what is descriptive literature review

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• Literature Review: The What, Why and How-to Guide
• Introduction

Literature Review: The What, Why and How-to Guide — Introduction

• Getting Started
• How to Pick a Topic
• Strategies to Find Sources
• Evaluating Sources & Lit. Reviews
• Tips for Writing Literature Reviews
• Writing Literature Review: Useful Sites
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What are Literature Reviews?

So, what is a literature review? "A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries." Taylor, D.  The literature review: A few tips on conducting it . University of Toronto Health Sciences Writing Centre.

Goals of Literature Reviews

What are the goals of creating a Literature Review?  A literature could be written to accomplish different aims:

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 

Baumeister, R. F., & Leary, M. R. (1997). Writing narrative literature reviews .  Review of General Psychology , 1 (3), 311-320.

What kinds of sources require a Literature Review?

• A research paper assigned in a course
• A thesis or dissertation
• A grant proposal
• An article intended for publication in a journal

All these instances require you to collect what has been written about your research topic so that you can demonstrate how your own research sheds new light on the topic.

Types of Literature Reviews

What kinds of literature reviews are written?

Narrative review: The purpose of this type of review is to describe the current state of the research on a specific topic/research and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weakness, and gaps are identified. The review ends with a conclusion section which summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.

• Example : Predictors and Outcomes of U.S. Quality Maternity Leave: A Review and Conceptual Framework:  10.1177/08948453211037398  

Systematic review : "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139). Nelson, L. K. (2013). Research in Communication Sciences and Disorders . Plural Publishing.

• Example : The effect of leave policies on increasing fertility: a systematic review:  10.1057/s41599-022-01270-w

Meta-analysis : "Meta-analysis is a method of reviewing research findings in a quantitative fashion by transforming the data from individual studies into what is called an effect size and then pooling and analyzing this information. The basic goal in meta-analysis is to explain why different outcomes have occurred in different studies." (p. 197). Roberts, M. C., & Ilardi, S. S. (2003). Handbook of Research Methods in Clinical Psychology . Blackwell Publishing.

• Example : Employment Instability and Fertility in Europe: A Meta-Analysis:  10.1215/00703370-9164737

Meta-synthesis : "Qualitative meta-synthesis is a type of qualitative study that uses as data the findings from other qualitative studies linked by the same or related topic." (p.312). Zimmer, L. (2006). Qualitative meta-synthesis: A question of dialoguing with texts .  Journal of Advanced Nursing , 53 (3), 311-318.

• Example : Women’s perspectives on career successes and barriers: A qualitative meta-synthesis:  10.1177/05390184221113735

Literature Reviews in the Health Sciences

• UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
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What is a Literature Review?

So, what is a literature review .

"A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available or a set of summaries." - Quote from Taylor, D. (n.d)."The Literature Review: A Few Tips on Conducting it".

• Citation: "The Literature Review: A Few Tips on Conducting it"

What kinds of literature reviews are written?

Each field has a particular way to do reviews for academic research literature. In the social sciences and humanities the most common are:

• Narrative Reviews: The purpose of this type of review is to describe the current state of the research on a specific research topic and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weaknesses, and gaps are identified. The review ends with a conclusion section that summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.
• Book review essays/ Historiographical review essays : A type of literature review typical in History and related fields, e.g., Latin American studies. For example, the Latin American Research Review explains that the purpose of this type of review is to “(1) to familiarize readers with the subject, approach, arguments, and conclusions found in a group of books whose common focus is a historical period; a country or region within Latin America; or a practice, development, or issue of interest to specialists and others; (2) to locate these books within current scholarship, critical methodologies, and approaches; and (3) to probe the relation of these new books to previous work on the subject, especially canonical texts. Unlike individual book reviews, the cluster reviews found in LARR seek to address the state of the field or discipline and not solely the works at issue.” - LARR

What are the Goals of Creating a Literature Review?

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 
• Baumeister, R.F. & Leary, M.R. (1997). "Writing narrative literature reviews," Review of General Psychology , 1(3), 311-320.

When do you need to write a Literature Review?

• When writing a prospectus or a thesis/dissertation
• When writing a research paper
• When writing a grant proposal

In all these cases you need to dedicate a chapter in these works to showcase what has been written about your research topic and to point out how your own research will shed new light into a body of scholarship.

Where I can find examples of Literature Reviews?

Note:  In the humanities, even if they don't use the term "literature review", they may have a dedicated  chapter that reviewed the "critical bibliography" or they incorporated that review in the introduction or first chapter of the dissertation, book, or article.

• UCSB electronic theses and dissertations In partnership with the Graduate Division, the UC Santa Barbara Library is making available theses and dissertations produced by UCSB students. Currently included in ADRL are theses and dissertations that were originally filed electronically, starting in 2011. In future phases of ADRL, all theses and dissertations created by UCSB students may be digitized and made available.

Where to Find Standalone Literature Reviews

Literature reviews are also written as standalone articles as a way to survey a particular research topic in-depth. This type of literature review looks at a topic from a historical perspective to see how the understanding of the topic has changed over time. 

• Find e-Journals for Standalone Literature Reviews The best way to get familiar with and to learn how to write literature reviews is by reading them. You can use our Journal Search option to find journals that specialize in publishing literature reviews from major disciplines like anthropology, sociology, etc. Usually these titles are called, "Annual Review of [discipline name] OR [Discipline name] Review. This option works best if you know the title of the publication you are looking for. Below are some examples of these journals! more... less... Journal Search can be found by hovering over the link for Research on the library website.

Social Sciences

• Annual Review of Anthropology
• Annual Review of Political Science
• Annual Review of Sociology
• Ethnic Studies Review

Hard science and health sciences:

• Annual Review of Biomedical Data Science
• Annual Review of Materials Science
• Systematic Review From journal site: "The journal Systematic Reviews encompasses all aspects of the design, conduct, and reporting of systematic reviews" in the health sciences.
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• URL: https://guides.library.ucsb.edu/litreview

Research Process :: Step by Step

• Introduction
• Select Topic
• Identify Keywords
• Background Information
• Develop Research Questions
• Refine Topic
• Search Strategy
• Popular Databases
• Evaluate Sources
• Types of Periodicals
• Reading Scholarly Articles
• Primary & Secondary Sources
• Organize / Take Notes
• Writing & Grammar Resources
• Annotated Bibliography
• Literature Review
• Citation Styles
• Paraphrasing
• Privacy / Confidentiality
• Research Process
• Selecting Your Topic
• Identifying Keywords
• Gathering Background Info
• Evaluating Sources

Organize the literature review into sections that present themes or identify trends, including relevant theory. You are not trying to list all the material published, but to synthesize and evaluate it according to the guiding concept of your thesis or research question.  

What is a literature review?

A literature review is an account of what has been published on a topic by accredited scholars and researchers. Occasionally you will be asked to write one as a separate assignment, but more often it is part of the introduction to an essay, research report, or thesis. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries

A literature review must do these things:

• be organized around and related directly to the thesis or research question you are developing
• synthesize results into a summary of what is and is not known
• identify areas of controversy in the literature
• formulate questions that need further research

Ask yourself questions like these:

• What is the specific thesis, problem, or research question that my literature review helps to define?
• What type of literature review am I conducting? Am I looking at issues of theory? methodology? policy? quantitative research (e.g. on the effectiveness of a new procedure)? qualitative research (e.g., studies of loneliness among migrant workers)?
• What is the scope of my literature review? What types of publications am I using (e.g., journals, books, government documents, popular media)? What discipline am I working in (e.g., nursing psychology, sociology, medicine)?
• How good was my information seeking? Has my search been wide enough to ensure I've found all the relevant material? Has it been narrow enough to exclude irrelevant material? Is the number of sources I've used appropriate for the length of my paper?
• Have I critically analyzed the literature I use? Do I follow through a set of concepts and questions, comparing items to each other in the ways they deal with them? Instead of just listing and summarizing items, do I assess them, discussing strengths and weaknesses?
• Have I cited and discussed studies contrary to my perspective?
• Will the reader find my literature review relevant, appropriate, and useful?

Ask yourself questions like these about each book or article you include:

• Has the author formulated a problem/issue?
• Is it clearly defined? Is its significance (scope, severity, relevance) clearly established?
• Could the problem have been approached more effectively from another perspective?
• What is the author's research orientation (e.g., interpretive, critical science, combination)?
• What is the author's theoretical framework (e.g., psychological, developmental, feminist)?
• What is the relationship between the theoretical and research perspectives?
• Has the author evaluated the literature relevant to the problem/issue? Does the author include literature taking positions she or he does not agree with?
• In a research study, how good are the basic components of the study design (e.g., population, intervention, outcome)? How accurate and valid are the measurements? Is the analysis of the data accurate and relevant to the research question? Are the conclusions validly based upon the data and analysis?
• In material written for a popular readership, does the author use appeals to emotion, one-sided examples, or rhetorically-charged language and tone? Is there an objective basis to the reasoning, or is the author merely "proving" what he or she already believes?
• How does the author structure the argument? Can you "deconstruct" the flow of the argument to see whether or where it breaks down logically (e.g., in establishing cause-effect relationships)?
• In what ways does this book or article contribute to our understanding of the problem under study, and in what ways is it useful for practice? What are the strengths and limitations?
• How does this book or article relate to the specific thesis or question I am developing?

Text written by Dena Taylor, Health Sciences Writing Centre, University of Toronto

http://www.writing.utoronto.ca/advice/specific-types-of-writing/literature-review

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• What is a Literature Review? | Guide, Template, & Examples

What is a Literature Review? | Guide, Template, & Examples

Published on 22 February 2022 by Shona McCombes . Revised on 7 June 2022.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research.

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarise sources – it analyses, synthesises, and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

Why write a literature review, examples of literature reviews, step 1: search for relevant literature, step 2: evaluate and select sources, step 3: identify themes, debates and gaps, step 4: outline your literature review’s structure, step 5: write your literature review, frequently asked questions about literature reviews, introduction.

• Quick Run-through
• Step 1 & 2

When you write a dissertation or thesis, you will have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and scholarly context
• Develop a theoretical framework and methodology for your research
• Position yourself in relation to other researchers and theorists
• Show how your dissertation addresses a gap or contributes to a debate

You might also have to write a literature review as a stand-alone assignment. In this case, the purpose is to evaluate the current state of research and demonstrate your knowledge of scholarly debates around a topic.

The content will look slightly different in each case, but the process of conducting a literature review follows the same steps. We’ve written a step-by-step guide that you can follow below.

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Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research objectives and questions .

If you are writing a literature review as a stand-alone assignment, you will have to choose a focus and develop a central question to direct your search. Unlike a dissertation research question, this question has to be answerable without collecting original data. You should be able to answer it based only on a review of existing publications.

Make a list of keywords

Start by creating a list of keywords related to your research topic. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list if you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can use boolean operators to help narrow down your search:

Read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

To identify the most important publications on your topic, take note of recurring citations. If the same authors, books or articles keep appearing in your reading, make sure to seek them out.

You probably won’t be able to read absolutely everything that has been written on the topic – you’ll have to evaluate which sources are most relevant to your questions.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models and methods? Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• How does the publication contribute to your understanding of the topic? What are its key insights and arguments?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible, and make sure you read any landmark studies and major theories in your field of research.

You can find out how many times an article has been cited on Google Scholar – a high citation count means the article has been influential in the field, and should certainly be included in your literature review.

The scope of your review will depend on your topic and discipline: in the sciences you usually only review recent literature, but in the humanities you might take a long historical perspective (for example, to trace how a concept has changed in meaning over time).

Remember that you can use our template to summarise and evaluate sources you’re thinking about using!

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It’s important to keep track of your sources with references to avoid plagiarism . It can be helpful to make an annotated bibliography, where you compile full reference information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

You can use our free APA Reference Generator for quick, correct, consistent citations.

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To begin organising your literature review’s argument and structure, you need to understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly-visual platforms like Instagram and Snapchat – this is a gap that you could address in your own research.

There are various approaches to organising the body of a literature review. You should have a rough idea of your strategy before you start writing.

Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarising sources in order.

Try to analyse patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organise your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text, your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

If you are writing the literature review as part of your dissertation or thesis, reiterate your central problem or research question and give a brief summary of the scholarly context. You can emphasise the timeliness of the topic (“many recent studies have focused on the problem of x”) or highlight a gap in the literature (“while there has been much research on x, few researchers have taken y into consideration”).

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, make sure to follow these tips:

• Summarise and synthesise: give an overview of the main points of each source and combine them into a coherent whole.
• Analyse and interpret: don’t just paraphrase other researchers – add your own interpretations, discussing the significance of findings in relation to the literature as a whole.
• Critically evaluate: mention the strengths and weaknesses of your sources.
• Write in well-structured paragraphs: use transitions and topic sentences to draw connections, comparisons and contrasts.

In the conclusion, you should summarise the key findings you have taken from the literature and emphasise their significance.

If the literature review is part of your dissertation or thesis, reiterate how your research addresses gaps and contributes new knowledge, or discuss how you have drawn on existing theories and methods to build a framework for your research. This can lead directly into your methodology section.

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a dissertation , thesis, research paper , or proposal .

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarise yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your  dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

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What is a Literature Review? How to Write It (with Examples)

A literature review is a critical analysis and synthesis of existing research on a particular topic. It provides an overview of the current state of knowledge, identifies gaps, and highlights key findings in the literature. 1 The purpose of a literature review is to situate your own research within the context of existing scholarship, demonstrating your understanding of the topic and showing how your work contributes to the ongoing conversation in the field. Learning how to write a literature review is a critical tool for successful research. Your ability to summarize and synthesize prior research pertaining to a certain topic demonstrates your grasp on the topic of study, and assists in the learning process. 

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 
• How to write a good literature review 
• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• Frequently asked questions 

What is a literature review?

A well-conducted literature review demonstrates the researcher’s familiarity with the existing literature, establishes the context for their own research, and contributes to scholarly conversations on the topic. One of the purposes of a literature review is also to help researchers avoid duplicating previous work and ensure that their research is informed by and builds upon the existing body of knowledge.

What is the purpose of literature review?

A literature review serves several important purposes within academic and research contexts. Here are some key objectives and functions of a literature review: 2  

• Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 
• Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field. 
• Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 
• Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 
• Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 
• Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example

Let’s delve deeper with a literature review example: Let’s say your literature review is about the impact of climate change on biodiversity. You might format your literature review into sections such as the effects of climate change on habitat loss and species extinction, phenological changes, and marine biodiversity. Each section would then summarize and analyze relevant studies in those areas, highlighting key findings and identifying gaps in the research. The review would conclude by emphasizing the need for further research on specific aspects of the relationship between climate change and biodiversity. The following literature review template provides a glimpse into the recommended literature review structure and content, demonstrating how research findings are organized around specific themes within a broader topic. 

Literature Review on Climate Change Impacts on Biodiversity:

Climate change is a global phenomenon with far-reaching consequences, including significant impacts on biodiversity. This literature review synthesizes key findings from various studies: 

a. Habitat Loss and Species Extinction:

Climate change-induced alterations in temperature and precipitation patterns contribute to habitat loss, affecting numerous species (Thomas et al., 2004). The review discusses how these changes increase the risk of extinction, particularly for species with specific habitat requirements. 

b. Range Shifts and Phenological Changes:

Observations of range shifts and changes in the timing of biological events (phenology) are documented in response to changing climatic conditions (Parmesan & Yohe, 2003). These shifts affect ecosystems and may lead to mismatches between species and their resources. 

c. Ocean Acidification and Coral Reefs:

The review explores the impact of climate change on marine biodiversity, emphasizing ocean acidification’s threat to coral reefs (Hoegh-Guldberg et al., 2007). Changes in pH levels negatively affect coral calcification, disrupting the delicate balance of marine ecosystems. 

d. Adaptive Strategies and Conservation Efforts:

Recognizing the urgency of the situation, the literature review discusses various adaptive strategies adopted by species and conservation efforts aimed at mitigating the impacts of climate change on biodiversity (Hannah et al., 2007). It emphasizes the importance of interdisciplinary approaches for effective conservation planning. 

How to write a good literature review

Writing a literature review involves summarizing and synthesizing existing research on a particular topic. A good literature review format should include the following elements. 

Introduction: The introduction sets the stage for your literature review, providing context and introducing the main focus of your review. 

• Opening Statement: Begin with a general statement about the broader topic and its significance in the field. 
• Scope and Purpose: Clearly define the scope of your literature review. Explain the specific research question or objective you aim to address. 
• Organizational Framework: Briefly outline the structure of your literature review, indicating how you will categorize and discuss the existing research. 
• Significance of the Study: Highlight why your literature review is important and how it contributes to the understanding of the chosen topic. 
• Thesis Statement: Conclude the introduction with a concise thesis statement that outlines the main argument or perspective you will develop in the body of the literature review. 

Body: The body of the literature review is where you provide a comprehensive analysis of existing literature, grouping studies based on themes, methodologies, or other relevant criteria. 

• Organize by Theme or Concept: Group studies that share common themes, concepts, or methodologies. Discuss each theme or concept in detail, summarizing key findings and identifying gaps or areas of disagreement. 
• Critical Analysis: Evaluate the strengths and weaknesses of each study. Discuss the methodologies used, the quality of evidence, and the overall contribution of each work to the understanding of the topic. 
• Synthesis of Findings: Synthesize the information from different studies to highlight trends, patterns, or areas of consensus in the literature. 
• Identification of Gaps: Discuss any gaps or limitations in the existing research and explain how your review contributes to filling these gaps. 
• Transition between Sections: Provide smooth transitions between different themes or concepts to maintain the flow of your literature review. 

Conclusion: The conclusion of your literature review should summarize the main findings, highlight the contributions of the review, and suggest avenues for future research. 

• Summary of Key Findings: Recap the main findings from the literature and restate how they contribute to your research question or objective. 
• Contributions to the Field: Discuss the overall contribution of your literature review to the existing knowledge in the field. 
• Implications and Applications: Explore the practical implications of the findings and suggest how they might impact future research or practice. 
• Recommendations for Future Research: Identify areas that require further investigation and propose potential directions for future research in the field. 
• Final Thoughts: Conclude with a final reflection on the importance of your literature review and its relevance to the broader academic community. 

Conducting a literature review

Conducting a literature review is an essential step in research that involves reviewing and analyzing existing literature on a specific topic. It’s important to know how to do a literature review effectively, so here are the steps to follow: 1  

Choose a Topic and Define the Research Question:

• Select a topic that is relevant to your field of study. 
• Clearly define your research question or objective. Determine what specific aspect of the topic do you want to explore? 

Decide on the Scope of Your Review:

• Determine the timeframe for your literature review. Are you focusing on recent developments, or do you want a historical overview? 
• Consider the geographical scope. Is your review global, or are you focusing on a specific region? 
• Define the inclusion and exclusion criteria. What types of sources will you include? Are there specific types of studies or publications you will exclude? 

Select Databases for Searches:

• Identify relevant databases for your field. Examples include PubMed, IEEE Xplore, Scopus, Web of Science, and Google Scholar. 
• Consider searching in library catalogs, institutional repositories, and specialized databases related to your topic. 

Conduct Searches and Keep Track:

• Develop a systematic search strategy using keywords, Boolean operators (AND, OR, NOT), and other search techniques. 
• Record and document your search strategy for transparency and replicability. 
• Keep track of the articles, including publication details, abstracts, and links. Use citation management tools like EndNote, Zotero, or Mendeley to organize your references. 

Review the Literature:

• Evaluate the relevance and quality of each source. Consider the methodology, sample size, and results of studies. 
• Organize the literature by themes or key concepts. Identify patterns, trends, and gaps in the existing research. 
• Summarize key findings and arguments from each source. Compare and contrast different perspectives. 
• Identify areas where there is a consensus in the literature and where there are conflicting opinions. 
• Provide critical analysis and synthesis of the literature. What are the strengths and weaknesses of existing research? 

Organize and Write Your Literature Review:

• Literature review outline should be based on themes, chronological order, or methodological approaches. 
• Write a clear and coherent narrative that synthesizes the information gathered. 
• Use proper citations for each source and ensure consistency in your citation style (APA, MLA, Chicago, etc.). 
• Conclude your literature review by summarizing key findings, identifying gaps, and suggesting areas for future research. 

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. 

Frequently asked questions

A literature review is a critical and comprehensive analysis of existing literature (published and unpublished works) on a specific topic or research question and provides a synthesis of the current state of knowledge in a particular field. A well-conducted literature review is crucial for researchers to build upon existing knowledge, avoid duplication of efforts, and contribute to the advancement of their field. It also helps researchers situate their work within a broader context and facilitates the development of a sound theoretical and conceptual framework for their studies.

Literature review is a crucial component of research writing, providing a solid background for a research paper’s investigation. The aim is to keep professionals up to date by providing an understanding of ongoing developments within a specific field, including research methods, and experimental techniques used in that field, and present that knowledge in the form of a written report. Also, the depth and breadth of the literature review emphasizes the credibility of the scholar in his or her field.  

Before writing a literature review, it’s essential to undertake several preparatory steps to ensure that your review is well-researched, organized, and focused. This includes choosing a topic of general interest to you and doing exploratory research on that topic, writing an annotated bibliography, and noting major points, especially those that relate to the position you have taken on the topic. 

Literature reviews and academic research papers are essential components of scholarly work but serve different purposes within the academic realm. 3 A literature review aims to provide a foundation for understanding the current state of research on a particular topic, identify gaps or controversies, and lay the groundwork for future research. Therefore, it draws heavily from existing academic sources, including books, journal articles, and other scholarly publications. In contrast, an academic research paper aims to present new knowledge, contribute to the academic discourse, and advance the understanding of a specific research question. Therefore, it involves a mix of existing literature (in the introduction and literature review sections) and original data or findings obtained through research methods. 

Literature reviews are essential components of academic and research papers, and various strategies can be employed to conduct them effectively. If you want to know how to write a literature review for a research paper, here are four common approaches that are often used by researchers.  Chronological Review: This strategy involves organizing the literature based on the chronological order of publication. It helps to trace the development of a topic over time, showing how ideas, theories, and research have evolved.  Thematic Review: Thematic reviews focus on identifying and analyzing themes or topics that cut across different studies. Instead of organizing the literature chronologically, it is grouped by key themes or concepts, allowing for a comprehensive exploration of various aspects of the topic.  Methodological Review: This strategy involves organizing the literature based on the research methods employed in different studies. It helps to highlight the strengths and weaknesses of various methodologies and allows the reader to evaluate the reliability and validity of the research findings.  Theoretical Review: A theoretical review examines the literature based on the theoretical frameworks used in different studies. This approach helps to identify the key theories that have been applied to the topic and assess their contributions to the understanding of the subject.  It’s important to note that these strategies are not mutually exclusive, and a literature review may combine elements of more than one approach. The choice of strategy depends on the research question, the nature of the literature available, and the goals of the review. Additionally, other strategies, such as integrative reviews or systematic reviews, may be employed depending on the specific requirements of the research.

The literature review format can vary depending on the specific publication guidelines. However, there are some common elements and structures that are often followed. Here is a general guideline for the format of a literature review:  Introduction:   Provide an overview of the topic.  Define the scope and purpose of the literature review.  State the research question or objective.  Body:   Organize the literature by themes, concepts, or chronology.  Critically analyze and evaluate each source.  Discuss the strengths and weaknesses of the studies.  Highlight any methodological limitations or biases.  Identify patterns, connections, or contradictions in the existing research.  Conclusion:   Summarize the key points discussed in the literature review.  Highlight the research gap.  Address the research question or objective stated in the introduction.  Highlight the contributions of the review and suggest directions for future research.

Both annotated bibliographies and literature reviews involve the examination of scholarly sources. While annotated bibliographies focus on individual sources with brief annotations, literature reviews provide a more in-depth, integrated, and comprehensive analysis of existing literature on a specific topic. The key differences are as follows: 

References 

• Denney, A. S., & Tewksbury, R. (2013). How to write a literature review.  Journal of criminal justice education ,  24 (2), 218-234. 
• Pan, M. L. (2016).  Preparing literature reviews: Qualitative and quantitative approaches . Taylor & Francis. 
• Cantero, C. (2019). How to write a literature review.  San José State University Writing Center . 

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Methodological Approaches to Literature Review

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• First Online: 09 May 2023
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• Dennis Thomas 2 ,
• Elida Zairina 3 &
• Johnson George 4  

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The literature review can serve various functions in the contexts of education and research. It aids in identifying knowledge gaps, informing research methodology, and developing a theoretical framework during the planning stages of a research study or project, as well as reporting of review findings in the context of the existing literature. This chapter discusses the methodological approaches to conducting a literature review and offers an overview of different types of reviews. There are various types of reviews, including narrative reviews, scoping reviews, and systematic reviews with reporting strategies such as meta-analysis and meta-synthesis. Review authors should consider the scope of the literature review when selecting a type and method. Being focused is essential for a successful review; however, this must be balanced against the relevance of the review to a broad audience.

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Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia

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Thomas, D., Zairina, E., George, J. (2023). Methodological Approaches to Literature Review. In: Encyclopedia of Evidence in Pharmaceutical Public Health and Health Services Research in Pharmacy. Springer, Cham. https://doi.org/10.1007/978-3-030-50247-8_57-1

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What Is A Literature Review?

A plain-language explainer (with examples).

By:  Derek Jansen (MBA) & Kerryn Warren (PhD) | June 2020 (Updated May 2023)

If you’re faced with writing a dissertation or thesis, chances are you’ve encountered the term “literature review” . If you’re on this page, you’re probably not 100% what the literature review is all about. The good news is that you’ve come to the right place.

Literature Review 101

• What (exactly) is a literature review
• What’s the purpose of the literature review chapter
• How to find high-quality resources
• How to structure your literature review chapter
• Example of an actual literature review

What is a literature review?

The word “literature review” can refer to two related things that are part of the broader literature review process. The first is the task of  reviewing the literature  – i.e. sourcing and reading through the existing research relating to your research topic. The second is the  actual chapter  that you write up in your dissertation, thesis or research project. Let’s look at each of them:

Reviewing the literature

The first step of any literature review is to hunt down and  read through the existing research  that’s relevant to your research topic. To do this, you’ll use a combination of tools (we’ll discuss some of these later) to find journal articles, books, ebooks, research reports, dissertations, theses and any other credible sources of information that relate to your topic. You’ll then  summarise and catalogue these  for easy reference when you write up your literature review chapter. 

The literature review chapter

The second step of the literature review is to write the actual literature review chapter (this is usually the second chapter in a typical dissertation or thesis structure ). At the simplest level, the literature review chapter is an  overview of the key literature  that’s relevant to your research topic. This chapter should provide a smooth-flowing discussion of what research has already been done, what is known, what is unknown and what is contested in relation to your research topic. So, you can think of it as an  integrated review of the state of knowledge  around your research topic. 

What’s the purpose of a literature review?

The literature review chapter has a few important functions within your dissertation, thesis or research project. Let’s take a look at these:

Purpose #1 – Demonstrate your topic knowledge

The first function of the literature review chapter is, quite simply, to show the reader (or marker) that you  know what you’re talking about . In other words, a good literature review chapter demonstrates that you’ve read the relevant existing research and understand what’s going on – who’s said what, what’s agreed upon, disagreed upon and so on. This needs to be  more than just a summary  of who said what – it needs to integrate the existing research to  show how it all fits together  and what’s missing (which leads us to purpose #2, next). 

Purpose #2 – Reveal the research gap that you’ll fill

The second function of the literature review chapter is to  show what’s currently missing  from the existing research, to lay the foundation for your own research topic. In other words, your literature review chapter needs to show that there are currently “missing pieces” in terms of the bigger puzzle, and that  your study will fill one of those research gaps . By doing this, you are showing that your research topic is original and will help contribute to the body of knowledge. In other words, the literature review helps justify your research topic.  

Purpose #3 – Lay the foundation for your conceptual framework

The third function of the literature review is to form the  basis for a conceptual framework . Not every research topic will necessarily have a conceptual framework, but if your topic does require one, it needs to be rooted in your literature review. 

For example, let’s say your research aims to identify the drivers of a certain outcome – the factors which contribute to burnout in office workers. In this case, you’d likely develop a conceptual framework which details the potential factors (e.g. long hours, excessive stress, etc), as well as the outcome (burnout). Those factors would need to emerge from the literature review chapter – they can’t just come from your gut! 

So, in this case, the literature review chapter would uncover each of the potential factors (based on previous studies about burnout), which would then be modelled into a framework. 

Purpose #4 – To inform your methodology

The fourth function of the literature review is to  inform the choice of methodology  for your own research. As we’ve  discussed on the Grad Coach blog , your choice of methodology will be heavily influenced by your research aims, objectives and questions . Given that you’ll be reviewing studies covering a topic close to yours, it makes sense that you could learn a lot from their (well-considered) methodologies.

So, when you’re reviewing the literature, you’ll need to  pay close attention to the research design , methodology and methods used in similar studies, and use these to inform your methodology. Quite often, you’ll be able to  “borrow” from previous studies . This is especially true for quantitative studies , as you can use previously tried and tested measures and scales. 

How do I find articles for my literature review?

Finding quality journal articles is essential to crafting a rock-solid literature review. As you probably already know, not all research is created equally, and so you need to make sure that your literature review is  built on credible research . 

We could write an entire post on how to find quality literature (actually, we have ), but a good starting point is Google Scholar . Google Scholar is essentially the academic equivalent of Google, using Google’s powerful search capabilities to find relevant journal articles and reports. It certainly doesn’t cover every possible resource, but it’s a very useful way to get started on your literature review journey, as it will very quickly give you a good indication of what the  most popular pieces of research  are in your field.

One downside of Google Scholar is that it’s merely a search engine – that is, it lists the articles, but oftentimes  it doesn’t host the articles . So you’ll often hit a paywall when clicking through to journal websites. 

Thankfully, your university should provide you with access to their library, so you can find the article titles using Google Scholar and then search for them by name in your university’s online library. Your university may also provide you with access to  ResearchGate , which is another great source for existing research. 

Remember, the correct search keywords will be super important to get the right information from the start. So, pay close attention to the keywords used in the journal articles you read and use those keywords to search for more articles. If you can’t find a spoon in the kitchen, you haven’t looked in the right drawer. 

Need a helping hand?

How should I structure my literature review?

Unfortunately, there’s no generic universal answer for this one. The structure of your literature review will depend largely on your topic area and your research aims and objectives.

You could potentially structure your literature review chapter according to theme, group, variables , chronologically or per concepts in your field of research. We explain the main approaches to structuring your literature review here . You can also download a copy of our free literature review template to help you establish an initial structure.

In general, it’s also a good idea to start wide (i.e. the big-picture-level) and then narrow down, ending your literature review close to your research questions . However, there’s no universal one “right way” to structure your literature review. The most important thing is not to discuss your sources one after the other like a list – as we touched on earlier, your literature review needs to synthesise the research , not summarise it .

Ultimately, you need to craft your literature review so that it conveys the most important information effectively – it needs to tell a logical story in a digestible way. It’s no use starting off with highly technical terms and then only explaining what these terms mean later. Always assume your reader is not a subject matter expert and hold their hand through a journe y of the literature while keeping the functions of the literature review chapter (which we discussed earlier) front of mind.

Example of a literature review

In the video below, we walk you through a high-quality literature review from a dissertation that earned full distinction. This will give you a clearer view of what a strong literature review looks like in practice and hopefully provide some inspiration for your own. 

Wrapping Up

In this post, we’ve (hopefully) answered the question, “ what is a literature review? “. We’ve also considered the purpose and functions of the literature review, as well as how to find literature and how to structure the literature review chapter. If you’re keen to learn more, check out the literature review section of the Grad Coach blog , as well as our detailed video post covering how to write a literature review . 

Psst… there’s more!

This post is an extract from our bestselling short course, Literature Review Bootcamp . If you want to work smart, you don't want to miss this .

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16 Comments

Thanks for this review. It narrates what’s not been taught as tutors are always in a early to finish their classes.

Thanks for the kind words, Becky. Good luck with your literature review 🙂

This website is amazing, it really helps break everything down. Thank you, I would have been lost without it.

This is review is amazing. I benefited from it a lot and hope others visiting this website will benefit too.

Timothy T. Chol [email protected]

Thank you very much for the guiding in literature review I learn and benefited a lot this make my journey smooth I’ll recommend this site to my friends

This was so useful. Thank you so much.

Hi, Concept was explained nicely by both of you. Thanks a lot for sharing it. It will surely help research scholars to start their Research Journey.

The review is really helpful to me especially during this period of covid-19 pandemic when most universities in my country only offer online classes. Great stuff

Great Brief Explanation, thanks

So helpful to me as a student

GradCoach is a fantastic site with brilliant and modern minds behind it.. I spent weeks decoding the substantial academic Jargon and grounding my initial steps on the research process, which could be shortened to a couple of days through the Gradcoach. Thanks again!

This is an amazing talk. I paved way for myself as a researcher. Thank you GradCoach!

Well-presented overview of the literature!

This was brilliant. So clear. Thank you

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Literature Reviews

What is a literature review.

An organized discussion of  published information like surveys scholarly articles, books and other sources (e.g. dissertations, conference proceedings) in a particular subject area (and/or a subject within a certain time period) relevant to a particular issue, area of research, or theory .

It provides a description, summary, and critical evaluation of each work.

What is it NOT?

• A descriptive list
• Not JUST a summary
• Not a survey of everything ever written on a subject

How is a literature review different from a research paper? 

The main focus of an academic research paper is to develop a new argument. Often times, a research paper or published article contains a literature review as one of its main sections. In a research paper, you use the literature as a foundation and as support for a new insight that YOU contribute.

The focus of a literature review, however, is to summarize and synthesize the arguments and ideas of others without adding new contributions or new arguments like you would in a research paper.

What is the purpose?

The purpose of a literature review is to:

• provide an overview of sources explored while researching a topic ( surveys the literature )
• provide solid background ( summary of prior research ) for a research paper’s investigation or research question/topic
• synthesize  ( integrate and analyze ) information about the subject
• define what you have learned from others and what the relationship of each work is to the others
• critically evaluate   the information gathered
• identify gaps in current knowledge (shows limitations of theories or points of view) and revealing those gaps
• demonstrate  how your research fits within the larger field of study
• establish credibility for your work

4 Easy Tasks

Let’s break it down more simply. There are 4 main tasks or reasons for completing a literature review. We present those for tasks below, and we also break down some of the difficult terms for a clearer understanding.

Evaluation and Synthesis

Things to consider as you evaluate and synthesize:

• Provenance -- what are the author's credentials? Are the author's arguments supported by evidence [e.g. primary historical material, case studies, narratives, statistics, recent scientific findings]?
• Methodology -- were the techniques used to identify, gather, and analyze the data appropriate to addressing the research problem? Was the sample size appropriate? Were the results effectively interpreted and reported?
• Objectivity -- is the author's perspective even-handed or prejudicial? Is contrary data considered or is certain pertinent information ignored to prove the author's point?
• Persuasiveness -- which of the author's theses are most convincing or least convincing?
• Value -- are the author's arguments and conclusions convincing? Does the work ultimately contribute in any significant way to an understanding of the subject?

Literature reviews usually consist of 3 major sections: an introduction, main body, and conclusion.

Introduction:

• Defines topic
• Establishes reasons/point of view for reviewing literature
• Explains the organization (see Literature Review page for more information)
• States the scope/depth of the review
• Current situation or information needed to understand topic and focus
• History and/or progression of topic (if necessary)
• Methods and/or standards for selecting sources for your literature review (i.e. only peer-reviewed articles and journals, current news, resources published between certain dates, etc.)

Offers conclusions about which pieces are better considered on analysis above, objectivity of topic, and greatest contribution to area of research

• Share source’s credentials and whether or not arguments within source are supported by evidence
• Examine methodology and techniques used to identify, gather, and analyze the data
• Explanation of how each work is similar to and/or how it varies from others
• Discuss relationship between topic and the wider subject area
• Evaluate objectivity (perspective) of source and persuasiveness

Conclusion:

• Summarize key points in your main body—what have you learned from the survey of the literature?
• Outlines areas for future study—where might discussion proceed?

Ways to organize a literature review

Once you have the basic categories in place, then you must consider how you will present the sources themselves within the body of your paper. Create an organizational method to focus this section even further. Below are the 5 most commons ways of organizing a literature review:

1. Chronologically: writing about the materials according to when they were published.

This approach should only be followed if a clear path of research building on previous research can be identified and that these trends follow a clear chronological order of development. Think of a timeline—can you write about your sources in a way that would fit nicely on a timeline? For example, a literature review that focuses on continuing research about the emergence of German economic power after the fall of the Soviet Union over a clear span of time would be a good reason to organize your topic chronologically.

If you choose this route, you might need to also sub-organize your review by publication only if the order demonstrates a more important trend. For instance, you could order a review of literature on biological studies of sperm whales if the progression revealed a change in dissection practices of the researchers who wrote and/or conducted the studies.

2. Thematically (conceptual categories):   writing about a cluster of topics and subtopics.

Here, you are going to focus on a specific topic or subtopic. You will provide background for the topic OR put the problem into historical perspective (why is this topic important, historically). This forces you to summarize your sources and to group topics that are important to your research.

3. Methodologically: focusing on the methods utilized by the researchers in your sources.

This differs from the two above in that the focusing factor usually does not have to do with the content of the material. Instead, it focuses on the “methods” of the researcher or writer. For questions to consider when evaluating the methods, see the "Common Errors" section below. 

Avoiding Common Errors

Many students commit the following errors when they write annotated bibliographies.

Here a great example of a thematic literature review . It was written by a student at the University of West Florida. (This PDF will open in a new window/tab).

https://writingcenter.unc.edu/tips-and-tools/literature-reviews/

https://guides.library.ucsc.edu/write-a-literature-review

https://libguides.usc.edu/writingguide/literaturereview

https://www.rlf.org.uk/resources/what-is-a-literature-review/

https://greatergood.berkeley.edu/article/item/10_questions_to_ask_about_scientific_studies

https://libguides.uwf.edu/c.php?g=215199&p=1420828

How do I Write a Literature Review?: #5 Writing the Review

• Step #1: Choosing a Topic
• Step #2: Finding Information
• Step #3: Evaluating Content
• Step #4: Synthesizing Content
• #5 Writing the Review
• Citing Your Sources

WRITING THE REVIEW 

You've done the research and now you're ready to put your findings down on paper. When preparing to write your review, first consider how will you organize your review.

The actual review generally has 5 components:

Abstract  -  An abstract is a summary of your literature review. It is made up of the following parts:

• A contextual sentence about your motivation behind your research topic
• Your thesis statement
• A descriptive statement about the types of literature used in the review
• Summarize your findings
• Conclusion(s) based upon your findings

Introduction :   Like a typical research paper introduction, provide the reader with a quick idea of the topic of the literature review:

• Define or identify the general topic, issue, or area of concern. This provides the reader with context for reviewing the literature.
• Identify related trends in what has already been published about the topic; or conflicts in theory, methodology, evidence, and conclusions; or gaps in research and scholarship; or a single problem or new perspective of immediate interest.
• Establish your reason (point of view) for reviewing the literature; explain the criteria to be used in analyzing and comparing literature and the organization of the review (sequence); and, when necessary, state why certain literature is or is not included (scope)  - 

Body :  The body of a literature review contains your discussion of sources and can be organized in 3 ways-

• Chronological -  by publication or by trend
• Thematic -  organized around a topic or issue, rather than the progression of time
• Methodical -  the focusing factor usually does not have to do with the content of the material. Instead, it focuses on the "methods" of the literature's researcher or writer that you are reviewing

You may also want to include a section on "questions for further research" and discuss what questions the review has sparked about the topic/field or offer suggestions for future studies/examinations that build on your current findings.

Conclusion :  In the conclusion, you should:

Conclude your paper by providing your reader with some perspective on the relationship between your literature review's specific topic and how it's related to it's parent discipline, scientific endeavor, or profession.

Bibliography :   Since a literature review is composed of pieces of research, it is very important that your correctly cite the literature you are reviewing, both in the reviews body as well as in a bibliography/works cited. To learn more about different citation styles, visit the " Citing Your Sources " tab.

• Writing a Literature Review: Wesleyan University
• Literature Review: Edith Cowan University
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• Next: Citing Your Sources >>
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Literature reviews, what is a literature review, learning more about how to do a literature review.

• Planning the Review
• The Research Question
• Choosing Where to Search
• Organizing the Review
• Writing the Review

A literature review is a review and synthesis of existing research on a topic or research question. A literature review is meant to analyze the scholarly literature, make connections across writings and identify strengths, weaknesses, trends, and missing conversations. A literature review should address different aspects of a topic as it relates to your research question. A literature review goes beyond a description or summary of the literature you have read. 

• Sage Research Methods Core Collection This link opens in a new window SAGE Research Methods supports research at all levels by providing material to guide users through every step of the research process. SAGE Research Methods is the ultimate methods library with more than 1000 books, reference works, journal articles, and instructional videos by world-leading academics from across the social sciences, including the largest collection of qualitative methods books available online from any scholarly publisher. – Publisher

• Next: Planning the Review >>
• Last Updated: May 2, 2024 10:39 AM
• URL: https://libguides.northwestern.edu/literaturereviews

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Literature review.

• What is a Literature Review?
• What is Its Purpose?
• 1. Select a Topic
• 2. Set the Topic in Context
• 3. Types of Information Sources
• 4. Use Information Sources
• 5. Get the Information
• 6. Organize / Manage the Information
• 7. Position the Literature Review
• 8. Write the Literature Review

A literature review is a comprehensive summary of previous research on a topic. The literature review surveys scholarly articles, books, and other sources relevant to a particular area of research.  The review should enumerate, describe, summarize, objectively evaluate and clarify this previous research.  It should give a theoretical base for the research and help you (the author) determine the nature of your research.  The literature review acknowledges the work of previous researchers, and in so doing, assures the reader that your work has been well conceived.  It is assumed that by mentioning a previous work in the field of study, that the author has read, evaluated, and assimiliated that work into the work at hand.

A literature review creates a "landscape" for the reader, giving her or him a full understanding of the developments in the field.  This landscape informs the reader that the author has indeed assimilated all (or the vast majority of) previous, significant works in the field into her or his research. 

 "In writing the literature review, the purpose is to convey to the reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. The literature review must be defined by a guiding concept (eg. your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries.( http://www.writing.utoronto.ca/advice/specific-types-of-writing/literature-review )

Recommended Reading

• Next: What is Its Purpose? >>
• Last Updated: Oct 2, 2023 12:34 PM

To read this content please select one of the options below:

Please note you do not have access to teaching notes, literature review writing: how information is selected and transformed.

Aslib Proceedings

ISSN : 0001-253X

Article publication date: 1 March 2013

This paper aims to report a study of researchers' preferences in selecting information from cited papers to include in a literature review, and the kinds of transformations and editing applied to the selected information.

Design/methodology/approach

This is a part of a larger project to develop an automatic summarization method that emulates human literature review writing behaviour. Research questions were: how are literature reviews written – where do authors select information from, what types of information do they select and how do they transform it? What is the relationship between styles of literature review (integrative and descriptive) and each of these variables (source sections, types of information and types of transformation)? The authors analysed the literature review sections of 20 articles from the Journal of the American Society for Information Science and Technology , 2001‐2008, to answer these questions. Referencing sentences were mapped to 279 source papers to determine the source sentences. The type of information selected, the sections of source papers where the information was taken from, and the types of editing changes made to include in the literature review were analyzed.

Integrative literature reviews contain more research result information and critique, and reference more information from the results and conclusion sections of the source papers. Descriptive literature reviews contain more research method information, and reference more information from the abstract and introduction sections. The most common kind of transformation is the high‐level summary, though descriptive literature reviews have more cut‐pasting, especially for information taken from the abstract. The types of editing – substitutions, insertions and deletions – applied to the source sentences are identified.

Practical implications

The results are useful in the teaching of literature review writing, and indicate ways for automatic summarization systems to emulate human literature review writing.

Originality/value

Though there have been several studies of abstracts and abstracting, there are few studies of literature reviews and literature review writing. Little is known about how writers select information from source papers, integrate it and present it in a literature review. This paper fills some of the gaps.

• Literature review writing
• Multi‐document summarization
• Information science
• Information extraction
• Information selection
• Information
• Information searches

Jaidka, K. , Khoo, C.S.G. and Na, J. (2013), "Literature review writing: how information is selected and transformed", Aslib Proceedings , Vol. 65 No. 3, pp. 303-325. https://doi.org/10.1108/00012531311330665

Emerald Group Publishing Limited

Copyright © 2013, Emerald Group Publishing Limited

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• Open access
• Published: 17 August 2023

Data visualisation in scoping reviews and evidence maps on health topics: a cross-sectional analysis

• Emily South   ORCID: orcid.org/0000-0003-2187-4762 1 &
• Mark Rodgers 1  

Systematic Reviews volume  12 , Article number:  142 ( 2023 ) Cite this article

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Scoping reviews and evidence maps are forms of evidence synthesis that aim to map the available literature on a topic and are well-suited to visual presentation of results. A range of data visualisation methods and interactive data visualisation tools exist that may make scoping reviews more useful to knowledge users. The aim of this study was to explore the use of data visualisation in a sample of recent scoping reviews and evidence maps on health topics, with a particular focus on interactive data visualisation.

Ovid MEDLINE ALL was searched for recent scoping reviews and evidence maps (June 2020-May 2021), and a sample of 300 papers that met basic selection criteria was taken. Data were extracted on the aim of each review and the use of data visualisation, including types of data visualisation used, variables presented and the use of interactivity. Descriptive data analysis was undertaken of the 238 reviews that aimed to map evidence.

Of the 238 scoping reviews or evidence maps in our analysis, around one-third (37.8%) included some form of data visualisation. Thirty-five different types of data visualisation were used across this sample, although most data visualisations identified were simple bar charts (standard, stacked or multi-set), pie charts or cross-tabulations (60.8%). Most data visualisations presented a single variable (64.4%) or two variables (26.1%). Almost a third of the reviews that used data visualisation did not use any colour (28.9%). Only two reviews presented interactive data visualisation, and few reported the software used to create visualisations.

Conclusions

Data visualisation is currently underused by scoping review authors. In particular, there is potential for much greater use of more innovative forms of data visualisation and interactive data visualisation. Where more innovative data visualisation is used, scoping reviews have made use of a wide range of different methods. Increased use of these more engaging visualisations may make scoping reviews more useful for a range of stakeholders.

Peer Review reports

Scoping reviews are “a type of evidence synthesis that aims to systematically identify and map the breadth of evidence available on a particular topic, field, concept, or issue” ([ 1 ], p. 950). While they include some of the same steps as a systematic review, such as systematic searches and the use of predetermined eligibility criteria, scoping reviews often address broader research questions and do not typically involve the quality appraisal of studies or synthesis of data [ 2 ]. Reasons for conducting a scoping review include the following: to map types of evidence available, to explore research design and conduct, to clarify concepts or definitions and to map characteristics or factors related to a concept [ 3 ]. Scoping reviews can also be undertaken to inform a future systematic review (e.g. to assure authors there will be adequate studies) or to identify knowledge gaps [ 3 ]. Other evidence synthesis approaches with similar aims have been described as evidence maps, mapping reviews or systematic maps [ 4 ]. While this terminology is used inconsistently, evidence maps can be used to identify evidence gaps and present them in a user-friendly (and often visual) way [ 5 ].

Scoping reviews are often targeted to an audience of healthcare professionals or policy-makers [ 6 ], suggesting that it is important to present results in a user-friendly and informative way. Until recently, there was little guidance on how to present the findings of scoping reviews. In recent literature, there has been some discussion of the importance of clearly presenting data for the intended audience of a scoping review, with creative and innovative use of visual methods if appropriate [ 7 , 8 , 9 ]. Lockwood et al. suggest that innovative visual presentation should be considered over dense sections of text or long tables in many cases [ 8 ]. Khalil et al. suggest that inspiration could be drawn from the field of data visualisation [ 7 ]. JBI guidance on scoping reviews recommends that reviewers carefully consider the best format for presenting data at the protocol development stage and provides a number of examples of possible methods [ 10 ].

Interactive resources are another option for presentation in scoping reviews [ 9 ]. Researchers without the relevant programming skills can now use several online platforms (such as Tableau [ 11 ] and Flourish [ 12 ]) to create interactive data visualisations. The benefits of using interactive visualisation in research include the ability to easily present more than two variables [ 13 ] and increased engagement of users [ 14 ]. Unlike static graphs, interactive visualisations can allow users to view hierarchical data at different levels, exploring both the “big picture” and looking in more detail ([ 15 ], p. 291). Interactive visualizations are often targeted at practitioners and decision-makers [ 13 ], and there is some evidence from qualitative research that they are valued by policy-makers [ 16 , 17 , 18 ].

Given their focus on mapping evidence, we believe that scoping reviews are particularly well-suited to visually presenting data and the use of interactive data visualisation tools. However, it is unknown how many recent scoping reviews visually map data or which types of data visualisation are used. The aim of this study was to explore the use of data visualisation methods in a large sample of recent scoping reviews and evidence maps on health topics. In particular, we were interested in the extent to which these forms of synthesis use any form of interactive data visualisation.

This study was a cross-sectional analysis of studies labelled as scoping reviews or evidence maps (or synonyms of these terms) in the title or abstract.

The search strategy was developed with help from an information specialist. Ovid MEDLINE® ALL was searched in June 2021 for studies added to the database in the previous 12 months. The search was limited to English language studies only.

The search strategy was as follows:

Ovid MEDLINE(R) ALL

(scoping review or evidence map or systematic map or mapping review or scoping study or scoping project or scoping exercise or literature mapping or evidence mapping or systematic mapping or literature scoping or evidence gap map).ab,ti.

limit 1 to english language

(202006* or 202007* or 202008* or 202009* or 202010* or 202011* or 202012* or 202101* or 202102* or 202103* or 202104* or 202105*).dt.

The search returned 3686 records. Records were de-duplicated in EndNote 20 software, leaving 3627 unique records.

A sample of these reviews was taken by screening the search results against basic selection criteria (Table 1 ). These criteria were piloted and refined after discussion between the two researchers. A single researcher (E.S.) screened the records in EPPI-Reviewer Web software using the machine-learning priority screening function. Where a second opinion was needed, decisions were checked by a second researcher (M.R.).

Our initial plan for sampling, informed by pilot searching, was to screen and data extract records in batches of 50 included reviews at a time. We planned to stop screening when a batch of 50 reviews had been extracted that included no new types of data visualisation or after screening time had reached 2 days. However, once data extraction was underway, we found the sample to be richer in terms of data visualisation than anticipated. After the inclusion of 300 reviews, we took the decision to end screening in order to ensure the study was manageable.

Data extraction

A data extraction form was developed in EPPI-Reviewer Web, piloted on 50 reviews and refined. Data were extracted by one researcher (E. S. or M. R.), with a second researcher (M. R. or E. S.) providing a second opinion when needed. The data items extracted were as follows: type of review (term used by authors), aim of review (mapping evidence vs. answering specific question vs. borderline), number of visualisations (if any), types of data visualisation used, variables/domains presented by each visualisation type, interactivity, use of colour and any software requirements.

When categorising review aims, we considered “mapping evidence” to incorporate all of the six purposes for conducting a scoping review proposed by Munn et al. [ 3 ]. Reviews were categorised as “answering a specific question” if they aimed to synthesise study findings to answer a particular question, for example on effectiveness of an intervention. We were inclusive with our definition of “mapping evidence” and included reviews with mixed aims in this category. However, some reviews were difficult to categorise (for example where aims were unclear or the stated aims did not match the actual focus of the paper) and were considered to be “borderline”. It became clear that a proportion of identified records that described themselves as “scoping” or “mapping” reviews were in fact pseudo-systematic reviews that failed to undertake key systematic review processes. Such reviews attempted to integrate the findings of included studies rather than map the evidence, and so reviews categorised as “answering a specific question” were excluded from the main analysis. Data visualisation methods for meta-analyses have been explored previously [ 19 ]. Figure  1 shows the flow of records from search results to final analysis sample.

Flow diagram of the sampling process

Data visualisation was defined as any graph or diagram that presented results data, including tables with a visual mapping element, such as cross-tabulations and heat maps. However, tables which displayed data at a study level (e.g. tables summarising key characteristics of each included study) were not included, even if they used symbols, shading or colour. Flow diagrams showing the study selection process were also excluded. Data visualisations in appendices or supplementary information were included, as well as any in publicly available dissemination products (e.g. visualisations hosted online) if mentioned in papers.

The typology used to categorise data visualisation methods was based on an existing online catalogue [ 20 ]. Specific types of data visualisation were categorised in five broad categories: graphs, diagrams, tables, maps/geographical and other. If a data visualisation appeared in our sample that did not feature in the original catalogue, we checked a second online catalogue [ 21 ] for an appropriate term, followed by wider Internet searches. These additional visualisation methods were added to the appropriate section of the typology. The final typology can be found in Additional file 1 .

We conducted descriptive data analysis in Microsoft Excel 2019 and present frequencies and percentages. Where appropriate, data are presented using graphs or other data visualisations created using Flourish. We also link to interactive versions of some of these visualisations.

Almost all of the 300 reviews in the total sample were labelled by review authors as “scoping reviews” ( n  = 293, 97.7%). There were also four “mapping reviews”, one “scoping study”, one “evidence mapping” and one that was described as a “scoping review and evidence map”. Included reviews were all published in 2020 or 2021, with the exception of one review published in 2018. Just over one-third of these reviews ( n  = 105, 35.0%) included some form of data visualisation. However, we excluded 62 reviews that did not focus on mapping evidence from the following analysis (see “ Methods ” section). Of the 238 remaining reviews (that either clearly aimed to map evidence or were judged to be “borderline”), 90 reviews (37.8%) included at least one data visualisation. The references for these reviews can be found in Additional file 2 .

Number of visualisations

Thirty-six (40.0%) of these 90 reviews included just one example of data visualisation (Fig.  2 ). Less than a third ( n  = 28, 31.1%) included three or more visualisations. The greatest number of data visualisations in one review was 17 (all bar or pie charts). In total, 222 individual data visualisations were identified across the sample of 238 reviews.

Number of data visualisations per review

Categories of data visualisation

Graphs were the most frequently used category of data visualisation in the sample. Over half of the reviews with data visualisation included at least one graph ( n  = 59, 65.6%). The least frequently used category was maps, with 15.6% ( n  = 14) of these reviews including a map.

Of the total number of 222 individual data visualisations, 102 were graphs (45.9%), 34 were tables (15.3%), 23 were diagrams (10.4%), 15 were maps (6.8%) and 48 were classified as “other” in the typology (21.6%).

Types of data visualisation

All of the types of data visualisation identified in our sample are reported in Table 2 . In total, 35 different types were used across the sample of reviews.

The most frequently used data visualisation type was a bar chart. Of 222 total data visualisations, 78 (35.1%) were a variation on a bar chart (either standard bar chart, stacked bar chart or multi-set bar chart). There were also 33 pie charts (14.9% of data visualisations) and 24 cross-tabulations (10.8% of data visualisations). In total, these five types of data visualisation accounted for 60.8% ( n  = 135) of all data visualisations. Figure  3 shows the frequency of each data visualisation category and type; an interactive online version of this treemap is also available ( https://public.flourish.studio/visualisation/9396133/ ). Figure  4 shows how users can further explore the data using the interactive treemap.

Data visualisation categories and types. An interactive version of this treemap is available online: https://public.flourish.studio/visualisation/9396133/ . Through the interactive version, users can further explore the data (see Fig.  4 ). The unit of this treemap is the individual data visualisation, so multiple data visualisations within the same scoping review are represented in this map. Created with flourish.studio ( https://flourish.studio )

Screenshots showing how users of the interactive treemap can explore the data further. Users can explore each level of the hierarchical treemap ( A Visualisation category >  B Visualisation subcategory >  C Variables presented in visualisation >  D Individual references reporting this category/subcategory/variable permutation). Created with flourish.studio ( https://flourish.studio )

Data presented

Around two-thirds of data visualisations in the sample presented a single variable ( n  = 143, 64.4%). The most frequently presented single variables were themes ( n  = 22, 9.9% of data visualisations), population ( n  = 21, 9.5%), country or region ( n  = 21, 9.5%) and year ( n  = 20, 9.0%). There were 58 visualisations (26.1%) that presented two different variables. The remaining 21 data visualisations (9.5%) presented three or more variables. Figure  5 shows the variables presented by each different type of data visualisation (an interactive version of this figure is available online).

Variables presented by each data visualisation type. Darker cells indicate a larger number of reviews. An interactive version of this heat map is available online: https://public.flourish.studio/visualisation/10632665/ . Users can hover over each cell to see the number of data visualisations for that combination of data visualisation type and variable. The unit of this heat map is the individual data visualisation, so multiple data visualisations within a single scoping review are represented in this map. Created with flourish.studio ( https://flourish.studio )

Most reviews presented at least one data visualisation in colour ( n  = 64, 71.1%). However, almost a third ( n  = 26, 28.9%) used only black and white or greyscale.

Interactivity

Only two of the reviews included data visualisations with any level of interactivity. One scoping review on music and serious mental illness [ 22 ] linked to an interactive bubble chart hosted online on Tableau. Functionality included the ability to filter the studies displayed by various attributes.

The other review was an example of evidence mapping from the environmental health field [ 23 ]. All four of the data visualisations included in the paper were available in an interactive format hosted either by the review management software or on Tableau. The interactive versions linked to the relevant references so users could directly explore the evidence base. This was the only review that provided this feature.

Software requirements

Nine reviews clearly reported the software used to create data visualisations. Three reviews used Tableau (one of them also used review management software as discussed above) [ 22 , 23 , 24 ]. Two reviews generated maps using ArcGIS [ 25 ] or ArcMap [ 26 ]. One review used Leximancer for a lexical analysis [ 27 ]. One review undertook a bibliometric analysis using VOSviewer [ 28 ], and another explored citation patterns using CitNetExplorer [ 29 ]. Other reviews used Excel [ 30 ] or R [ 26 ].

To our knowledge, this is the first systematic and in-depth exploration of the use of data visualisation techniques in scoping reviews. Our findings suggest that the majority of scoping reviews do not use any data visualisation at all, and, in particular, more innovative examples of data visualisation are rare. Around 60% of data visualisations in our sample were simple bar charts, pie charts or cross-tabulations. There appears to be very limited use of interactive online visualisation, despite the potential this has for communicating results to a range of stakeholders. While it is not always appropriate to use data visualisation (or a simple bar chart may be the most user-friendly way of presenting the data), these findings suggest that data visualisation is being underused in scoping reviews. In a large minority of reviews, visualisations were not published in colour, potentially limiting how user-friendly and attractive papers are to decision-makers and other stakeholders. Also, very few reviews clearly reported the software used to create data visualisations. However, 35 different types of data visualisation were used across the sample, highlighting the wide range of methods that are potentially available to scoping review authors.

Our results build on the limited research that has previously been undertaken in this area. Two previous publications also found limited use of graphs in scoping reviews. Results were “mapped graphically” in 29% of scoping reviews in any field in one 2014 publication [ 31 ] and 17% of healthcare scoping reviews in a 2016 article [ 6 ]. Our results suggest that the use of data visualisation has increased somewhat since these reviews were conducted. Scoping review methods have also evolved in the last 10 years; formal guidance on scoping review conduct was published in 2014 [ 32 ], and an extension of the PRISMA checklist for scoping reviews was published in 2018 [ 33 ]. It is possible that an overall increase in use of data visualisation reflects increased quality of published scoping reviews. There is also some literature supporting our findings on the wide range of data visualisation methods that are used in evidence synthesis. An investigation of methods to identify, prioritise or display health research gaps (25/139 included studies were scoping reviews; 6/139 were evidence maps) identified 14 different methods used to display gaps or priorities, with half being “more advanced” (e.g. treemaps, radial bar plots) ([ 34 ], p. 107). A review of data visualisation methods used in papers reporting meta-analyses found over 200 different ways of displaying data [ 19 ].

Only two reviews in our sample used interactive data visualisation, and one of these was an example of systematic evidence mapping from the environmental health field rather than a scoping review (in environmental health, systematic evidence mapping explicitly involves producing a searchable database [ 35 ]). A scoping review of papers on the use of interactive data visualisation in population health or health services research found a range of examples but still limited use overall [ 13 ]. For example, the authors noted the currently underdeveloped potential for using interactive visualisation in research on health inequalities. It is possible that the use of interactive data visualisation in academic papers is restricted by academic publishing requirements; for example, it is currently difficult to incorporate an interactive figure into a journal article without linking to an external host or platform. However, we believe that there is a lot of potential to add value to future scoping reviews by using interactive data visualisation software. Few reviews in our sample presented three or more variables in a single visualisation, something which can easily be achieved using interactive data visualisation tools. We have previously used EPPI-Mapper [ 36 ] to present results of a scoping review of systematic reviews on behaviour change in disadvantaged groups, with links to the maps provided in the paper [ 37 ]. These interactive maps allowed policy-makers to explore the evidence on different behaviours and disadvantaged groups and access full publications of the included studies directly from the map.

We acknowledge there are barriers to use for some of the data visualisation software available. EPPI-Mapper and some of the software used by reviews in our sample incur a cost. Some software requires a certain level of knowledge and skill in its use. However numerous online free data visualisation tools and resources exist. We have used Flourish to present data for this review, a basic version of which is currently freely available and easy to use. Previous health research has been found to have used a range of different interactive data visualisation software, much of which does not required advanced knowledge or skills to use [ 13 ].

There are likely to be other barriers to the use of data visualisation in scoping reviews. Journal guidelines and policies may present barriers for using innovative data visualisation. For example, some journals charge a fee for publication of figures in colour. As previously mentioned, there are limited options for incorporating interactive data visualisation into journal articles. Authors may also be unaware of the data visualisation methods and tools that are available. Producing data visualisations can be time-consuming, particularly if authors lack experience and skills in this. It is possible that many authors prioritise speed of publication over spending time producing innovative data visualisations, particularly in a context where there is pressure to achieve publications.

Limitations

A limitation of this study was that we did not assess how appropriate the use of data visualisation was in our sample as this would have been highly subjective. Simple descriptive or tabular presentation of results may be the most appropriate approach for some scoping review objectives [ 7 , 8 , 10 ], and the scoping review literature cautions against “over-using” different visual presentation methods [ 7 , 8 ]. It cannot be assumed that all of the reviews that did not include data visualisation should have done so. Likewise, we do not know how many reviews used methods of data visualisation that were not well suited to their data.

We initially relied on authors’ own use of the term “scoping review” (or equivalent) to sample reviews but identified a relatively large number of papers labelled as scoping reviews that did not meet the basic definition, despite the availability of guidance and reporting guidelines [ 10 , 33 ]. It has previously been noted that scoping reviews may be undertaken inappropriately because they are seen as “easier” to conduct than a systematic review ([ 3 ], p.6), and that reviews are often labelled as “scoping reviews” while not appearing to follow any established framework or guidance [ 2 ]. We therefore took the decision to remove these reviews from our main analysis. However, decisions on how to classify review aims were subjective, and we did include some reviews that were of borderline relevance.

A further limitation is that this was a sample of published reviews, rather than a comprehensive systematic scoping review as have previously been undertaken [ 6 , 31 ]. The number of scoping reviews that are published has increased rapidly, and this would now be difficult to undertake. As this was a sample, not all relevant scoping reviews or evidence maps that would have met our criteria were included. We used machine learning to screen our search results for pragmatic reasons (to reduce screening time), but we do not see any reason that our sample would not be broadly reflective of the wider literature.

Data visualisation, and in particular more innovative examples of it, is currently underused in published scoping reviews on health topics. The examples that we have found highlight the wide range of methods that scoping review authors could draw upon to present their data in an engaging way. In particular, we believe that interactive data visualisation has significant potential for mapping the available literature on a topic. Appropriate use of data visualisation may increase the usefulness, and thus uptake, of scoping reviews as a way of identifying existing evidence or research gaps by decision-makers, researchers and commissioners of research. We recommend that scoping review authors explore the extensive free resources and online tools available for data visualisation. However, we also think that it would be useful for publishers to explore allowing easier integration of interactive tools into academic publishing, given the fact that papers are now predominantly accessed online. Future research may be helpful to explore which methods are particularly useful to scoping review users.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Organisation formerly known as Joanna Briggs Institute

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

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Acknowledgements

We would like to thank Melissa Harden, Senior Information Specialist, Centre for Reviews and Dissemination, for advice on developing the search strategy.

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Both authors conceptualised and designed the study and contributed to screening, data extraction and the interpretation of results. ES undertook the literature searches, analysed data, produced the data visualisations and drafted the manuscript. MR contributed to revising the manuscript, and both authors read and approved the final version.

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Additional file 1..

Typology of data visualisation methods.

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References of scoping reviews included in main dataset.

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• Published: 05 May 2024

The learning curve in endoscopic transsphenoidal skull-base surgery: a systematic review

• Abdulraheem Alomari 1 ,
• Mazin Alsarraj 2 &
• Sarah Alqarni 3  

BMC Surgery volume  24 , Article number:  135 ( 2024 ) Cite this article

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Metrics details

The endoscopic endonasal transsphenoidal approach (EETA) has revolutionized skull-base surgery; however, it is associated with a steep learning curve (LC), necessitating additional attention from surgeons to ensure patient safety and surgical efficacy. The current literature is constrained by the small sample sizes of studies and their observational nature. This systematic review aims to evaluate the literature and identify strengths and weaknesses related to the assessment of EETA-LC.

A systematic review was conducted following the PRISMA guidelines. PubMed and Google Scholar were searched for clinical studies on EETA-LC using detailed search strategies, including pertinent keywords and Medical Subject Headings. The selection criteria included studies comparing the outcomes of skull-base surgeries involving pure EETA in the early and late stages of surgeons’ experience, studies that assessed the learning curve of at least one surgical parameter, and articles published in English.

The systematic review identified 34 studies encompassing 5,648 patients published between 2002 and 2022, focusing on the EETA learning curve. Most studies were retrospective cohort designs (88%). Various patient assortment methods were noted, including group-based and case-based analyses. Statistical analyses included descriptive and comparative methods, along with regression analyses and curve modeling techniques. Pituitary adenoma (PA) being the most studied pathology (82%). Among the evaluated variables, improvements in outcomes across variables like EC, OT, postoperative CSF leak, and GTR. Overcoming the initial EETA learning curve was associated with sustained outcome improvements, with a median estimated case requirement of 32, ranging from 9 to 120 cases. These findings underscore the complexity of EETA-LC assessment and the importance of sustained outcome improvement as a marker of proficiency.

Conclusions

The review highlights the complexity of assessing the learning curve in EETA and underscores the need for standardized reporting and prospective studies to enhance the reliability of findings and guide clinical practice effectively.

Peer Review reports

With the advent of endoscopic techniques, skull-base surgery has significantly advanced. The modern history of neuro-endoscopy began in the early 1900s with an innovation by Lespinasse and Dandy, involving intraventricular endoscopy to coagulate the choroid plexus for treating communicating hydrocephalus [ 1 ]. In 1963, Guiot first reported an endoscopic approach via the transsphenoidal route as an adjunct to procedures performed under microscopy [ 2 , 3 ]. In 1992, Jankowski et al. described a purely endoscopic approach for pituitary adenoma resection [ 1 ].

The advantages of endoscopy have encouraged skull-base surgeons to adopt this technique, which provides a panoramic view of critical anatomical landmarks and improved access to the corners and deep surgical areas while inducing only minor trauma to the nasal structures, thereby enhancing postoperative patient comfort [ 4 ]. Compared with procedures involving microscopy, the endoscopic approach results in a shorter operating time (OT), a reduced hospitalization period, a lower rate of complications, and a higher endocrinological cure rate [ 5 , 6 ]. Despite these benefits, the endoscopic approach is hindered by a two-dimensional view, instrument interference, difficulties in achieving homeostasis, and a steep learning curve (LC) [ 4 ].

Since its inception, pioneers in the field have recognized the steep LC associated with the endoscopic technique [ 7 ]. The safety and efficacy of the endoscopic endonasal transsphenoidal approach (EETA), as an alternative to the gold-standard microscopic technique, have been established. However, the steep LC associated with the endoscopic approach may affect short-term outcomes post-procedure [ 5 , 6 ]. Additionally, as the skull-base endoscopic technique constantly evolves and expands, a thorough understanding of the associated LC is critical.

The results of existing publications on the EETA-LC are challenging to interpret due to small sample sizes, observational study designs, and a lack of standardization in assessment methodologies. In this systematic review aims to elucidate the EETA-LC from the literature by addressing the following questions: How was EETA LC evaluated? Which set of variables was used to assess the LC? What is the influence of the LC on the examined variables?

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines [ 8 ]. The review was registered on PROSPERO (CRD42023494731). We searched different databases for articles that assessed the learning curve of EETA without date restriction (PubMed, and Google Scholar). We used a particular equation for each database using a combination of the following keywords and Medical Subject Headings: (Endoscopy OR endoscopic skull base OR endoscopic endonasal transsphenoidal approach) AND (Skull Base Neoplasms OR Pituitary OR pituitary adenoma) AND (Learning Curve OR endoscopic learning curve OR surgical learning curve).

First, two authors (AA, MA) independently screened the titles and abstracts of articles in the databases for learning curve analysis of EETA, either for a single surgeon or a team, by directly comparing outcomes between early and late cases performed. The full texts of the relevant articles were reviewed. When there was a disagreement, the articles were thoroughly discussed before their inclusion in the review. The bibliographies of the selected studies were also screened for relevant citations, which turned up studies that were already selected from the database search.

Studies were included according to the following inclusion criteria: 1) Comparison of outcomes between initial and advanced experiences with the endonasal endoscopic transsphenoidal approach to treat skull-base pathology, defined as "early experience" and "late experience," respectively; 2) Assessment of at least one parameter based on early and late experiences; 3) Randomized controlled trials, prospective cohort studies, retrospective cohort studies, case–control studies, and case series studies were included; and 4) English-language publications.

The study’s exclusion criteria included the following: 1) Studies not performing learning curve analysis; 2) Studies comparing the outcomes of microscopic and endoscopic transsphenoidal approaches without providing separate data for the endoscopic approach; 3) Studies comparing the learning curve between two EETA techniques, using simulated models or questionnaire-based analysis; 4) Studies comparing the microscopic vs. endoscopic approach without separate data available specifically for the endoscopic arm. Additionally, case reports, reviews, animal studies, technical notes, comments, and correspondence were excluded.

Data collection and analysis

The following data were extracted directly from the articles: 1) author names; 2) the year of publication; 3) Time interval of performed procedures; 4) study design; 5) the sample size; 6) techniques used for learning curve analysis (methods used to assort the patients for the analysis); (conducting statistical analysis vs. simple comparison of outcomes); 7) the sample size in each study arm when group splitting performed (early experience vs. late experience); 8) detailed information about surgeon experience at the time of LC assessment (including or omitting the first few EETA cases); 9) single vs. multiple pathologies; 10) team vs. single-surgeon experiences; 11) evaluated set of variables; 12) Variables that improved with experience; and 13) the number of cases required to overcome the initial LC or other methods to identify overcoming the learning curve.

Study quality assessment and risk of bias

Two reviewers conducted a quality assessment and evaluated the risk of bias in the included articles. We utilized the Newcastle–Ottawa Scale (NOS) [ 9 ] and the GRADE system [ 10 ].

Heterogeneity Analysis: Due to substantial heterogeneity observed among the included studies, which encompassed variations in study design, included pathologies, and outcome measures, a formal meta-analysis was not feasible. Therefore, we opted for a qualitative synthesis instead of a formal meta-analysis. Heterogeneity analysis and sensitivity analyses were not explicitly conducted.

Based on the inclusion and exclusion criteria, a total of 34 studies were identified (6 articles excluded after reviewing the full articles), including 5,648 patients [ 7 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ] (Fig.  1 ). The included studies were published between 2002 and 2022, and the evaluated procedures were performed between 1990 and 2018. The majority of the included articles comprised retrospective cohort studies (88%), with two being prospective studies, and two articles presenting data from both prospective and retrospective study designs. Assessing a surgical learning curve involves various methods and techniques documented within the included articles. We observed various methods for patient assortment in conducting learning curve analyses across the literature, with group-based learning curve analysis noticeable in a significant proportion of articles (68%). Within these studies, there was an unclear rationale behind patient grouping. Nonetheless, patients were categorized into either equal group, segmented based on arbitrary time periods, or separated based on improvements in outcomes observed retrospectively after data analysis. Eleven articles (32%) utilize case-based analysis, where individual surgical cases serve as distinct data points, and their outcomes are monitored over time.

PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses

* The bibliographies of the selected studies were also screened for relevant citations which turned up studies already included from databases search

Our systematic review encompasses a wide range of statistical tests employed in the included studies to analyze various data types and address multifaceted research inquiries. The primary statistical methodologies utilized encompass descriptive statistical analysis, which includes metrics such as mean, median, frequency, and standard deviation, along with comparative statistical analysis, which includes techniques such as Chi-square analysis, analysis of variance (ANOVA), and t-tests. Descriptive statistical analysis alone was evident in 10 articles (29%), whereas comparative statistical analysis was present in 24 articles (71%). Noteworthy examples include Leach et al. [ 16 ], who conducted analysis of variance (ANOVA) with post hoc Bonferroni tests for parametric data, Chi-Square Test, or Mann–Whitney tests for nonparametric data, and regression analysis to explore the relationship between surgical duration and relevant factors. Smeth et al. [ 17 ] undertook analyses using chi-square, Fisher exact, Student t-test, Mann–Whitney U test, and analysis of variance, aligning with their examination of categorical and continuous variables across distinct groups. Similarly, Sonnenburg et al. [ 12 ] applied a one-way ANOVA to discern variations between groups, highlighting the importance of understanding differences in means across categorical variables or treatment cohorts.

Regression analyses, scatterplots, McNemar tests, ROC curve analysis, and logistic regression models were integral across various studies, serving multiple purposes. Regression analyses, such as linear regression models, facilitated the exploration of intricate relationships among variables like age, tumor size, and surgical duration, identifying potential risk factors in surgical contexts [ 22 ]. Scatterplots visually depicted these relationships, offering intuitive insights into temporal variations, notably in the examination of surgery date versus duration [ 22 ]. McNemar tests were instrumental in evaluating changes in hormone levels, crucial for understanding postoperative outcomes and hormonal dynamics [ 37 ]. Additionally, ROC curve analysis provided a robust method for determining the level of surgical experience necessary to achieve gross total resection (GTR), offering actionable insights into surgical proficiency and patient outcomes [ 37 ]. Binary logistic regression models were utilized to identify prognostic factors contributing to the attainment of Gross Total Resection (GTR), hormonal recuperation, and visual restoration. For instance, variables such as surgical experience (≤ 100 vs. > 100 cases) were examined within this analytical framework [ 37 ].

In our examination of the included articles, we noted a lack of thorough description regarding the experience of surgeons or surgical teams with the endoscopic endonasal transsphenoidal approach (EETA), the extent of the approach undertaken, and the level of involvement of individual surgeons or surgical teams during procedures. Thirteen articles (38%) reported including the initial cases of EETA, which may indicate a lack of prior experience with the approach. Additionally, seven articles (21%) detailed the experience of a single surgeon, while the majority (79%) evaluated team experiences. There was a wide range of pathologies included in all the studies. Twenty articles (59%) focused on a single pathology, while fourteen studies (41%) examined multiple pathologies. Pituitary adenoma (PA) was the most frequently reported pathology (82%), followed by craniopharyngioma (CP) (44%). Three studies assessed the learning curve of cerebrospinal fluid (CSF) leak repair following treatment of multiple pathologies. Descriptions of the surgical approach, particularly distinguishing between simple and extended techniques, were notably lacking across all articles. However, seventeen articles (50%) did mention pathologies that often require an extended approach, such as meningioma, chordoma, and CP. A number of studies have investigated the variations in tumor type and size among the examined groups, particularly between early and late groups. Notably, findings from studies such as [ 7 , 16 , 17 , 22 , 23 , 26 , 38 ] indicated that no statistical differences were observed between these groups. The characteristics of the included studies [ 7 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ] are summarized in Table  1 .

The EETA-LC was evaluated based on a diverse set of variables. The most frequently analyzed variables were postoperative cerebrospinal fluid (CSF) leak in 28 articles (82%) [ 7 , 12 , 13 , 15 , 16 , 17 , 19 , 20 , 21 , 22 , 23 , 25 , 27 , 28 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ], gross total resection (GTR) in 21 articles (62%) [ 7 , 13 , 14 , 16 , 19 , 21 , 22 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 40 ], post operative diabetes insipidus (DI) in 15 articles (44%) [ 12 , 13 , 16 , 17 , 19 , 21 , 22 , 29 , 30 , 31 , 32 , 34 , 36 , 37 , 41 ], operative time (OT) in 12 articles (35%) [ 7 , 13 , 14 , 16 , 17 , 22 , 29 , 32 , 34 , 35 , 36 , 38 ] and visual improvement in 12 articles (35%) [ 13 , 14 , 16 , 21 , 22 , 28 , 31 , 32 , 34 , 36 , 37 , 41 ]. (Fig.  2 ).

Frequency at which certain variables were evaluated in the literature to assess the EETA learning curve. EETA, endoscopic endonasal transsphenoidal approach; post-op, postoperative; CSF, cerebrospinal fluid; GTR, gross total resection; DI, diabetes insipidus; LOS, length of stay; IOP, intraoperative; ICA, internal carotid artery; SIADH, syndrome of inappropriate antidiuretic hormone secretion; LD, lumbar drain; CNS, central nervous system; CN, cranial nerve; EBL, estimated blood loss; DVT, deep vein thrombosis

In all the studies included, improvements were observed between early and late-experience stages [ 7 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Among the evaluated variables, the following improvements were noted: the endocrinological cure rate (EC) showed improvement in all 7 articles out of 7 evaluated [ 13 , 16 , 18 , 21 , 24 , 30 , 33 ], operative time (OT) improved in 11 out of 12 articles (91%) [ 13 , 14 , 16 , 17 , 22 , 29 , 32 , 34 , 35 , 36 , 38 ], postoperative cerebrospinal fluid leak (CSF) improved in 23 out of 28 articles (82%) [ 12 , 15 , 17 , 19 , 20 , 22 , 23 , 25 , 27 , 28 , 29 , 31 , 32 , 33 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ], visual improvement was observed in 9 out of 12 articles (75%) [ 13 , 14 , 16 , 22 , 28 , 31 , 34 , 37 , 41 ], gross total resection (GTR) improved in 14 out of 21 articles (67%) [ 7 , 13 , 14 , 19 , 21 , 22 , 26 , 27 , 28 , 29 , 30 , 38 , 39 , 40 ], hospital length of stay (LOS) decreased in five out of 10 studies (50%) [ 11 , 12 , 16 , 17 , 22 ], and postoperative diabetes insipidus (DI) decreased in 7 out of 15 articles (47%) [ 3 , 14 , 16 , 17 , 21 , 22 , 33 ] (Fig.  3 ).

Proportion of main improved variables with experiences. EC, Endocrinological cure; OT, Operative time; post-op: postoperative; CSF, cerebrospinal fluid; GTR, gross total resection; hLOS, hospital length of stay; DI, diabetes insipidus

Moreover, 12 articles (35%) reported both significant and non-significant improvements in outcomes [ 7 , 13 , 14 , 16 , 17 , 21 , 22 , 31 , 32 , 34 , 38 , 41 ]. In 10 studies (29%), solely a trend of improvement was observed [ 11 , 15 , 19 , 20 , 23 , 26 , 27 , 29 , 30 , 40 ], while 8 articles (23%) reported solely significant improvements [ 18 , 24 , 25 , 35 , 36 , 37 , 42 , 43 ]. However, in four studies, despite observing a tendency towards better outcomes, no statistical disparities were identified among all assessed variables [ 12 , 28 , 33 , 39 ]. None of the included studies reported a deterioration in any of the assessed outcomes over time, except for one study where a significant decline in GTR was observed in the late group [ 33 ]. This decline was attributed to the inclusion of more invasive and complex tumors in the late group. Nevertheless, Younus et al. documented ongoing improvement in GTR even after surpassing the initial learning curve [ 7 ].

In this systematic review, the primary technique employed to determine the transition point indicating the overcoming of the initial learning curve involved observing sustained and consistent improvement in outcomes over time. In almost half of the included articles, overcoming the initial learning curve (observing improvement of outcomes) was linked to the number of cases performed. Out of the 34 analyzed studies, 16 (47%) estimated the number of cases needed to overcome the initial learning curve of EETA. Reported cases ranged widely from 9 to 120, with a mode of 50. Considering both the median and the Interquartile Range (IQR) provides a comprehensive understanding of the reported case distribution and central tendency for overcoming the initial EETA learning curve. The median number of cases needed is 32, with an IQR of 20. These numbers are estimates and require careful interpretation [ 16 , 17 , 20 , 21 , 22 , 23 , 24 , 25 , 29 , 31 , 32 , 33 , 35 , 36 , 37 , 38 , 42 ].

Regarding the quality of included studies, the NOS quality assessment scale was used. 21 studies graded as fair quality while the remaining 13 articles rated as poor quality [ 9 ]. The risk of bias was evaluated according to the GRADE system. All included studies are observational cohort study and graded either as low or very low grade [ 10 ]. This reflects the great heterogeneity and high risk of bias due to the study design of the current EETA-LC literature.

Endoscopic techniques have drastically improved skull-base surgery. Unlike procedures involving a microscope, many neurosurgeons have acquired experience in endoscopic techniques later in their careers, and the level of exposure to these techniques during training years has varied among surgeons. The LC is a critical factor in the acquisition of new surgical skills. Understanding the link between the EETA-LC and surgical outcomes will enable surgeons to better understand what to expect and what measures to apply as those surgical skills develop. Many studies in other surgical domains have reported on the LC during the acquisition of new surgical techniques [ 44 , 45 , 46 , 47 ]. Most minimally invasive surgeries are associated with a challenging LC, and EETA is no exception [ 7 , 46 ].

The concept of the LC was first established in the field of aircraft manufacturing and refers to an improvement in performance over time [ 48 ]. Smith et al. [ 17 ] have defined it as the number of procedures that must be performed for the outcomes to approach a long-term mean rate. Typically, an LC is characterized by an S-shaped curve with three stages: an early phase, during which new skill sets are acquired; a middle phase, in which the speed of learning rapidly increases; and an expert phase in which the performance reaches a plateau [ 49 ]. However, other curves have been proposed that involve a dip in the LC following the initial acceleration of the learning rate; this occurs especially with handling more challenging cases. Another potential decline may emerge after a long period of experience. Despite having reached a plateau in the learning curve after an extended period, declines in manual dexterity, eyesight, memory, and cognition may overshadow the benefits of accumulated experience, leading to diminished performance levels [ 50 ].

The absence of consensus on the best applicable methods to describe and assess the learning curve may explain the diversity of analysis methods observed in this systematic review. In their large systematic review regarding learning curve assessment in healthcare technologies, Ramsay et al. [ 51 ] reported that group splitting was the most frequent method. They defined group splitting as dividing the data by experience levels and conducting testing on discrete groups, often halves or thirds. The statistical methods applied included t-tests, chi-squared tests, Mann–Whitney U tests, and simple ANOVA.

In our review, we reached a similar conclusion. We observed that a substantial portion of articles (68%) utilized group-based learning curve analysis [ 7 , 11 , 12 , 13 , 16 , 17 , 19 , 21 , 22 , 23 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 42 , 43 ]. Additionally, we similarly noted that papers frequently lacked explanations for the selection of cut points, raising concerns about potential bias resulting from data-dependent splitting. It is important to acknowledge that this method of group categorization has inherent drawbacks, including challenges related to small sample sizes, the use of arbitrary cutoff points, and the inability to eliminate all potential confounding variables [ 52 ].

Descriptive analysis was found in 10 articles (29%) within this review [ 11 , 15 , 19 , 20 , 23 , 26 , 27 , 29 , 30 , 40 ]. While providing an initial grasp of data distribution and characteristics, descriptive analysis may fall short in capturing the intricate dynamics of the learning curve over time or the factors affecting its impact [ 51 ]. Alternatively, conducting rigorous statistical analyses afterward offers better insight and interpretation of the results. This approach aims to mitigate the influence of confounding factors on outcome assessments over time [ 51 , 52 ].

In our review, 24 articles (71%) conducted a wide variety of statistical analyses [ 7 , 12 , 13 , 14 , 16 , 17 , 18 , 21 , 22 , 24 , 25 , 28 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 41 , 42 , 43 ], including but not limited to the following tests: Chi-square Test, Fischer exact test, Student's t-test, Analysis of Variance (ANOVA), Mann–Whitney U Test, McNemar tests, Multivariate linear regression model, Cumulative Sum (CUSUM), and ROC Curve Analysis [ 13 , 16 , 22 , 32 , 37 , 38 , 39 ]. Four studies indicated that there was no statistically significant difference observed among the variables under evaluation. The lack of significance was attributed to several factors including small sample sizes, meticulous case selection, involvement of an otolaryngology team throughout the procedure, an increase in the number of invasive tumors in the late-experience study group, previous surgical experience, intensive training, level of supervision, and gradual inclusion of residents [ 12 , 28 , 33 , 39 ]. These efforts should be regarded as beneficial strategies aimed at reducing the steepness of the EETA learning curve.

To obtain more accurate results, it is crucial to eliminate confounding factors, such as the level of supervision, prior experience, the heterogeneity of cases being treated, and their complexity when evaluating the LC. Thus, it is essential to incorporate multivariate logistic regression analysis to mitigate the impact of these potential confounding factors [ 51 ]. Chi et al. [ 22 ] divided their patients into equal groups of 40 cases each. They then compared potential confounding variables to minimize their influence on learning curve assessment. This comparison includes demographic and clinical factors between the two groups, such as sex distribution, mean age, tumor size (microadenomas vs. macroadenomas), visual field defects, and tumor types (non-functioning, functioning adenomas, etc.). By conducting these comparisons, the researchers sought to identify discrepancies in demographic and clinical features between the groups.

The description of a surgeon's extensive prior experience is crucial for accurately quantifying the assessment of the learning curve, a point reported to be neglected during the assessment in various types of learning assessments related to healthcare procedures [ 49 ]. In our review, we observed the same conclusion in all included studies. However, the inclusion of the initial first few cases was mentioned in 13 (38%) articles, which might be used as a surrogate for no prior experience with EETA. Furthermore, five articles did not include the initial few cases. Among these, four studies examined the learning curve of more complex cases such as meningioma, craniopharyngioma, and growth hormone pituitary adenoma, employing an extended approach. Conversely, Younus et al. [ 7 ] deliberately excluded these cases to assess various stages of the learning curve.

Assessing multiple pathologies with varying complexities could significantly impact learning curve assessments. In our review, 59% of articles focused on a single pathology, while 41% explored multiple pathologies. Pituitary adenoma (PA) was the most evaluated (82%), followed by craniopharyngioma (CP) (44%). Controlling confounding variables like tumor type and size may yield more reliable results. Some studies used statistical analyses to compare early and late cases, while others relied on descriptive analyses. Shou et al. noted a drop in GTR over time due to late involvement of complex cases [ 33 ]. Conversely, studies analyzing tumor size and type found GTR improvement with experience [ 7 , 23 ]. Thorough multivariable analysis of confounding factors is crucial for representative LC analysis.

The LC is often assessed based on two main categories of variables: those related to the surgical procedure (OT, estimated blood loss, and extent of resection) and those related to patient outcomes (duration of hospitalization, the incidence of complications, and the mortality rate) [ 50 ]. In this systematic review, OT was one of the most frequent parameters that significantly reduced as one gained experience. Although OT is commonly utilized as an outcome measure, it is only a surrogate means of evaluating the LC and may not always accurately represent patient outcomes [ 52 ]. Another point to consider is the lack of standardized variables for assessing the LC, and the included studies evaluated more than 45 distinct variables. Khan et al. highlighted the importance of using consistent variable definitions across studies to derive accurate conclusions from aggregated LC data [ 52 ].

A dynamic relationship exists between surgical outcomes and the LC, and each phase of the LC influences a distinct set of variables differently. One study, which included data from 1,000 EETA cases after purposely eliminating the first 200 cases, showed that variables such as GTR and the endocrinological cure rate continued to improve after the first 200 cases, whereas other parameters remained unchanged. Authors concluded that some variables will continue to improve after passing the initial LC phase [ 7 ]. Determining the precise number of cases needed to surpass the initial learning curve (LC) has proven challenging. Shikary et al. observed a notable decrease in postoperative CSF leaks after 100 surgeries, while a reduction in operative time was evident after 120 cases [ 35 ]. However, specifying a definitive number to overcome the learning curve of the Endoscopic Endonasal Transsphenoidal Approach (EETA) remains challenging due to individual variability, diverse pathologies, and evolving surgical techniques.

Assessing the learning curve of the Endoscopic Endonasal Transsphenoidal Approach (EETA-LC) faces notable challenges due to its intricate techniques and the wide array of pathologies it addresses. The diversity across specialties makes standardizing studies difficult. To understand the dynamic learning process in EETA-LC, influenced by individual surgeon skill, patient nuances, and procedural complexities, longitudinal studies and advanced analytical methods are essential. Moreover, the complexity of statistical analysis adds another layer of challenge, highlighting the necessity for interdisciplinary collaboration and innovative methodologies.

To address the current limitations in the literature regarding the EETA LC, we propose several key strategies for future studies. Firstly, we advocate for multicenter collaboration, coupled with standardized processes, to comprehensively assess the EETA LC. This collaborative approach will facilitate the aggregation of data from diverse surgical settings, enhancing the generalizability of findings and minimizing bias. Furthermore, rigorous documentation of the previous and current experience of involved surgeons is paramount. We suggest categorizing surgeons based on their levels of experience to accurately elucidate the impact of proficiency on surgical outcomes. Secondly, given the wide variety of complexities of skull base pathologies encountered, we recommend further categorization of cases based on their levels of complexity. This stratification will enable a more nuanced analysis of the learning curve across different levels of surgical challenge. Thirdly, standardization of outcome measures used to assess the learning curve is imperative, with specific definitions provided for each outcome. This ensures consistency and comparability across studies, facilitating meaningful interpretation of results. Finally, conducting prospective study designs with sufficient follow-up periods, along with rigorous multivariate statistical analyses among these categorized groups, is essential to mitigate the influence of confounding variables and strengthen the validity of findings. Implementing these strategies will help future studies to overcome the current limitations in the literature, leading to a deeper understanding of the EETA learning curve and ultimately improving patient outcomes.

This systematic review identified 34 studies that reported a relationship between improvements in surgical outcomes and a surgeon’s level of experience with EETA. There is notable significant heterogeneity in the current literature on EETA-LC regarding the techniques used to assess the LC, variables assessed, types of pathology included, and insufficient reporting of the surgeon or team's current and previous experience with EETA. The main variables improved with experience were EC, postoperative CSF leak, OT, GTR visual improvement, and hospital LOS. Future studies with multicenter collaboration and standardized processes for assessing the EETA LC will enhance generalizability and minimize bias. Rigorous documentation of surgeons' experience levels, categorization of cases by complexity, and standardized outcome measures are essential. Additionally, rigorous statistical analyses will strengthen validity and mitigate confounding variables. Implementing these strategies will deepen our understanding of the EETA learning curve, ultimately leading to improved patient outcomes.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Endoscopic endonasal transsphenoidal approach

• Learning curve

Cerebrospinal fluid

Diabetes insipidus

Gross total resection

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Alomari, A., Alsarraj, M. & Alqarni, S. The learning curve in endoscopic transsphenoidal skull-base surgery: a systematic review. BMC Surg 24 , 135 (2024). https://doi.org/10.1186/s12893-024-02418-y

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Nursing students’ perspectives on patients' safety competencies: a cross-sectional survey

• Yasmin Ibrahim Abdelkader Khider 1 ,
• Shaimaa Mohamed Elghareeb Allam 1 ,
• Mohamed A. Zoromba 2 , 3 &
• Heba Mohammed Mahmoud Elhapashy 1  

BMC Nursing volume  23 , Article number:  323 ( 2024 ) Cite this article

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Nurses constitute the largest body of healthcare professionals globally, positioning them at the forefront of enhancing patient safety. Despite their crucial role, there is a notable gap in the literature regarding the comprehension and competency of nursing students in patient safety within Egypt. This gap underscores the urgent need for research to explore how nursing students perceive patient safety and the extent to which these competencies are integrated into their clinical and educational experiences. Understanding these perspectives is essential for developing targeted interventions that can significantly improve patient safety outcomes. The objective of this study was to fill this gap by assessing the perspectives of nursing intern students on patient safety competencies, thereby contributing to the global efforts in enhancing patient safety education and practice.

In this research, a cross-sectional study design was employed to investigate the topic at hand. A purposive sample of 266 nursing intern students was enrolled from the Faculty of Nursing at Mansoura University. The data were collected using a patient safety survey. Subsequently, the collected data underwent analysis through the application of descriptive and inferential statistical techniques using SPSS-20 software.

Among the studied intern nursing students, we found that 55.3% and 59.4% of the involved students agreed that they could understand the concept of patient safety and the burden of medical errors. Regarding clinical safety issues, 51.1% and 54.9% of the participating students agreed that they felt confident in what they had learned about identifying patients correctly and avoiding surgical errors, respectively. Concerning error reporting issues, 40.2% and 37.2% of the involved students agreed that they were aware of error reports and enumerated the barriers to incident reporting, respectively. There was a statistically significant difference between the nursing student patient safety overview domain and their age ( p  = 0.025).

Conclusions

Our study's compelling data demonstrated that intern students who took part in the patient safety survey scored higher overall in all patient safety-related categories. However, problems with error reporting showed the lowest percentage. The intern students would benefit from additional educational and training workshops to increase their perspectives on patients' safety competencies.

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Introduction

Patient safety refers to the perspectives, beliefs, attitudes, and values shared among members of the health community that focus on the prevention of errors and adverse effects on patients associated with health care [ 1 ]. In addition to becoming more efficient, health care has also grown more complicated due to the increased use of novel tools, medications, and therapies [ 2 ]. Medical errors (MEs) are a major public health concern that endangers patient safety significantly. Research conducted in Australia found that 16.6% of all admissions resulted in preventable negative outcomes, with approximately 5% of cases involving an iatrogenic injury ending in death [ 3 ].

Adverse event incidence rates varied from 2.9% to 16.6%. About 5% to 13% of the patients in these situations passed away, but 25% to 50% of them were thought to have been avoidable [ 4 ]. MEs can occur in any care setting, including hospitals, health centers, clinics, and laboratories; thus, they can negatively affect patient safety [ 5 ].

Medical errors raise hospital and medical expense costs in both wealthy and underdeveloped nations, which lowers the standard of healthcare systems. The most common errors that practitioners should exercise great care to avoid are catheter-associated urinary tract infections, central line bloodstream infections, adverse drug events, falls, pressure ulcers, obstetrical adverse events, venous thrombosis, surgical site infections, and the development of ventilator-associated pneumonia. Errors can be prevented by changing the healthcare system to make it more difficult for practitioners to perform incorrect actions and easier for them to do correct ones [ 6 ].

More time is spent with patients by nurses than by any other healthcare practitioner, making them the largest profession in the health sector. Therefore, in addition to advocating for patient safety, nurses can significantly reduce errors [ 7 ]. Students’ perspectives are how students think to respond about what they have done or about what they learned [ 8 ]. The viewpoints of nursing students can shed light on how nursing education helps prepare students to give safe care both while they are enrolled in school and after they become practitioners. Their identification of the strengths and limitations of curriculum and teaching practices can help guide our efforts to enhance nurse education and improve healthcare systems [ 9 ].

Therefore, nursing college students must comprehend and develop patient safety competency, as this fosters patients' recuperation, averts unfavorable situations, and has been a global priority for academic and healthcare institutions. Additionally, ensuring patient safety not only improves healthcare outcomes but also enhances the reputation and credibility of healthcare institutions. By prioritizing patient safety, nursing colleges can produce competent and skilled nurses who contribute to the overall development and progress of the healthcare industry [ 10 ].

Consequently, we investigated how nursing college final-year students perceived their level of patient safety competency. These results will be useful in formulating plans to raise students' proficiency in patient safety among health professionals.

Significance of the study

Patient safety issues have become a priority in health policy and healthcare management. It was reported that MEs are the third principal cause of death in the USA, with an estimated 251,000 deaths annually. Patient safety is considered an endemic concern by the WHO. However, literature reports that nursing students might need more knowledge and skills to enhance patient safety. Moreover, the students need help managing errors that might occur [ 11 ].

Also, nursing curricula need more emphasis on patient safety. Graduate nurses should have sufficient knowledge to recognize potential safety risks [ 12 ]. Sufficient knowledge will increase nursing students' confidence to protect patients from potential harm, errors, and avoidable injuries [ 13 ]. Thus, it is imperative to evaluate nursing students’ perspectives on patients' safety competencies.

Aim of the study

The study aims to evaluate nursing students’ perspectives on patients' safety competencies.

Research objectives

Assess nursing students' knowledge regarding patient safety competencies.

Evaluate nursing students' perspectives on patient safety competencies.

Research questions

What are nursing students’ perspectives on patients' safety competencies?

Research design

A descriptive cross-sectional design was utilized in this study. Descriptive cross-sectional studies explain things or how things are related to each other at a specific time [ 14 ]. A descriptive cross-sectional design was suitable for assessing nursing students’ perspectives on patients' safety competencies in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STORBE) statement ( Appendix ).

This study was conducted at the Faculty of Nursing, Mansoura University, Egypt.

Study sample

A purposive sample of 266 internship nursing students from both genders was included in the study. Purposive sampling was chosen due to its effectiveness in identifying and selecting individuals that meet a predefined set of characteristics essential for the research question. This approach ensured that the participants had a foundational understanding of nursing practices and were in the process of applying these concepts in a clinical environment, making their perspectives on patient safety both unique and immediately relevant. Students were chosen because they have received sufficient training to practice nursing care, and it is also important to investigate nursing safety considerations among these students before offering complete care to patients.

The appropriate sample size for this investigation was determined using the Steven K. Thompson equation [ 15 ]. There are 516 students enrolled in nursing internships overall, according to the Student Affairs administration. A minimum of 221 students should be included in the sample size for this study, according to the previously provided data. As the confidence level is 95%, the error proportion is 0.05, and the probabilities are 50%, add 20% for better data and follow-up drop. So the final number should be 266 nursing students.

Inclusion criteria include intern nursing students of both genders who are enrolled in the orientation program in the faculty of nursing at Mansoura University, willing to participate, and signing informed consent. Exclusion criteria include students who have a nursing diploma before joining the faculty of nursing, as those students have more knowledge and clinical experience than other students.

One tool was used in this study to collect pertinent data.

Patient Safety Survey (PSS)

Our literature review revealed that while there are several established tools for assessing patient safety competencies, most are tailored to qualified healthcare professionals or general nursing students, without a specific focus on internship nursing students in the Egyptian context. Furthermore, our study aimed to explore nuanced aspects of patient safety competencies, including students' perspectives on error reporting and clinical safety issues specific to their internship experiences. These nuances were not adequately covered by existing tools. Therefore, to capture the specific competencies and perspectives of our target population accurately, we decided to develop PSS. Researchers developed this survey after reviewing national and international literature reviews [ 16 , 17 , 18 ]. This survey consists of 24 items, divided into two parts. Part one is used to assess internship nursing students’ socio-demographic data. This data includes four items: student name, age, gender, and residence.

Part two is designed to measure internship nursing students’ perspectives regarding patient safety issues. This part covers students’ perspectives in three domains: an overview of patient safety (five items), clinical safety issues (10 items), and error reporting (five items). A 5-point Likert scale, with one representing "strongly disagree" and five representing "strongly agree," was used to gauge the students' perspectives .

Validity and reliability

The researcher developed the study tool after reviewing national and international literature [ 16 , 17 , 18 ]. The content validity of the PSS was rigorously evaluated through a structured process involving a panel of seven experts in nursing education, patient safety, and research methodology. These experts were selected based on their extensive experience and contributions to the field, ensuring a comprehensive assessment of the tool's content. Initially, the development of the survey items was informed by an extensive review of both national and international literature on patient safety competencies. This ensured that the content of the tool was grounded in the latest research and best practices in the field. The draft version of the PSS was then presented to the expert panel for evaluation. Each expert independently assessed the relevance, clarity, and comprehensiveness of the survey items, using a standardized scale to rate each item.

Based on the expert ratings, the Content Validity Index (CVI) for the tool was calculated. The CVI provides a quantitative measure of the degree to which experts agree that the survey items are relevant and representative of the construct of patient safety competencies. For our tool, the CVI was calculated at 0.82, indicating a high level of agreement among experts and confirming the content validity of the PSS. A CVI of 0.82 suggests that the majority of the items were deemed relevant and essential for assessing patient safety competencies among nursing students.

In addition to assessing content relevance, the expert panel also provided feedback on the face validity of the tool, focusing on the clarity, simplicity, and readability of the items. This process ensured that the survey would be easily understood by the target population of nursing intern students. Following the expert panel review, several adjustments were made to enhance the clarity and respondent-friendliness of the survey. For instance, the original binary response format was modified to a five-point Likert scale to allow for a more nuanced expression of respondents' perspectives. Additionally, based on expert suggestions, specific items, such as “I know the institution of medicine report, To Error is Human, and its recommendations," were added to enrich the tool's comprehensiveness and relevance. The reliability of the tools was tested using Cronbach’s alpha coefficient (0.89 for the patient safety survey, part two).

Pilot study

A pilot study was conducted with 27 participants, representing 10% of the total sample, to test the tool's applicability in the research setting. Feedback from the pilot study identified potential issues and challenges. Modifications were made to the survey tool, ensuring relevance and comprehensibility and addressing practical issues.

Data collection

Ethical approval was obtained from the Research Ethics Committee of the Faculty of Nursing, Mansoura University . The study tool, a patient safety survey, was developed by the researcher based on a recent relevant literature review. A panel of seven experts in the associated fields evaluated the study instrument for face- and content-related validity, and any necessary adjustments were made in response. The reliability of the tools was tested using Cronbach’s alpha coefficient (0.89 for the patient safety survey, part two). A pilot study was carried out with 27 (10%) of the study sample to test the feasibility and applicability of the study tool, and it will be excluded from the study sample. The necessary modifications were made accordingly. The researchers introduced themselves to the selected internship nursing students. The researchers explained the nature and purpose of this study to the study sample. After accepting to participate in this study, the researchers started to collect students’ socio-demographic data and their perspectives regarding patient safety issues using the study tool. Each student was given the appropriate time to answer the patient safety survey (about 20–30 min). The data was collected from January to February 2024.

To avoid bias in the study, we employed a purposive sampling strategy to select a representative sample of internship nursing students from Mansoura University. This strategy was chosen based on specific inclusion and exclusion criteria designed to minimize selection bias and ensure that our sample accurately reflected the population of interest. Additionally, to address potential information bias, we rigorously developed and validated the Patient Safety Survey. The survey underwent a pilot study to identify and correct any ambiguities, further enhancing the reliability and validity of the data collected. The uniform application of a 5-point Likert scale across all survey items was a deliberate choice to provide a consistent measure of nursing students' perspectives, thereby reducing measurement bias. Additionally, we standardized the training for all researchers involved in data collection to ensure uniform survey administration. We took several measures to minimize response bias, including guaranteeing anonymity and confidentiality for all participants and making participation entirely voluntary. These steps were intended to foster an environment where students felt comfortable providing honest and accurate responses without fear of repercussions.

Statistical analysis of the data

The computer was fed data, and IBM SPSS software package version 20.0 was used for analysis. [IBM Corp. Armonk, NY] Numbers and percentages were used to describe the qualitative data. The distribution's normality was confirmed using the Kolmogorov–Smirnov test. The range (minimum and maximum), mean, standard deviation, and median were used to characterize quantitative data. The results were deemed significant at the 5% level. Student t-test: to compare two examined categories for quantitative variables that are regularly distributed. F-test (ANOVA): for normally distributed quantitative variables, to compare between more than two categories. Pearson coefficient: to correlate between two normally distributed quantitative variables.

Ethical considerations and human rights

The Research Ethical Committee of the Faculty of Nursing at Mansoura University in Egypt provided ethical permission (No.0526). After being fully informed about the purpose of the study, each intern nursing student who was enrolled gave their informed consent. The pupils were reminded by the researcher that participation is completely voluntary. Throughout the whole study, confidentiality, privacy, safety, and anonymity were guaranteed. Every participant was free to leave the research at any moment. The survey did not include participant names or any other type of identifying information. The Helsinki Declaration and other pertinent rules and regulations carry out every procedure.

Demographic characteristics

The study included a total of 266 students. About 57.9% of the involved students were aged 22, and 65% of them were female. Moreover, 64.7% of the enrolled students lived in rural areas. All the involved students (100%) were from Mansoura University (Table  1 ).

Students’ distribution according to the patient safety overview domain

Among the studied intern nursing students, we found that 55.3%, 59.4%, 40.6%, 41.7%, and 49.6% of the involved students agreed that they can understand the concept of patient safety, understand the burden of medical errors, differentiate between errors, adverse events, close call/near miss, and sentinel events, know the Institution of Medicine report “To Error is Human” and its recommendations, and are aware of the ethical aspect of patient safety. The total score of the patient safety overview domain (mean ± SD) was 19.76 ± 2.69 (Table  2 ).

Distribution of the studied students according to clinical safety issues

Regarding clinical safety issues, 50.4%, 51.1%, 54.9%, 52.3%, and 52.3% of the participating students agreed that they felt confident in what they had learned about curbing infection spread, identifying patients correctly, avoiding surgical errors, using medicines safely, and preventing venous thromboembolism, respectively. In addition, 51.1%, 52.3%, 47.7%, 48.1%, and 48.5% of the participating students agreed that they felt confident in what they had learned about customizing hospital discharges, using good hospital design principles, assembling better teams and rapid response systems, sharing data for quality improvement, and fostering an open-communication culture (Table  3 ).

Distribution of the studied students according to error reporting issues domain

Concerning their error reporting, 40.2%, 50%, 37.2%, 44.7%, and 41% of the involved students agreed that they were aware of error reports, understood the importance of incident reports, enumerated the barriers to incident reporting, listed the features of an incident report, and differentiated between manual and electronic incidence reports (Table  4 ).

Relation between nursing students’ perspectives toward patient safety, their gender, and their age

Regarding gender, there was no statistically significant difference between nursing students' perceptions of patient safety and their gender ( p  > 0.05). At the same time, there was a statistically significant difference between the nursing student patient safety overview domain and their age ( p  = 0.025) (Table  5 ).

Correlation among nursing students’ perspectives domains toward patient safety

There were very high positive correlations between the overall patient safety score and its three domains: the patient safety overview domain ( r  = 0.806, p  < 0.001), the clinical safety issues domain ( r  = 0.932, p  < 0.001), and the error reporting domain ( r  = 0.842, p  < 0.001). Moreover, there was a statistically significant difference between the patient safety overview domain and the clinical safety issues domain ( p  < 0.001) with a high positive correlation ( r  = 0.659). In addition, there was a moderately positive correlation between the patient safety overview domain and the error reporting domain with a statistically significant difference ( r  = 0.543, p  < 0.001). Also, there was a high positive correlation between the clinical safety issues domain and the error reporting domain ( r  = 0.660, p  < 0.001) (Table  6 ).

Nursing students are the foundation upon which nursing care for patients will be built, and patient safety must be considered the cornerstone of the student’s education before graduation to prepare them well to provide the best care with the highest quality and efficiency [ 19 ]. Working across professions in clinical fields requires an early understanding of the responsibilities of different healthcare providers and the extent of nursing students' engagement [ 20 ].

Using a self-reported approach, we evaluated nursing students' perspectives of patient safety competency concerning safety overview, clinical safety issues, and error reporting issues. Our study's compelling data demonstrated that intern students who took part in the patient safety survey scored higher overall in all patient safety-related categories. When it came to clinical safety considerations, the students received the highest percentage of points. On the other hand, problems with error reporting showed the lowest percentage.

The clinical safety dimension, with its focus primarily on infection control, patient identification, safe medication administration, and waste disposal, might be the most familiar to students, as our students start clinical training from the first academic level in the hospital with regular and varied evaluations that help them to have a comprehensive understanding of nursing students' proficiency in infection control and patient identification. Another possible explanation for this is that combining written assessments, practical evaluations, simulations, and real-world clinical experiences in our faculty allows educators to gauge students' competence and readiness for professional practice, which increases their knowledge base.

This is in line with the results of a study in Portugal, which reported a high perception of students in terms of infection control [ 21 ]. Another study conducted in Saudi Arabia indicated a modest perception among nursing students regarding infection prevention [ 22 ]. Regarding the error reporting issue, this is because students were worried about disciplinary actions, damage to their reputation, or a potential impact on their academic and professional future. Also, the majority of our students are from rural areas with a blame culture present that can discourage open communication about error reporting.

Another significant aspect of the safety overview domain is that students have a deeper perspective on the burden of medication errors and the concept of patient safety. This finding might relate to prior exposure to patient safety-related topics. This is in harmony with those of Chan 2019, who reported students had a good perception of general terms and the concept of safety [ 23 ]. Another study assessing medical students’ knowledge, skills, and attitudes also reported high perceptions of students regarding general aspects of patient safety [ 24 ].

Another interesting finding regarding clinical safety issues is that the high perspective and confidence percentage about avoiding surgical error and the lowered perspective percentage represented assembling better teams and rapid response systems. We attribute this superiority in preventing surgical errors to the fact that the majority of respondents work part-time in the surgical and plastic surgery hospitals spread across the governorate, which gave them practical experience in this part. In combination with education, experience, mentorship, and a supportive healthcare culture, this contributes to nursing interns developing a positive perception regarding avoiding surgical errors. Following the present results, a previous study in Turkey demonstrated that nurses who formerly received preparation on patient safety had a higher statistical percentage [ 25 ]. However, the findings of the current study do not support the previous research that reported that pre-licensure nursing students have little knowledge regarding perioperative care and should be well-trained again [ 26 ].

Regarding lack of perspective in assembling a better team and rapid response system, because interns feel hesitant to voice concerns or take charge due to hierarchical structures, insufficient resources, both in terms of staffing and equipment, may hinder the interns' ability to assemble an effective team and respond. This outcome is contrary to that of Kamran, who reported that the best score of safety was given for team functioning and response [ 27 ].

Regarding gender, there was no statistically significant difference between nursing students’ perspectives on patient safety and their gender ( p  > 0.05). This is in line with those of Ramírez, who reported that the differences in means between genders were not significantly different in the overall perspective of patient safety [ 28 ]. Additionally, those who stated that there were no discernible variations in opinions about gender and past exposure to medical errors ( p  =  > 0.05) [ 27 ]. This outcome is contrary to that stated: male students apparent competence in “working in teams” is higher than that of females [ 29 ].

Another pilot study reported that the overall patient safety grade, the number of reported events, and the number of reported events by nursing students were significantly predicted by several patient safety competence dimensions ( p  ≤ 0.05) [ 30 ].

Our results indicated that there is a significant relationship between age and patient safety. The rationale of this finding is that during the academic years, including clinical practicum, students’ ability to communicate with patients and other health professionals clearly and consistently seemed to increase with age. Similar positive student assessments about safety and age have been noted in a study by Usher, who reported highly significant scores of patient safety with age and level of students. The results are also inconsistent with those conducted in Australia and New Zealand that assess nursing students' patient safety knowledge. These results corroborate the findings of a great deal of the previous work reported a significant difference was found in the patient safety competence of nursing students with year of study [ 29 ].

Another finding that stands out from the results is that there were very high positive correlations between the overall patient safety score and the three domains. These results reflect those of another study that examined the relationship between all-cause harm and patient safety and demonstrated strong correlations between all-cause harm measures and patient safety culture [ 31 ]. These findings also lend support to previous literature, which reported that subscales of safety correlated positively with the perceived patient safety culture scale [ 32 ]. Our finding also supports evidence from previous observations that found a positive correlation between the six domains and safety-related behaviors [ 33 ].

Another finding is that there was a statistically significant difference between the patient safety overview domain and the clinical safety issues domain. The same results were reported in a cross-sectional study conducted in China that assessed the patient safety competency of Chinese nurses [ 34 ]. Also, there was a high positive correlation between the clinical safety issues domain and the error reporting domain; this finding is consistent with Mahsoon [ 35 ]. This finding is contrary to the findings of another Saudi cross-sectional study that showed a significant negative correlation [ 36 ]. Another vital aspect of patient safety that students recognized is likewise related to understanding the function of trust and error reporting in maintaining patient safety.

Nursing students ought to have a strong understanding of patient safety, grounded in the highest standards of nursing care. Students completing nursing internships knew about patient safety. This result supports the conclusion drawn from several recent studies that patient safety education improves nurses' patient safety competence. These elements could have an impact on nursing students' patient safety competence and performance. The intern students would benefit from additional educational and training workshops to increase their perspectives on patients' safety competencies. Therefore, we recommend that academic institutions and medical facilities reorganize the framework for patient safety education to begin at the earliest academic level while taking into account students' pedagogical demands and varying safety levels. This will be done to increase public awareness of patient safety education. Establishing a structured curriculum on patient safety and upholding this shift in hospital culture is also crucial if we are to optimize the impact of patient safety education. Future research in various cultural and contextual settings is necessary to enhance our understanding of the variables affecting patient safety in nursing practice and education.

Limitations

When evaluating the results, it is important to take into account the study's limitations, which include its cross-sectional design and the inclusion of only one site. An additional constraint pertains to the survey's timing, which was carried out during the internship's orientation program. The student was not entirely tasked with providing comprehensive and intense care to patients with minimal exposure to clinical safety and real-error reporting concerns. The results could have been altered if the data had been gathered closer to the internship's conclusion, when the students would have gained more clinical experience. The study was conducted at a single nursing faculty; the use of purposive sampling, while ensuring a detailed exploration of our specific research question, may also limit the generalizability of the results. Therefore, it is recommended that it be repeated across other faculties to enable generalization of results.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due to protecting the confidentiality of the participants, but are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to thank the nursing student who participated in this study.

Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB). This research did not receive explicit support from any public organizations, businesses, or the private sector.

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Medical-Surgical Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt

Yasmin Ibrahim Abdelkader Khider, Shaimaa Mohamed Elghareeb Allam & Heba Mohammed Mahmoud Elhapashy

College of Nursing, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia

Mohamed A. Zoromba

Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt

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YIAK: conceptualization, data collection, validation, visualization, original draft preparation, and writing; SMEA: reviewing, editing, and resources; MAZ: software, and data analysis; HMME: reviewing, editing, and resources. All the authors have read and approved the final version of the manuscript to be published.

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Khider, Y.I.A., Allam, S.M.E., Zoromba, M.A. et al. Nursing students’ perspectives on patients' safety competencies: a cross-sectional survey. BMC Nurs 23 , 323 (2024). https://doi.org/10.1186/s12912-024-01966-1

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Received : 28 February 2024

Accepted : 22 April 2024

Published : 13 May 2024

DOI : https://doi.org/10.1186/s12912-024-01966-1

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