello I, Broberger E, Lindström V. Clinical education: nursing students' experiences with multisource feedback using a digital assessment instrument in the emergency medical service - a qualitative study. BMC Med Educ. 2025;25(1):391. <a href="https://doi.org/10.1186/s12909-025-06950-0" rel="noreferrer" target="_blank">https://doi.org/10.1186/s12909-025-06950-0</a></p>

<p dir="ltr">Introduction<br>Clinical education is a cornerstone of undergraduate nursing programs, traditionally situated in hospitals and other care facilities. However, the rising demand for placements highlights the need for alternative learning environments. The Emergency Medical Services (EMS) represents an underutilized, but valuable context that exposes undergraduate nursing students (UNS) to diverse patient encounters, fosters interprofessional collaboration, and strengthens rapid decision-making skills in unpredictable situations. Despite its potential, assessing UNS in EMS is complex due to brief patient interactions, multiple supervisors, and dynamic clinical conditions. Traditional assessment instruments, developed for hospital context, may not capture the unique competencies required in EMS, such as adaptability, rapid clinical reasoning, and teamwork. Moreover, reliance on summative assessments can limit opportunities for ongoing learning. Consequently, there is a need to explore innovative feedback approaches that supports formative assessment, promote objectivity, and ensure alignment with intended learning outcomes (LO`s) and national curriculum standards. This thesis addresses this gap through three studies exploring UNS learning experiences and assessment processes during clinical education in the EMS, focusing on the use of digital assessment tool (DAT) and Multi-source feedback (MSF) to enhance formative and assessment.</p><p dir="ltr"><br></p><p dir="ltr">Methods<br>A mixed-methods approach was employed in study I were 50 clinical supervisors assessed four simulated scenarios using two different instruments with similar LOs, followed by 28 qualitative interviews. Quantitative data were analysed using descriptive statistics and logistic regression, while qualitative data were analysed using thematic analysis. Study II used a qualitative design, with group interviews including 16 UNS and individual interviews including 13 supervisors, focusing on their experiences using a DAT in EMS for formative feedback purposes. Data were analysed using Graneheim and Landman’s method for content analysis. Study III adopted a qualitative, inductive approach, conducting four focus group interviews with 31 final-semester UNS who received MSF facilitated by a digital tool during EMS placements. Data were analysed using reflexive thematic analysis according to Braun and Clark.</p><p dir="ltr"><br></p><p dir="ltr">Results<br>Study I demonstrated that while the two assessment instruments produced equivalent pass/fail outcomes, supervisors reported challenges with subjectivity, ambiguous phrasing of LOs, and inconsistent grading scales. These factors contributed to arbitrary judgments, limited day-to-day use, and difficulties in providing formative feedback. Supervisors emphasized the potential of team-based assessments and repeated evaluations to improve validity.</p><p dir="ltr">Study II found that both UNS and supervisors experienced DAT as supportive of learning, reflection, and transparency. The Likert scale enabled visualization of progress, and the digital format facilitated communication compared to traditional paper-based methods. UNS valued its clarity and structure, while supervisors noted improved opportunities for formative feedback. However, participants requested greater integration with university systems and stronger links to course objectives.<br>Study III highlighted UNS positive experiences with MSF in EMS. Feedback from supervisors and peers fostered self-awareness, professional growth, and reflective practice, while input from patients and health care professionals provided diverse perspectives despite contextual and logistical challenges. UNS appreciated the breadth of insights offered through MSF but stressed the need for structured implementation and digital support to ensure relevance and manage workload constraints.</p><p dir="ltr"><br></p><p dir="ltr">Conclusion<br>This thesis demonstrates that assessment in EMS requires approaches that extend beyond traditional summative instruments and adapt to the unique challenges of the prehospital environment. While existing tools may yield consistent grading outcomes, their formative value is limited by subjectivity, unclear definitions, and contextual constraints. The findings show that DAT can enhance transparency, structure, and communication, offering UNS clearer insight into their learning progress. Similarly, MSF enriches professional development by incorporating diverse perspectives, fostering self-reflection, and supporting collaborative learning, although patient and interprofessional input can be challenging to obtain. Supervisors emphasized the potential of team-based approaches to mitigate subjectivity and strengthen validity, highlighting the importance of structured support in the assessment process. Collectively, the three studies underscore the need for innovative, context-sensitive feedback frameworks that align with curriculum standards while capturing competencies central to EMS practice, such as adaptability, rapid clinical reasoning, and teamwork. By integrating DAT and MSF into EMS education, clinical placements can evolve into structured, high-quality learning environments that not only enhance formative assessment but also prepare UNS for safe, effective, and patientcentred care.</p><h3>List of scientific papers</h3><p dir="ltr">I. <b>Tomas N</b>, Italo M, Eva B, Veronica L. Assessment during clinical education among nursing students using two different assessment instruments. BMC Med Educ. 2024;24(1):852. <a href="https://doi.org/10.1186/s12909-024-05771-x" rel="noreferrer" target="_blank">https://doi.org/10.1186/s12909-024-05771-x</a></p><p dir="ltr">II. <b>Nilsson T</b>, Masiello I, Broberger E, Lindström V. Digital feedback during clinical education in the emergency medical services: a qualitative study. BMC Med Educ. 2023 Mar 14;23(1):156. <a href="https://doi.org/10.1186/s12909-023-04138-y" rel="noreferrer" target="_blank">https://doi.org/10.1186/s12909-023-04138-y</a></p><p dir="ltr">III. <b>Nilsson T</b>, Masiello I, Broberger E, Lindström V. Clinical education: nursing students' experiences with multisource feedback using a digital assessment instrument in the emergency medical service - a qualitative study. BMC Med Educ. 2025;25(1):391. <a href="https://doi.org/10.1186/s12909-025-06950-0" rel="noreferrer" target="_blank">https://doi.org/10.1186/s12909-025-06950-0</a></p>