The Use of Micro-Credentials in Health Professions Education: A Scoping Review

Research co-production approach and knowledge user involvement

This project is grounded in a research co-production framework, where knowledge users actively participate as partners in the research process [30]. Since the results will inform an educational initiative for the respiratory therapy profession in Canada, representatives of the professional association (the Canadian Society of Respiratory Therapists) and its board of directors are included as key knowledge users [31]. Specifically, they collaborated in refining and aligning the objectives and research questions, shaped the methodology, and participated in the search, selection, data extraction, analysis and dissemination of the final results [3032].

We used the six-stage methodological framework developed by Arksey and O’Malley [33], further refined by Levac and colleagues [34] and the JBI [35]. In keeping with the purpose of scoping reviews [36], we chose this type of review as it is designed to a) identify the types of available evidence in a given field, b) clarify key concepts/definitions in the literature, c) examine how research is conducted on a certain topic or field, and d) identify key characteristics or factors related to a concept. The full protocol was registered a priori in the Open Science Framework [37]. This study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR) checklist [38].

Stage 1- Formulating the research question

The overarching research question guiding this review is: what is known about the use of micro-credentials in health professions education? The sub-questions include: 1) What are the instructional design features of micro-credentials in health professions education (e.g., cohort size, length, format)? 2) What pedagogical theories and approaches underpin the design of micro-credential programs in health professions education?; 3) What types of assessment strategies are used to evaluate learning outcomes?; 4) What are the reported impacts of using or implementing micro-credentials?

Stage 2- Identifying the relevant literature

The research team worked with an academic research librarian (PF) to develop a database search strategy to retrieve records on micro-credentials in the context of health professions education. The search strategy was developed in MEDLINE and inspired by a previous review on the topic [39]. It was externally peer-reviewed by a second librarian according to the PRESS guidelines and then translated for other databases [40]. Supplemental File 1 includes the full search strategies. We systematically searched MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), ERIC (Ovid), Education Source (EBSCOhost), Scopus, and APA PsycINFO (Ovid) from the inception dates of the databases to December 2024. The references of the final included papers were hand-searched for additional relevant articles.

To complement the database searches, we conducted a structured grey literature search of Canadian sources. We reviewed the websites of institutions of higher education across all provinces in Canada that offered micro-credentials for healthcare professionals. Specifically, we conducted searches across the websites of U15 universities in Canada using each institution’s internal site search engine. The U15 is a group of Canada’s leading research-intensive universities committed to advancing research, innovation, and higher education. Commonly used search terms included “micro-credential,” “micro-credential AND health,” and “micro-credential AND continuing education.” When searches returned more than 50 results, only the first 50 were reviewed. This process was then repeated across all other Canadian universities with medical degree-granting faculties. Additionally, we searched the eCampus Ontario platform using its internal search filters to identify micro-credentials, further narrowing results with the keyword “health.” We then manually searched the websites of institutions identified as offering health-related micro-credentials. eCampus Ontario is a provincially funded organization that supports innovation, collaboration, and digital learning in Ontario’s post-secondary education system. Sources were included if their publicly available data addressed at least one of our research questions and specified a method of assessment. Grey literature searches were conducted between December 2024 and January 2025 and updated in May 2025.

We used the Population, Concept, and Context (PCC) framework to assess whether a paper was relevant to our research question and to define our inclusion and exclusion criteria [41]. The population for this review includes healthcare professionals. We define healthcare professionals as individuals formally recognized by a credentialling body as professionals who have passed and maintained all the qualifications to practice in that profession in a given state, province, or country. The list includes, but is not limited to, physicians, nurses, pharmacists, dietitians, social workers, clinical psychologists, and rehabilitation professionals (occupational therapists, physiotherapists, respiratory therapists, speech-language pathologists). We considered papers written in any language for inclusion and used a neural machine translation engine (DeepL) to translate articles into English to determine their eligibility.

The concept of interest is the use of micro-credentials to support continuous learning (i.e., CPD). We broadly define micro-credentials as short, competency-based certifications that validate and assess specific skills and knowledge aligned with industry or community needs. They are awarded by various providers, portable, and may complement larger qualifications. Micro-credentials are often used for upskilling and enhancing employability and are underpinned by quality assurance. We excluded records that described digital badges solely as visual indicators of participation or completion without formal assessment or credentialed learning, or records that described micro-learning strategies solely, defined as short, focused instructional content without associated certification or validation of learning outcomes.

The context for this review is continuing education in healthcare professions worldwide. Given that this review supports the development of an educational initiative for the respiratory therapy profession in Canada, we limited inclusion to papers that addressed at least one of the guiding research questions: (1) the design features of micro-credentials, (2) the pedagogical theories or approaches underpinning their development, (3) the assessment strategies used to evaluate learning outcomes, and (4) the reported impacts of implementing micro-credentials. Records that did not contribute substantively to at least one of these questions were excluded to ensure the relevance and applicability of findings to the intended knowledge user context. Supplemental File 2 includes the inclusion and exclusion criteria.

Stage 3- Selecting the literature

Following the search, all identified records were imported into Covidence for duplicate removal and screening. The screening process consisted of two phases: a title and abstract review followed by a full-text review, carried out by three members of the research team (MZ, BD, ST).

For the title and abstract screening phase, all records were dual-screened. MZ served as the lead reviewer and screened all records, while BD and ST each independently screened 50% of the identified records. To ensure consistency, each reviewer pair (MZ+BD and MZ+ST) first completed a calibration exercise on 5% of the records. Reviewers independently screened these records and then met to discuss discrepancies. This process was repeated until a 90% agreement rate was reached [42]. Once the 90% agreement was reached, the remaining records were screened independently by each pair.

After screening all titles and abstracts, the team conducted full-text dual screening of the included papers using the same approach as previously described. In cases of disagreement, the reviewer pair discussed their decisions and attempted to reach consensus. If consensus could not be reached, the third team member resolved the conflict by reviewing the article and making the final decision.

Stage 4- Data charting

The full research team participated in developing a data extraction form and mounted it onto Microsoft Excel. The charting form was based on existing micro-credential concept forms used in academic institutions [434445]. The forms included information about each paper, including author(s), year of publication, country of origin, type of study, specific healthcare professional, design features of micro-credentials (e.g., delivery methods), gaps that the course aims to fill, learning outcomes, competencies, pedagogical theories/approach, assessment tools and information pertaining to the outcomes or impacts of micro-credentials (Supplemental File 3).

Although the original protocol outlined proposed dual independent data extraction following calibration, a pragmatic decision was made for the corresponding author (MZ) to complete data extraction for all included studies. This decision was based on resource limitations and the availability of team members during the review timeline. This approach is considered acceptable when justified, as noted in methodological references [4146]. To maintain consistency, several safeguards were implemented: the extraction tool was structured and piloted to ensure clarity and reduce subjectivity, we documented all decisions systematically, and conducted regular check-ins with the two other reviewers (BD, ST) to review a subset of entries and clarify uncertainties. This approach promoted transparency and analytic rigour while balancing feasibility.

Stage 5 – Reporting the results

Data analysis consisted of two phases: a numerical (i.e., bibliometric) analysis and qualitative content analysis [41]. The numerical analysis involved reporting the frequency and distribution of characteristics such as year of publication, country of origin, the targeted professions, terminology used to describe the micro-credentials, duration and cost to complete the micro-credential, and the modes of content delivery. The process of qualitative content analysis began with repeatedly reading all the excerpts to immerse oneself in the data. This is followed by reading excerpts word by word to capture key thoughts and concepts, and then using those concepts to generate the codes. We then organized the codes into categories based on how they were related and linked. Finally, we organized the categories into meaningful clusters.

Specifically, we also organized the extracted data related to the assessment strategies according to Miller’s Pyramid, which served as a guiding framework for classifying competency levels. While originally developed for assessing medical students and trainees, Miller’s Pyramid remains widely used across health professions, including in CPD [47]. This approach allowed us to identify whether micro-credential assessments primarily targeted knowledge acquisition or applied competencies.

Stage 6- Consultation with knowledge users

This project is grounded in a co-production framework [3032]. Two knowledge users (ST and AJW), who are members of the broader project steering committee, assumed more active leadership roles in this particular study. They contributed to the development of the research questions, data extraction and analysis, and interpretation of the findings. Additionally, BD, a practicing clinician, brought the end-user perspective to the team. Once the manuscript was drafted, we shared it, along with an executive summary of the results with the project steering committee. This group includes students and practicing professionals from various provinces and practice areas (e.g., education, clinical management, and bedside care). They were invited to review the findings and provide written feedback to ensure relevance and contextual accuracy. Their perspectives have been incorporated into the final manuscript.

The research team included both respiratory therapists and non-respiratory therapy members. While the project was conducted in the context of respiratory therapy to inform ongoing professional development initiatives, we deliberately structured the research questions and analytic process to ensure the findings would be applicable and relevant across health professions and educational contexts.

Numerical analysis

Table 1 summarizes the characteristics of the included papers. Most were published in 2024 (n = 8; 42.1%) and originated from the United States (n = 8; 42.1%). Nearly half of the studies (n = 9; 47.4%) did not employ a formal methodology and primarily consisted of descriptive accounts of micro-credential programs. Most micro-credentials were targeted at nurses (n = 11; 57.9%), followed by physicians (n = 6; 31.6%). No information about these characteristics was available for the grey literature.

Table 2 summarizes the characteristics of micro-credentials described in the included papers and grey literature, where available. Most papers used the term micro-credential verbatim (n = 11; 57.9%), while some referred to digital badges (n = 4; 21.1%). Many micro-credentials focused on job- or discipline-specific topics (n = 14; 73.7%), including addiction medicine, bladder cancer management, gerontological care, global health, Indigenous cultural safety, and nighttime support for individuals living with dementia.

The training needs included in micro-credentials were most commonly identified by healthcare institutions/employers (n = 5; 26.3%). In over half of the papers, the micro-credentials were co-designed with the stakeholders who initially identified the need (n = 11; 57.9%). Most programs were delivered exclusively online (n = 8; 42.1%).

Information about instructors or facilitators was often lacking, with over half of the papers not specifying who led the training (n = 11; 57.9%). Among the peer-reviewed papers, micro-credentials were typically offered free of charge to participants under study (n = 7; median cost = $0 [IQR $0–96.75]) and required a median of 16 hours to complete (n = 15; IQR 10.6–28.5 hours). In contrast, the grey literature, which consisted of institutional websites, more commonly described micro-credentials that were delivered online and asynchronously (n = 22; 68.8%), with a median cost of $514 (n = 28; IQR $218.75–905.75) and a median duration of 35 hours (IQR 10.5–62.25 hours).

Qualitative content analysis

We conducted a qualitative content analysis of the included peer-reviewed and grey literature sources to address our four research questions. Using inductive data analysis, we systematically extracted and coded descriptive text related to the following categories: (1) design features, (2) pedagogical theories/approaches underpinning micro-credentials, (3) assessment strategies, and (4) reported impacts. Codes were grouped into categories based on recurring patterns and features across studies.

Assessment in micro-credentials: Focused on knowing

Assessment strategies across the reviewed peer-reviewed papers primarily emphasized summative assessment (i.e., assessment of learning) methods, with a focus on knowledge-check tasks such as multiple-choice questions and quizzes [4849505558596061]. We organized these summative assessments according to Miller’s Pyramid of Clinical Competence as a guiding framework [47] (Figure 2). In the context of assessment, Miller’s Pyramid provides a structured framework for evaluating competence, progressing from assessing factual knowledge (knows), to applied understanding (knows how), to demonstration of skills in controlled settings (shows how), and ultimately to performance in real-world practice (does). The summative assessments described in the papers were predominantly situated at the “knows” and “knows how” levels. In fewer cases (n = 4; 25.0%), assessments moved beyond knowledge recall to evaluate higher-level competencies, such as “shows how” through simulation or team-based tasks. For example, defining a problem as a team, generating an executive summary, and presenting it as a team [62]. Another example includes teams co-creating a knowledge translation tool or resource on family engagement in research (e.g., podcasts, videos, infographics) and presenting the resource [54]. No summative assessments were categorized under the “does” level.

Figure 2

Formative assessment (i.e., assessment for learning) strategies, such as self-reflection, discussion forums, and participating in synchronous and asynchronous peer discussions were occasionally used to support learner progression. This approach to assessment for learning provides deeper insight into what learners know and how they use it. This enables more effective modification of learning activities to engage learners and address individual student learning needs [63]. Additionally, few (n = 2; 10.5%) papers described the use of collaborative assessment, defined as an approach that incorporates reciprocal feedback between instructors and students or among peers. In these cases, assessment involved working in teams, co-creating knowledge translation tools, or engaging in peer “teach-back” activities [5254]. One paper (5.3%) made mention equity-oriented assessment methods, which allowed learners some control over how they were assessed, for example, by selecting their own project as part of the assessment to earn the micro-credential [62]. Overall, assessment practices in micro-credentials were largely weighted toward knowledge acquisition.

Assessment practices in the grey literature mirrored those in peer-reviewed sources, focusing primarily on knowledge acquisition. The most frequently reported strategy was the use of knowledge quizzes, which appeared across the majority of institutional listings (n = 24; 68.6%). Other approaches included self-assessment activities (n = 5; 14.3%), lab or simulation components (n = 5; 14.3%), written case projects (n = 3; 8.6%), and assessments tied to participation in discussion forums or reflective exercises (n = 2; 5.7%). In most cases, assessment strategies were listed in the course description but lacked detailed explanations of their purpose or alignment with learning outcomes. Across sources, assessment within micro-credentials remains largely limited to lower levels of competence and provides minimal insight into learners’ ability to apply or sustain skills in practice.

Strengths and limitations

This review has several strengths but is not without limitations. The search strategy was robust, developed in collaboration with an academic research librarian and externally peer-reviewed to ensure comprehensiveness and methodological rigor. The peer-reviewed literature captured international perspectives, ensuring that findings are not solely reflective of the Canadian context. For the grey literature, we included only publicly available webpages that described assessment criteria. While this may not capture all existing micro-credential offerings, it provides a strong snapshot of current practice.

The grey literature was limited to Canadian sources due to the co-production foundation of the study, which may affect the transferability of findings to other countries with different educational systems. However, the co-designed nature of the study is a strength, ensuring the findings are relevant, actionable, and useful for guiding the future development and evaluation of micro-credentials in health professions education.

Consistent with scoping review methodology, we did not conduct a formal quality appraisal of included studies, as our focus was on mapping the breadth and nature of the evidence rather than evaluating its quality. This limits our ability to distinguish methodologically rigorous studies from descriptive accounts, though this limitation reflects the current state of the field, where nearly half (47.4%) of identified papers lacked a formal research methodology.

Finally, this review focused specifically on practicing healthcare professionals, where micro-credentials remain an emerging area of research. As such, the findings may not apply to other disciplines, such as engineering or law, or be directly applicable to healthcare professional students. Finally, although the proposed composite framework does not constitute a formal theory, it integrates several well-established educational perspectives and provides a useful lens for understanding current micro-credentials and guiding their future design. Similarly, the assessment component of our analysis was guided by Miller’s Pyramid, which remains a widely used framework for categorizing competency levels in health professions education. Nonetheless, frameworks specifically designed for CPD may provide additional insights for evaluating micro-credentials in professional learning contexts.