A study examined structures, processes, and practices of assessing competence in nursing and midwifery education programs in Britain. The methodology included documentation, interviews, and observations. Most interviewees were clear about the shortcomings of traditional assessment. In a satisfactory partnership, all the partners made a significant contribution to the design of the assessment strategies and documents and felt a sense of ownership. Continuous dialogue was essential. Increasing the number of independent witnesses and increasing the evidence base were proposed to overcome inadequacies of the widely used checklist assessment format. The following contextual issues were raised by interviewees with regard to practice placement: liaison and continuity of support, course constraints, workplace demands, and individual commitment. Principles required for effective monitoring and development included the following: involvement of all relevant groups, appropriate support, putting discussion about assessment on the agenda, action based on discussion, and development on the national level. Dialogue was found to be a mechanism for combining learning and assessment in which theory was examined in the light of practice and practice in the light of theory. Recommendations were made for action to develop the assessment of competence in nursing and midwifery education. (Appendixes contain 18 references, 160-item bibliography, and a list of survey methods.) (YLB)