This scoping review examined how competency frameworks have been developed across healthcare professions. From 5,710 screened citations, 190 studies were analysed. Literature reviews and group techniques were the most common approaches, each used in 61% of studies; stakeholder deliberation was used in 45%, mapping exercises in 38%, consensus methods in 28%, surveys in 26%, focus groups in 19%, interviews in 16% and practice analysis in only 12%. The median study used three methods, and 69% used three or more. Despite this activity, only 42% clearly explained why particular methods had been chosen, and only 4% reported evaluation of the final framework. The authors conclude that there is no apparent gold standard for competency-framework development and call for stronger guidance linking intended purpose, methodology, context, reporting and evaluation.