This article, titled “Scoping reviews in health professions education: challenges, considerations and lessons learned about epistemology and methodology,” authored by Aliki Thomas, Stuart Lubarsky, Lara Varpio, Steven J. Durning, and Meredith E. Young, offers a profound exploration into the application and philosophical underpinnings of scoping reviews, particularly within the field of health professions education (HPE).
The authors assert that a scholar’s philosophical stance, encompassing their understanding of fundamental concepts such as knowledge and evidence (epistemology), critically dictates how information from diverse literature is gathered, analyzed, and interpreted during a scoping review. This perspective piece aims to articulate the core principles guiding scoping reviews and to demonstrate how epistemology – defined as the branch of philosophy concerning “the nature of knowledge, the justification of beliefs, and rationality” – should inform methodological choices to ensure the production of high-quality reviews with defensible conclusions.
Key aspects discussed in the article include:
- Purpose and Distinction of Scoping Reviews:
- Scoping reviews are increasingly utilized in HPE to synthesize research and scholarship, and to report on the breadth and depth of literature on a given topic.
- Their primary purpose is to explore and describe the breadth of knowledge related to a specific topic, effectively mapping the literature to identify key concepts, gaps, and various types and sources of evidence.
- This stands in contrast to systematic reviews, which primarily aim to identify, evaluate, and integrate pre-existing literature to answer a specific research question.
- A critical point is that these different review types possess distinct purposes, methods, and quality indicators, all stemming from their underlying philosophical orientations. Therefore, applying quality standards from one review type to another is inappropriate.
- The Centrality of Epistemology:
- The authors emphasize that epistemology is at the heart of research methodology. It forms the foundation upon which a researcher determines what kind of knowledge is considered possible, adequate, and legitimate in any study.
- Every study, and indeed every researcher, inherently addresses epistemological questions, such as: What constitutes legitimate and meaningful data? What data are trustworthy? Is objective, quantifiable data more legitimate than subjective, qualitative constructions? Is there an external, objective truth that can be identified?.
- Understanding the epistemological foundations of a methodology is vital for rigorous knowledge synthesis and for avoiding low-quality syntheses or erroneous conclusions.
- Epistemological Alignment of Scoping Reviews:
- Scoping reviews historically emerged from the social sciences to synthesize broad, complex knowledge from diverse methodological and epistemological traditions.
- They are primarily aligned with “subjectivism” (also labeled “transactional/subjectivist”), an epistemology that rejects the notion of a single objective truth to discover.
- Instead, subjectivism posits that individuals construct their own understanding of reality through interactions. In this view, researchers are inherently shaped by their lived experiences, which inevitably influence the knowledge they generate and the data they collect.
- While most commonly rooted in subjectivism, the article notes that scoping reviews can be conducted from an objectivist epistemology (e.g., post-positivism), though such an approach would necessitate modifications to align the review process with that stance.
- Authors’ Experience and Methodological Challenges:
- The authors illustrate how their own experiences conducting a scoping review on clinical reasoning helped them understand how philosophical underpinnings shape the process of gathering, analyzing, and interpreting knowledge from a heterogeneous body of literature.
- They highlight methodological challenges and potential resolutions that arose from a deeper understanding of the methodology’s philosophical basis. For example:
- Research Questions (Step 1): Scoping review questions should be broad, open, and exploratory, focusing on mapping or describing (“what” or “how”), reflecting constructivism, rather than seeking definitive “solutions” or singular “truths”.
- Study Selection (Step 3): Given the subjectivist foundation, simply computing inter-rater agreement (e.g., Kappa) as a marker of rigor might be inappropriate. Disagreements among reviewers can themselves be an important indicator of the current state of knowledge on a topic. In their clinical reasoning review, the authors chose not to calculate agreement because a consensus definition for study selection would have contradicted their goal of mapping diverse understandings of the concept.
- Data Charting (Step 4): A subjectivist stance allows for a broad scope of inclusion for manuscripts, leading to highly variable data. The team must work iteratively to develop extraction methods that allow for comparison, amalgamation, and insight generation from this diverse data.
- Collating and Reporting (Step 5): Remaining true to subjectivism requires acknowledging diverse ways of aggregating and analyzing data. The authors’ review on clinical reasoning, for instance, unexpectedly identified 110 different terms related to clinical reasoning, necessitating adaptations to their analysis plan and demonstrating how a subjectivist perspective can enrich findings by mapping multiple terminologies.
- Stakeholder Consultation (Step 6): This optional step, when adopted, should involve stakeholders as equal partners, acknowledging their expertise and the multiple ways of knowing that underpin scoping reviews.
- Lessons Learned:
- The authors share key lessons for scholars undertaking scoping reviews, including the importance of communication among team members, transparency and thorough documentation of discussions and decisions, and embracing iteration and methodological adaptations.
- Teams should anticipate and be prepared to articulate and defend methodological choices, especially when deviating from traditional approaches, while respecting the methodology’s epistemological base and acknowledging disciplinary and epistemological differences within the team.
- The inherent iterative nature of scoping reviews, particularly when mapping new or emerging areas, necessitates a flexible “analyze as you go” approach, involving pauses for preliminary analyses and reflection.
In conclusion, the manuscript aims to guide scholars in HPE by describing the foundational principles of scoping reviews and illustrating how their philosophical underpinnings should inform methodological considerations, ultimately sharing lessons learned to help others avoid common pitfalls related to the epistemological foundations of this review type.
Reference: Thomas, A., Lubarsky, S., Varpio, L., Durning, S. J., & Young, M. E. (2019). Scoping reviews in health professions education: challenges, considerations and lessons learned about epistemology and methodology. Advances in Health Sciences Education. https://doi.org/10.1007/s10459-019-09932-2