The Determinants of Clinical Competence: A Systematic Review

Abstract

Clinical competence is central to safe, reliable health care because it translates professional knowledge, technical skill, judgement, communication, and adaptive performance into practice. This systematic literature review synthesised determinants of clinical competence across health-professional education and practice. The evidence base was concentrated in nursing populations, which limits cross-professional generalisation. A PRISMA-informed narrative synthesis covered English-language primary empirical studies published from 1 January 2015 to 31 December 2025. Sixty-three studies met the eligibility criteria and were mapped across thirteen determinant domains. The evidence most consistently supported clinical experience and exposure, structured education and training, enabling clinical environments, effective supervision and support, and self-efficacy as contributors to competence development. Knowledge and academic performance, emotional resources, organisational empowerment, satisfaction and commitment, motivation and attitude, simulation and technology, stress and well-being, and demographic or contextual characteristics showed meaningful but more heterogeneous or context-dependent relationships. Simulation frequently improved task-specific or perceived competence, although comparative studies did not establish universal superiority over conventional clinical learning. The synthesis indicates that competence is best understood as a multilevel developmental outcome shaped by aligned educational, supervisory, organisational, and individual resources.