PONE-D-19-29135

The AaLplus near-peer teaching program in Family Medicine strengthens basic medical skills – A cross-sectional analysis

PLOS ONE

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Samy A Azer, M.D., Ph.D., (USyd), M.Ed. (UNSW), M.P.H. (UNSW),

Academic Editor

PLOS ONE

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[All authors are involved in the AaLplus program. All authors declare no further competing interests.]

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Dear Dr Jan Hundertmark

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Thank you

Professor S Azer

EDITOR PLOS ONE.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: PONE-D-19-29135

The AaLplus near-peer teaching program in Family Medicine strengthens basic medical skills – A cross-sectional analysis.

This is a good study and is of interest to medical educators. However, there are issues that need to be addressed by the authors.

Title: I think it is “a retrospective study” not cross-sectional, you could state “an analysis of five-year experience.”

Abstract: State what triggered the study. State the study research questions, not just aims.

Abstract - method: Provide more information such as how long did the participants use AaL plus program in each of the four semesters? What was the OSCE about? Did it cover history taking, clinical examination and procedures? How many stations? Not clear how feedback was given? Was feedback given by students (tutees) or also by standardized patients? Time of distribution of questionnaires? Was it before or after the OSCE?

Abstract- results: State number of females (% of females), state the SD, not just the MEAN, state the confidence interval. Were there differences between the results in the first year when you started the program and the results over the next years? How about maintenance issues, did you compare results in 2016, 2017 vs 2019, what was the trend, p values.

The feedback needs to clearly explained, the way it is written shows that there was no standardization or organization. Please give a clear description in the manuscript (not necessary in the abstract). In the abstract, the sentence needs to be rewritten. Words like “very” should not be used.

Abstract- conclusion should be strengthened.

Background- State what triggered the study, State the research questions. Also, a third objective is to show that the program was maintained across these five years. We need to see if there were differences between when the course started compared to next years, and how the course was maintained and were there differences between the years 2016, 2017 and 2019.

Methods- What do you mean by “all students (tutees) participated in the OSCE required…” This sentence needs to be clearly explained, It is not how “near peer-teaching” was organized, prepared, and how students were trained for this job. I see “AaL plus” repeated many times, giving an impression like a computer-aided program? Explain what do you mean by “AaL plus” very early in the manuscript. Describe the program and how it was developed.

Line 19, “In total, AaL plus encompasses 30 hours within two years, with every….” Again, not clear and should be clearly written, how long each session, how many sessions per week, what are the total hours per semester, how many hours in the two preclinical years. How these sessions matched with the blocks/modes in the curriculum?

How were the standardized patients supervised? Did you train them? Details needed.

Methods- The method section is crowded and not well organized. We have several issues AaL plus program, standardized patients, students, tutees (near-peer teaching), clinical exam, history, procedures, and others. You need to add two coloured flow diagrams explaining issues, (see for example the figures in the paper by Azer SA, et al. BMC Med Educ. 2013 May 24;13:71. doi: 10.1186/1472-6920-13-71). This part needs organization as well.

Omit “cross-sectional”; it is a retrospective study. Briefly show how this program was integrated with other programs in the preclinical years, and then with Family Medicine later in the course. What statistical analysis was used?

We need to see if there were differences between when the course started, how the course was maintained and were there differences between the years 2016, 2017 and 2019.

Discussion and conclusions could be strengthened, in light of suggested changes.

References: Some references are too old. Ref 28 covers the same idea here? Explain how this paper adds to what was studied earlier.

Reviewer #2: What is the role of the medical staff supervisors?

In OSCE, the cases are real or dummies? With clinical finding or without? Who prepares and selects these cases for the exam?

Lines 19-20 from page 11, what is the evidence for this conclusion?

Lines 22-23 from page 11, what is the evidence for this conclusion?

Line 2, page 12, is there evidence that these basic skills are especially fundamental for family medicine rather than other clinical specialties? The same comment applies to lines 6-7 page 13.

How can you explain the discrepancy between low scores in self-assessment for hand disinfection and blood pressure measurements on one hand and the relatively high scores in OSCE on the other hand?

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Reviewer #1: Yes: Professor Samy Azer

Reviewer #2: No

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The AaLplus near-peer teaching program in Family Medicine strengthens basic medical skills – a five-year retrospective study

PONE-D-19-29135R1

Dear Dr. Hundertmark,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication.

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With kind regards,

Samy A Azer, M.D., Ph.D., (USyd), M.Ed. (UNSW), M.P.H. (UNSW),

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear Dr Jan Hundertmark

Thank you for submitting an amended version of the above-titled articles. Both reviewers agreed that the manuscript is suitable for publication.

It is my pleasure to inform you that your article has been accepted in PLOS ONE for publication.

The journal office will be in contact with you.

Best regards,

Prof Samy Azer

Editor PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have addressed all points raised by the reviewer. The manuscript is suitable for publication.

Reviewer #2: The authors addressed the comments adequately. I think, significant improvements have been made. Satisfied with the changes.

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7. 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: Yes: Professor Samy A Azer, MD, PhD, MPH, MEd, FRSM, FACG

Reviewer #2: Yes: Saad Mohammed AlShareef