Abstract
<title>Abstract</title> <p>Background Clinical reasoning is central to nurse practitioner (NP) preparation, yet NP-specific evidence about how reasoning is taught and assessed remains dispersed. Existing reviews of nursing and health professions education provide useful background, but they do not resolve the distinctive challenge of preparing nurses for expanded diagnostic responsibility, uncertainty management and accountable advanced practice decision-making. This scoping review mapped teaching strategies, assessment approaches, outcomes and evidence gaps in NP and advanced practice nursing education. Methods A scoping review was conducted using JBI guidance and reported with reference to PRISMA-ScR. PubMed, Scopus, Web of Science, ScienceDirect, SpringerLink and Google Scholar were searched from inception to 25 December 2025. Empirical qualitative, quantitative and mixed-methods studies were eligible when they included NP students, advanced practice nursing learners, registered nurses transitioning into advanced practice or NP trainees and reported a teaching strategy, assessment approach or reasoning-related outcome. Two reviewers screened records and charted data on study design, learner population, setting, pedagogical strategy, assessment approach, outcomes and main findings. Results Seven studies met the eligibility criteria. Teaching approaches included self-explanation during diagnostic cases, unfolding case scenarios, structured reflection in simulation, simulated patient encounters, physical examination competence development and clinical placement exposure. Assessment approaches included diagnostic accuracy, coded self-explanations, diagnostic reasoning scales, structural memory scores, confidence ratings and qualitative reflection. Across studies, the strongest pattern was not the superiority of one educational modality, but the value of designs that require learners to externalize, test and revise their thinking. Evidence was limited by small samples, single-site designs, short follow-up, reliance on perceived learning and weak measurement of transfer into authentic practice. Conclusions NP clinical reasoning education should move from modality-led teaching toward mechanism-led curriculum design. Educators should make reasoning visible through structured prompts, evolving cases, diagnostic justification, feedback and programmatic assessment across classroom, simulation, skills laboratory and clinical placement settings. Future research should use multi-site and longitudinal designs that test whether reasoning gains persist and transfer to unfamiliar patients and independent advanced practice. Trial registration Not applicable.</p>