Hallucination vs interpretation: rethinking accuracy and precision in AI-assisted data extraction for knowledge synthesis

Knowledge syntheses (literature reviews) are essential to health professions education (HPE), consolidating findings to advance theory and practice. However, they are labor-intensive, especially during data extraction. Artificial Intelligence (AI)-assisted extraction promises efficiency but raises concerns about accuracy, making it critical to distinguish AI 'hallucinations' (fabricated content) from legitimate interpretive differences. We developed an extraction platform using large language models (LLMs) to automate data extraction and compared AI to human responses across 187 publications and 17 extraction questions from a published scoping review. AI-human, human-human, and AI-AI consistencies were measured using interrater reliability (categorical) and thematic similarity ratings (open-ended). Errors were identified by comparing extracted responses to source publications. AI was highly consistent with humans for concrete, explicitly stated questions (e.g., title, aims) and lower for questions requiring subjective interpretation or absent in text (e.g., Kirkpatrick's outcomes, study rationale). Human-human consistency was not higher than AI-human and showed the same question-dependent variability. Discordant AI-human responses (769/3179 = 24.2%) were mostly due to interpretive differences (18.3%); AI inaccuracies were rare (1.51%), while humans were nearly three times more likely to state inaccuracies (4.37%). Findings suggest AI variability depends more on interpretability than hallucination. Repeating AI extraction can identify interpretive complexity or ambiguity, refining processes before human review. AI can be a transparent, trustworthy partner in knowledge synthesis, though caution is needed to preserve critical human insights.