PNTD-D-26-00401

Validated National Tool to Assess Preparedness of Young Physicians on Neglected Tropical Diseases

PLOS Neglected Tropical Diseases

Dear Dr. GUIDO,

Thank you for submitting your manuscript to PLOS Neglected Tropical Diseases. After careful consideration, we feel that it has merit but does not fully meet PLOS Neglected Tropical Diseases's publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

Kind regards,

Damiano Pizzol

Guest Editor

PLOS Neglected Tropical Diseases

Sitara Ajjampur

Section Editor

PLOS Neglected Tropical Diseases

Shaden Kamhawi

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-4304-636XX

Paul Brindley

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-1765-0002

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Note: If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

Reviewers' Comments:

Reviewer's Responses to Questions

Key Review Criteria Required for Acceptance?

As you describe the new analyses required for acceptance, please consider the following:

Methods

-Are the objectives of the study clearly articulated with a clear testable hypothesis stated?

-Is the study design appropriate to address the stated objectives?

-Is the population clearly described and appropriate for the hypothesis being tested?

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested?

-Were correct statistical analysis used to support conclusions?

-Are there concerns about ethical or regulatory requirements being met?

Reviewer #1: Are the objectives of the study clearly articulated with a clear testable hypothesis stated?

Yes. The objectives are clearly articulated and the study addresses a well-defined and testable research question.

Is the study design appropriate to address the stated objectives?

Yes. The study design is appropriate and adequately aligned with the stated objectives.

Is the population clearly described and appropriate for the hypothesis being tested?

Yes. The study population is clearly described and appropriate for the research question.

Is the sample size sufficient to ensure adequate power to address the hypothesis being tested?

Yes. The sample size appears adequate to support the analyses and the study objectives.

Were correct statistical analyses used to support conclusions?

Yes. The statistical analyses are appropriate and support the conclusions drawn.

Are there concerns about ethical or regulatory requirements being met?

No. There are no major concerns regarding ethical or regulatory requirements based on the information provided.

Reviewer #2: The method was clear,well prepared and detailed however minor revision required, please add and clearly state the study population, setting and the sampling in their specific appropriate sections.

Reviewer #3: -Clarify recruitment strategy and representativeness

- Explicit statement of: Ethics approval (with reference number), Informed consent

-The sample size used for psychometric validation is relatively small, especially for analyses such as CFA and subgroup comparisons. While acceptable for an initial validation study, this limitation should be more explicitly acknowledged, and conclusions should be framed accordingly to avoid overgeneralization.

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Results

-Does the analysis presented match the analysis plan?

-Are the results clearly and completely presented?

-Are the figures (Tables, Images) of sufficient quality for clarity?

Reviewer #1: Does the analysis presented match the analysis plan?

Yes. The analyses presented are consistent with the study aims and appear to match the analysis plan.

Are the results clearly and completely presented?

Yes. The results are clearly organized and sufficiently presented.

Are the figures (Tables, Images) of sufficient quality for clarity?

Yes. The tables and figures are clear, appropriate, and of sufficient quality to support the manuscript.

Reviewer #2: The results were organized and reported the findings of the study objectives, however no items were cited or mentioned and no scale attached.

Reviewer #3: - Currently, it is dense with numerical detail, which may hinder readability. Streamlining the presentation and moving highly detailed outputs to supplementary files would improve accessibility.

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Conclusions

-Are the conclusions supported by the data presented?

-Are the limitations of analysis clearly described?

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study?

-Is public health relevance addressed?

Reviewer #1: Are the conclusions supported by the data presented?

Yes. The conclusions are supported by the data presented and remain appropriately balanced.

Are the limitations of analysis clearly described?

Yes. The main limitations are acknowledged and discussed adequately.

Do the authors discuss how these data can be helpful to advance our understanding of the topic under study?

Yes. The manuscript clearly explains how these findings contribute to advancing knowledge in the field.

Is public health relevance addressed?

Yes. The public health relevance is clearly addressed and represents one of the strengths of the manuscript.

Reviewer #2: The conclusion supported with the data but it require revision and clarity and it should be separated from the discussion and kindly organized it with future interventions which help advance the topic and the outcomes of this study.

Please provide a section for the strength and limitations of this study as were not stated in this version of manuscript.

Reviewer #3: - the limitations section should be expanded to include not only sample size constraints but also potential selection bias, limitations inherent to KAP surveys, and constraints in psychometric testing (e.g., limited power for DIF analysis).

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Editorial and Data Presentation Modifications?

Use this section for editorial suggestions as well as relatively minor modifications of existing data that would enhance clarity. If the only modifications needed are minor and/or editorial, you may wish to recommend “Minor Revision” or “Accept”.

Reviewer #1: Minor revision

Reviewer #2: For the title please revise it to be more reflective and interesting, add the population and revise it.

The heading abstract word is missed, and at the conclusion of the abstract stated that,the study aims to assess the knowledge without mentioning the other objectives. Please add the attitude and practice and rephrase the conclusion to be well reflected.

In the justification of the background please add how this study addresses a gap and identifies how it provides an unexisting instrument.

Reviewer #3: (No Response)

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Summary and General Comments

Use this section to provide overall comments, discuss strengths/weaknesses of the study, novelty, significance, general execution and scholarship. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. If requesting major revision, please articulate the new experiments that are needed.

Reviewer #1: This is a timely, relevant, and well-written manuscript addressing an important educational and public health gap. The topic is highly appropriate for the journal, and the authors should be commended for focusing on preparedness regarding neglected tropical diseases in a high-income European context, where these competencies are often underestimated despite changing epidemiological patterns. Overall, I believe the manuscript is suitable for publication after minor revisions, mainly aimed at improving the clarity, conciseness, and interpretative strength. Below my suggestions:

1.The rationale is strong and convincing, but the final paragraph currently repeats the study aim almost verbatim. I suggest removing the duplicated sentence and slightly tightening the transition from the broader global-health framing to the specific Italian educational context. This would improve readability and make the study objective stand out more clearly.

2.Please improve the balance of the Introduction by focusing more directly on the educational gap.

The opening of the Introduction is broad and well contextualized within globalization, migration, climate change, and health inequities, which is valuable. However, the educational dimension of the problem emerges somewhat late. I would recommend bringing forward, a little earlier, the point that the core issue is insufficient preparedness among medical trainees in high-income settings, so that the narrative becomes more immediately aligned with the specific purpose of the paper.

3. The Discussion appropriately argues that preparedness among young physicians may reflect broader health-system readiness. However, at present these two levels are somewhat blended. I suggest separating more clearly what the study directly supports—namely, curriculum assessment and educational gap identification—from the broader downstream implications for surveillance, preparedness, and health-system responsiveness. This would make the interpretation more precise and proportionate to the study findings.

4, Please expand the practical implications of the tool for curriculum development.

The Discussion rightly emphasizes that the instrument may inform educational reform, but this point could be made even more useful by adding a few concrete examples of application. For instance, the authors might briefly mention its potential use for curriculum mapping, pre/post educational interventions, inter-university comparisons, or assessment of targeted teaching modules in tropical medicine or global health. This would increase the practical value of the paper for educators and policy makers.

5.

The final message is compelling, but it could be strengthened by outlining what the next logical step should be after validation of this national tool. For example, the authors could mention future multicenter use across Italian universities, periodic reassessment of preparedness over time, or eventual adaptation of the instrument for broader European contexts. This would give the Discussion a stronger forward-looking perspective and highlight the manuscript’s wider relevance.

Reviewer #2: This study was well structured, sequenced and organized, however some revisions required specifically in the title of this study, the study justification and conclusion.

Reviewer #3: (No Response)

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

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Dear Dr GUIDO,

We are pleased to inform you that your manuscript 'Development and Validation of a National Questionnaire Assessing Knowledge, Attitudes, and Practices on Neglected Tropical Diseases Among Italian Medical Trainee' has been provisionally accepted for publication in PLOS Neglected Tropical Diseases.

Before your manuscript can be formally accepted you will need to complete some formatting changes, which you will receive in a follow up email. A member of our team will be in touch with a set of requests.

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

IMPORTANT: The editorial review process is now complete. PLOS will only permit corrections to spelling, formatting or significant scientific errors from this point onwards. Requests for major changes, or any which affect the scientific understanding of your work, will cause delays to the publication date of your manuscript.

Should you, your institution's press office or the journal office choose to press release your paper, you will automatically be opted out of early publication. We ask that you notify us now if you or your institution is planning to press release the article. All press must be co-ordinated with PLOS.

Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Neglected Tropical Diseases.

Best regards,

Damiano Pizzol

Guest Editor

PLOS Neglected Tropical Diseases

Sitara Ajjampur

Section Editor

PLOS Neglected Tropical Diseases

Shaden Kamhawi

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-4304-636XX

Paul Brindley

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-1765-0002

***********************************************************

Reviewer's Responses to Questions

Key Review Criteria Required for Acceptance?

As you describe the new analyses required for acceptance, please consider the following:

Methods

-Are the objectives of the study clearly articulated with a clear testable hypothesis stated?

-Is the study design appropriate to address the stated objectives?

-Is the population clearly described and appropriate for the hypothesis being tested?

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested?

-Were correct statistical analysis used to support conclusions?

-Are there concerns about ethical or regulatory requirements being met?

Reviewer #1: excellent

Reviewer #3: (No Response)

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Results

-Does the analysis presented match the analysis plan?

-Are the results clearly and completely presented?

-Are the figures (Tables, Images) of sufficient quality for clarity?

Reviewer #1: NA

Reviewer #3: (No Response)

**********

Conclusions

-Are the conclusions supported by the data presented?

-Are the limitations of analysis clearly described?

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study?

-Is public health relevance addressed?

Reviewer #1: excellent

Reviewer #3: (No Response)

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Editorial and Data Presentation Modifications?

Use this section for editorial suggestions as well as relatively minor modifications of existing data that would enhance clarity. If the only modifications needed are minor and/or editorial, you may wish to recommend “Minor Revision” or “Accept”.

Reviewer #1: NA

Reviewer #3: (No Response)

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Summary and General Comments

Use this section to provide overall comments, discuss strengths/weaknesses of the study, novelty, significance, general execution and scholarship. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. If requesting major revision, please articulate the new experiments that are needed.

Reviewer #1: The authors have written an important paper with great methodological rigour. From my point of view, this is an excellent manuscript.

Reviewer #3: The authors have satisfactorily addressed all reviewer comments and have made appropriate revisions throughout the manuscript. The changes have significantly improved the quality, transparency, and readability of the work. In my opinion, the manuscript is now suitable for publication, and I have no further revisions to request.

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PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review?  For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #3: No