Purpose/Hypothesis: Direct Observation (DO) is a necessary component of health professions education (HPE) and has been shown to benefit students and their assessors alike. DO consists of a supervisor watching a student complete a skill, patient evaluation, or other task that is relevant to his or her education. Despite literature demonstrating the effectiveness of DO, research is lacking across and within HPE programs regarding the specific methods that are utilized for observation. This review aims to further the body of research regarding the presence of, and potential need for, DO tool availability and standardization throughout HPE. Number of Subjects: N/A Materials and Methods: A systematic review methodology was followed to perform a comprehensive review of the health professions literature regarding DO of pre-licensure HPE students. The authors searched the databases PubMed, Scopus, Education Resources Information Center, The Cumulative Index to Nursing & Allied Health Literature, and Education Full-Text for articles published between 1998-2018. Relevant articles underwent data extraction and quality assessment utilizing the Best Evidence Medical Education (BEME) Guide Number 44. Results: 15 total articles covering medical, physical therapy, nursing, and occupational therapy programs were identified for review. Included studies were categorized based on purpose of the study by authors of the present review as follows: “Validation of a direct observation tool”, “Ease of use and student experience with a tool”, and “Qualitative assessment of health professions students.” A variety of tools and methods to carry out DO were identified in these studies. Among the identified tools, the Mini-Clinical Evaluation Exercise (mCEX) was reported as the most commonly used tool (4/15, 26.67%) and appears to be the most validated of the identified tools. Conclusions: Following review, no standardization among HPE programs regarding direct observation tools was found. Due to the lack of consistency across the tools utilized for direct observation, despite the mCEX being used in 4 of the 15 included studies, no recommendation can be made for using one DO tool over another at this time. Further research is warranted to determine the appropriateness of a standardized approach to DO of pre-licensure health professions students and the use of one tool or set of tools over others. Clinical Relevance: This review highlights the great variety and lack of consistency in the ways in which HPE students are being observed and trained in the clinic every day. The next step in identifying the best method for DO and assessment of HPE students is to determine the effectiveness and validation of the tools identified in this study.