Programmatic Assessment in Health Professions Education: A Systematic Review of Its Impact on Learner Agency, Feedback Culture, and Professional Identity Formation
Abstract
A BSTRACT Programmatic assessment has emerged as a key component of competency-based health professions education, with the intention of supporting learning through the longitudinal use of assessment information and feedback. Despite its increasing adoption, questions remain regarding how programmatic assessment influences learners’ educational experiences beyond performance measurement, particularly in relation to learner agency, feedback culture, and professional identity formation. This systematic review synthesizes empirical evidence published between 2020 and 2025 to examine how programmatic assessment shapes these interrelated educational outcomes across health professions education contexts. A PRISMA-guided search was conducted across five databases—PubMed/MEDLINE, Scopus, Web of Science, ERIC, and PsycINFO—resulting in the inclusion of 23 peer-reviewed empirical studies. Given the conceptual and methodological diversity of the included literature, a theory-informed narrative synthesis was undertaken to explore underlying mechanisms and contextual influences. The findings indicate that programmatic assessment can support learner agency when assessment information is interpreted longitudinally and embedded within sustained mentoring or coaching relationships. Feedback culture emerged as a critical mediating factor, with dialogic feedback practices and psychologically safe learning environments facilitating meaningful learner engagement with assessment information. Professional identity formation was supported when learners were able to integrate cumulative feedback into coherent narratives of professional development. However, these benefits were not consistently observed across all settings. Tensions between formative intent and summative accountability, fragmented feedback practices, and variable faculty readiness were identified as factors constraining learning and developmental outcomes in some contexts.