Mapping the dark matter of context: a conceptual scoping review

CONTEXT: Like dark matter, the contexts for medical education are largely invisible to those within them, although context can have profound influences on teaching, learning and practice. For something that is so intrinsic to the field of medical education, the concept of context remains troubling to scholars and those running medical education programmes. This paper reports on a critical and conceptual review of the concept of context within the medical education literature and beyond. METHODS: A review was undertaken drawing on two sources: concepts of context in the medical education literature, and concepts of context across multiple academic disciplines. This body of material was iteratively, discursively and inductively synthesised. RESULTS: Few of the articles from the medical education literature described or defined context directly, tending instead to focus on describing specific elements of context, such as clinical disciplines, physical settings and political pressures, that could or did influence learning outcomes. The results were framed in terms of what context 'is', how context works (in terms of context-mechanism-outcome), and how context can be represented using patterns. The authors propose a definition of context in medical education, along with the means to model, contrast and compare different contexts based on recurring patterns. CONCLUSIONS: Context matters in medical education and it can, despite many challenges, be considered systematically and objectively. The findings from this study both represent a catalyst and challenge medical education researchers to look at context afresh.