What exactly constitutes “science?” Science today is not the science of ancient or medieval times; modern science began with methodical, designed experiments, not solely observations. In the 21st century, modern empiricism and post-modernism philosophies of science co-exist as pathways to knowledge. Scientific initiatives – team science, discipline-specific science, innovation science and data analytics – are relative newcomers to what constitutes “science.” A critical challenge facing scientists and scholars is how we continue to develop scientific initiatives in this and future centuries.
When we first learn about science, we are told that it is a cooperative endeavor and systematic process that builds knowledge through research over time. Research scientists garner consensus until there are facts that form a knowledge base; the consensus period can take years or even decades. During this time, many different ideas and theories are espoused, and the scientific community tries to make sense of them, make them fit into a model or make them fit into the best guess about what is known. If we seek to support our ideas or budding theory, we search through the scientific literature where hundreds or even thousands of articles may be published. Instead of selectively opting (i.e. cherry picking) for those articles that align with our ideas, world view or paradigm, we could conduct a systematic review as a method to generate science.
The systematic review process accommodates both traditional science and new initiatives in science, to determine what we do and do not know, shape future research agendas and determine how consistent this information is and if it can be generalized across settings, populations and treatments. Systematic reviews can tell us whether findings vary by subgroups and what those implications may hold for knowledge translation. Similarly, systematic reviews can be used to identify and refine hypotheses, avoid errors of previous work, estimate sample sizes, delineate adverse effects and identify covariates that require additional research.
Done well, systematic review is a cost effective, scientific activity. A systematic review often takes less time than original research, with less cost, wasteful duplication and risk of harm. Synthesized findings can highlight and reinforce new healthcare findings, as in the case of placing babies supine for sleep, instead of prone.1 Mahtani1 advocates that all researchers perform a systematic review prior to conducting clinical trials and provide at least a brief review at the completion of their trial. Conducting pre-trial systematic reviews could address any scientific, ethical and economic concerns proactively.
What is the role of systematic reviews in the further development of the new scientific initiatives? Any scientific initiative can use systematic reviews to further define and move their discipline toward more knowledge and theoretical bases. However, how does science conceptualize the systematic review? Is it a structure, a process or an outcome? Donabedian2 developed a conceptual model that evaluates the quality of health care. In this framework, three boxes represent the domains of structure, process and outcome and are connected by unidirectional arrows (Figure 1). Applying Donabedian's three domains as a nexus, where are science and systematic reviews placed within this schema? We propose the following:
For scientific initiatives to continue to develop innovations and knowledge for translation, systematic reviews, linked with the elements of their structure, process and outcomes, constitute research synthesis that is “meant to focus on the re-use of existing data to address ‘big picture’ questions”.3 (p.1) Systematic reviews provide a venue for innovation and clarity on pragmatic and epistemological questions on clinical, empirical and conceptual knowledge for health care.
1. Mahtani KR. All health researchers should begin their training by preparing at least one systematic review. J R Soc Med
2016; 109 7:264–268.
2. Donabedian A. An introduction to quality assurance in health care. New York, NY:Oxford University Press; 2002.
3. Rodrigo A, Alberts S, Cranston K, Kingsolver J, Lapp H, McClain C, et al. Science incubators: synthesis centers and their role in the research ecosystem. PLoS Biol
2013; 11 1:e1001468.