Innovations in assessment for graduate and fellowship medical education in critical care: a scoping review

Background As critical care medical education advances within a competency-based framework, effective assessment strategies are essential to ensure trainees acquire the necessary skills for high-stakes situations. Despite growing interest, assessment practices remain inconsistent, with significant variations in their application, although conceptual and technological innovations support this process. This scoping review aimed to map the literature on innovation in assessment within graduate and fellowship critical care medical education. Methods Following the Joanna Briggs' Institute framework and PRISMA-ScR, a search of four databases (PubMed, Scopus, Web of Science, LILACS) was conducted for articles from January 2014 to June 2025. Results Sixty-seven peer-reviewed articles were analyzed across four domains: assessment methods and tools, competency frameworks, innovation and technology, and ethics in assessment. Assessment in critical care is shifting toward a structured, multimodal, formative, and longitudinal model. Commonly used tools include workplace-based assessments and simulation. Milestones and entrustable professional activities are increasingly used to support entrustment decisions and track progress. Technology-enhanced strategies, including high-fidelity simulations, mobile apps, and artificial intelligence, improve feedback quality and real-time assessment. Ethical challenges, especially rater bias, underassessment of professionalism, and inequities, remain persistent concerns, highlighting the importance of fairness and transparency in evaluation. Conclusions Graduate critical care assessment is advancing towards a programmatic, multidimensional model that integrates clinical and professional competencies. Emerging frameworks and digital platforms are supporting more equitable, formative, and trustworthy evaluations. Future efforts should focus on standardization, bias, and ethical practices throughout the assessment continuum.