Background: Video-based assessment is increasingly used in health professions education to develop clinical reasoning within theoretical learning contexts. In speech and language therapy education, it might help bridge the gap between theory and practice by exposing students to authentic communication interactions.Problem: Despite growing use of video analysis assessment, limited evidence exists on SLT students’ perceptions of its support for learning, clinical reasoning, assessment quality, and implementation. Understanding its educational value and perceived impact remains underexplored.Methodology: This study evaluated a video analysis assessment using a mixed-methods design. 29 SLT students completed a questionnaire and open-ended responses. Data were analysed using descriptive statistics and reflexive thematic analysis to explore perceptions of preparation, learning outcomes, and assessment quality.Results: Students reported strong support in observational skills, especially identifying communication behaviours and symptoms. Moderate support was seen in interpreting clinical information and applying ICF, while clinical decision-making was weaker. Qualitative data showed improved theory-practice transfer and engagement with authentic material, but also cognitive load and uncertainty. Overall findings indicate a mid-fidelity approach supporting early reasoning but requiring higher-fidelity learning for advanced decision-making.Conclusion: Video analysis assessment supports foundational clinical observation and should be combined with scaffolding and higher-fidelity learning experiences for clinical reasoning.