BackgroundPoint-of-Care-Ultrasound (POCUS) curricula have rapidly expanded in undergraduate medical education (UME). However, the assessments used in UME remain variable without national standards. This scoping review characterizes and categorizes current assessment methods using Miller’s pyramid for skills, performance, and competence of POCUS in UME.A structured protocol was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). A literature search of MEDLINE was performed from January 1, 2010, to June 15, 2021. Two independent reviewers screened all titles and abstracts for articles that met inclusion criteria. The authors included all POCUS UME publications in which POCUS-related knowledge, skills, or competence were taught and objectively assessed. Articles were excluded if there were no assessment methods used, if they exclusively used self-assessment of learned skills, were duplicate articles, or were summaries of other literature. Full text analysis and data extraction of included articles were performed by two independent reviewers. A consensus-based approach was used to categorize data and a thematic analysis was performed.ResultsA total of 643 articles were retrieved and 157 articles met inclusion criteria for full review. Most articles (n= 132; 84%) used technical skill assessments including objective structured clinical examinations (n= 27; 17%), and/or other technical skill-based formats including image acquisition (n= 107; 68%). Retention was assessed inn= 98 (62%) studies. One or more levels of Miller’s pyramid were included in 72 (46%) articles. A total of four articles (2.5%) assessed for students’ integration of the skill into medical decision making and daily practice.ConclusionsOur findings demonstrate a lack of clinical assessment in UME POCUS that focus on integration of skills in daily clinical practice of medical students corresponding to the highest level of Miller’s Pyramid. There exists opportunities to develop and integrate assessment that evaluate higher level competencies of POCUS skills of medical students. A mixture of assessment methods that correspond to multiple levels of Miller’s pyramid should be used to best assess POCUS competence in UME.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13089-023-00325-6.