Nursing education is shifting towards a competency-based model, as outlined in the American Association of Colleges of Nursing's 2021 Essentials. This means that nurse practitioner (NP) students need to demonstrate mastery of key knowledge, skills, and abilities required for practice. How can NP programs effectively assess competency development? One helpful framework highlighted in a recent journal article is Miller's Pyramid of Clinical Competence. Miller's Pyramid includes four ascending levels of competence: knows, knows how, shows how, and does. This builds from a foundation of core knowledge to being able to demonstrate and apply skills in practice. Here's a quick overview of what each entails: Knows: Factual knowledge assessed through multiple-choice questions or written reports Knows How: Understanding principles and being able to explain concepts Shows How: Demonstrating skill in a simulated setting Does: Performing the ...